The Centre for Mental Health, in partnership with the Institute of Education at UCL, recently published a report outlining the current understanding of conduct problems and their course through childhood. The study team (Gutman, Joshi, Khan, & Schoon, 2018) examined longitudinal data obtained from a sample of over 19,000 children born in the United Kingdom between 2000-2002 for the Millennium Cohort Study.
What is conduct disorder?
Clinical guidance from the National Institute for Health and Care Excellence (NICE) and the Social Care Institute for Excellence (SCIE) defines conduct disorders as “repetitive and persistent patterns of antisocial, aggression or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations”. Examples of violations of age-appropriate social expectations include angry outbursts or physical aggression towards other children between the ages of 3-7 years; violence, robbery or substance misuse between the ages of 12 – 17 years amongst others. The scale of the conduct problems is significant as the child or young person’s daily functioning is disrupted, and distress is experienced by those around them. The prevalence of conduct problems is around 5% (for children and young people between 5 – 16 years; Green, McGinnity, Meltzer, Ford, & Goodman, 2004), and is considered the most commonly diagnosed mental health condition for children between 5- 10 years.
Pathways of childhood conduct problems by gender
- The prevalence of conduct problems is higher in boys, compared to girls, between the ages of 3 – 11 years (e.g., at 3 years old: boys = 22% and girls = 19%; at 11 years old: boys = 14% and girls = 9%).
- Between 3 – 11 years old, the majority of girls (78%) and around half of boys (54%) had a low risk of developing severe conduct problems.
Pathways of childhood conduct problems and the impact of multiple risks over time
- Between the ages of 3 – 14 years, the majority of children in the sample (56%) had a low risk of severe conduct problems, whereas 8% of children had a high risk.
- Whilst 13% of children were identified to have a low risk of severe conduct disorder from 3 – 7 years, this increased by age 14.
- A subset of children (23%) were identified as having a moderate to high risk of developing severe conduct problems by age 3 years, but this then declined with age.
Pathways of childhood conduct problems and co-occurring mental health difficulties
- Different groups of children were identified who also presented who co-occurring mental health conditions (conduct problems, hyperactivity/inattention, emotional problems, and problems with peer interactions) between 3 – 11 years:
- Low problems (52%)
- Moderate externalising, low internalising (27%)
- Moderate internalising, low externalising (12%)
- Persistent high problems (8%)
Recommendations (for England only)
Gutman et al. (2018) proposed 10 recommendations for key stakeholders (e.g., the Government, NHS England, NICE), based on the findings of their report. Recommendations include calls for improved cross-agency working, quality of support available, and guidance. The full report can be viewed here.
Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associate on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).