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Risk Factors for Conduct Disorder and Oppositional/Defiant Disorder: Evidence from a New Zealand Birth Cohort

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Objective

To examine the social, family background, and individual antecedents of conduct disorder (CD) and oppositional defiant disorder (ODD), the extent to which CD and ODD symptoms were predicted by common environmental risk factors, and the extent to which the antecedents of CD and ODD accounted for the comorbidity between the two disorders.

Method

Data were gathered from 926 members of a New Zealand longitudinal birth cohort. The outcome measures were DSM-IV symptom count measures of CD and ODD at age 14 to 16 years. Predictors measured during the period from 0 to 14 years included the following: maternal smoking during pregnancy; exposure to socioeconomic adversity; parental maladaptive behavior; childhood exposure to abuse and interparental violence; gender; cognitive ability; and affiliation with deviant peers in early adolescence. Associations between the predictors and outcome measures were modeled using structural equation modeling.

Results

The analyses showed that each of the predictors was significantly (p < .05) associated with CD and ODD, with the exception of gender and ODD. After model fitting, the profile of risk factors that predicted CD and ODD were largely similar. The analyses revealed that approximately 40% of the comorbidity between disorders could be accounted for by common factors.

Conclusions

The data showed that CD and ODD had largely similar social and environmental antecedents. One implication of this finding is that treatment and prevention approaches that are developed for use with a particular behavior disorder may in fact reduce the incidence of both disorders.

Section snippets

Adverse Childhood Family Environment

A number of studies have identified a range of adverse childhood family environmental circumstances that are related to increased risk of behavior disorder later in life. One factor is maternal smoking during pregnancy; evidence suggests that children whose mothers smoked while pregnant are at increased risk for CD and ODD in childhood and adolescence.8, 9, 10, 11 A second factor is exposure to socioeconomic adversity; data show that living in impoverished or adverse socioeconomic conditions

Exposure to Child Abuse and Interparental Violence

An additional factor that has been linked to increased risks of behavior disorder is exposure to abuse. A number of studies have shown that exposure to sexual abuse and physical abuse in childhood, and exposure to interparental violence, are associated with increased risks of both CD and ODD symptoms in both the short and long term.19, 21, 22, 23

Individual Characteristics

In addition to the factors discussed above, a number of individual factors have also been linked to increased risks of CD and ODD. These factors include gender, cognitive ability, and deviant peer affiliation. A wide range of studies have shown that behavior disorders are more likely to occur in males than in females2, 24, 25 and are more likely to occur among individuals with lower levels of cognitive ability.2, 14, 24 Also, affiliation with deviant peers in childhood and adolescence has been

Background to the Present Study

One issue arising from the accumulated research on the etiology of behavior disorders is the extent to which the risk profile for each of the two disorders overlaps; that is, is each disorder predicted by the same risk factors, or is it the case that a particular combination of risk factors is more likely to lead to a particular disorder? A number of studies have found evidence that a common set of factors predict each of the two behavior disorders.1, 2, 3, 27 On the other hand, recent evidence

Method

Data were gathered during the course of the Christchurch Health and Development Study, a longitudinal study of an unselected birth cohort of 1,265 children born in the Christchurch (New Zealand) urban region during a 4-month period in mid-1977. This cohort has been studied at birth, 4 months, 1 year, annual intervals to age 16 years, and at ages 18, 21, 25 and 30. A more detailed description of the study and an overview of study findings have been provided by Fergusson and Horwood.36 The

Correlations Between Latent CD, ODD (Ages 14-16 years), and Predictors

Table 1 shows the estimated bivariate correlations between the latent CD and ODD constructs (see Methods) and each of the predictors, including the following: family socioeconomic disadvantage; changes of parents; parental adjustment problems; childhood abuse and interparental violence exposure; maternal smoking during pregnancy; gender; IQ; and deviant peer affiliations. Table shows the following:

  • 1

    With the exception of gender and ODD, each of the predictors was significantly (p < .001)

Discussion

In this paper, we have used data from a longitudinal birth cohort to examine three related issues: (1) the extent to which a range of social, family background, and individual predictors were associated with increased risk of later CD and ODD; (2) the extent to which the predictors of CD and ODD were similar; and (3) the extent to which similarity of predictors could account for the observed comorbidity between CD and ODD. These issues are addressed below.

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    This research was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation, the Canterbury Medical Research Foundation and the New Zealand Lottery Grants Board.

    Disclosure: Drs. Boden and Fergusson, and Mr. Horwood report no biomedical financial interests or potential conflicts of interest.

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