• By Kevin Mount
  • Posted on Tuesday 27th January, 2009

Outlook is bleakest for the most troubled children

Studies of the progress of UK children born in a single week fifty years ago suggest that aggression and impulsiveness in infancy are very bad for long-term health. The new work by researchers at the University of London indicates that the earlier conduct problems become apparent the more likely they are to have devastating effects. Very naughty children are likely to be anti-social adults and to engage in risky behaviors that, in turn, shorten lifespan.The analysis is based on the wealth of data assembled during the last half century by the UK National Child Development Study and is believed to be the first of its kind to establish a link between childhood behavior problems and such extreme adult outcomes.Writing in the January edition of the Journal of the American Academy of Child and Adolescent Psychiatry Markus Jokela and colleagues report that children who scored very badly on a measure of (internalizing and externalizing) behavior problems experienced double the mortality than better-scoring peers by the time they reached their mid forties.The pattern was similar, although not as marked, among those who were withdrawn, avoidant and anxious as children. They were more likely to be depressed and anxious as adults, and these negative adult outcomes were also associated with shorter life expectancy. The findings provide evidence of the long-term mortality risk associated with childhood social maladjustment and psychiatric vulnerability, says Jokela. Jokelas team also tested whether childhood family environments (ie fathers social class and family size) might influence the strength of the relationship, but found no striking effect. They concluded that the link was better explained by the dangers associated with engaging in risky and self-harmful behavior.The National Child Development Study is tracking the lives of thousands of people born in Great Britain in a single week in 1958. Over 11,000 individuals were included in the London analysis. Behavior at ages seven and 11 was assessed by teachers using the Bristol Social Adjustment Scale, which measures hostility towards other children and adults, restlessness, anxiety, depression and withdrawal.The use of this standardized measure and the fact that participants death certificates are automatically sent to the researchers by the UK National Health Service gave the study unusual strength. The large national sample and the solidness of the follow-up data are also significant. Commenting on the research in the same journal, Adrian Angold, associate professor of psychiatry and behavioral sciences at Duke University, observes: If this disparity were to continue throughout life, it would amount to an unprecedented number of life-years lost to an easily measured childhood risk factor affecting a large proportion of the population.It is not often that one is asked to provide a commentary on an article that one expects to become a cornerstone of justifications for new psychiatric research.More work to test possible mechanisms underlying the links to mortality is required.References:Angold A (2009) Childhood Psychopathology Can Be Really Bad for Your Health, Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1, 3-4.Jokela M, Ferrie J, Kivimaki M (2009) Childhood Problem Behaviors and Death by Midlife: The British National Child Development Study, Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1, 19-24.

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