Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: Results of a 25-year longitudinal study

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Abstract

Background

This paper examines the linkages between conduct problems and attentional problems in middle childhood and adolescence and later substance use, abuse and dependence in young adulthood.

Methods

Data were gathered over the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand born children. These data included: (a) measures of conduct and attentional problems in middle childhood (7–9 years) and adolescence (14–16 years); (b) measures of substance use, abuse and dependence from 18–25 years; and (c) confounding social, family and related factors.

Results

Statistical modelling produced a consistent set of results showing: (i) conduct problems in childhood and adolescence were generally related to later substance use, abuse and dependence even after control for attentional problems and confounders; (ii) attentional problems were largely unrelated to later substance use, abuse and dependence after control for conduct problems and confounders.

Conclusions

Conduct problems in both middle childhood and adolescence are related to increased risks of longer-term substance use, abuse and dependence. Any association between early attentional problems and later substance use abuse and dependence is largely mediated via the association between conduct and attentional problems.

Introduction

In recent years, there has been growing research into the extent to which early psychopathology and developmental problems are predictors and precursors of longer-term psychopathology. Particular attention has been focussed on the extent to which children with early externalizing disorders including conduct disorder, oppositional defiant disorder and attention deficit disorders are at increased risks of later adverse outcomes. This research has established that, as a general rule, children and young people with early externalizing disorders are at increased risk of a wide range of later adverse outcomes even when due allowance is made for potentially confounding factors. These outcomes span: crime (e.g. Caspi, 2000, Farrington, 1998, Fergusson and Lynskey, 1998); substance use (e.g. Flory et al., 2003, Lynskey and Fergusson, 1995; e.g. Molina and Pelham, 2003); mental disorders (e.g. Fergusson and Lynskey, 1998, Kim-Cohen et al., 2003, Kratzer and Hodgins, 1997); suicidality (e.g. Beautrais et al., 1998); poor partner relationships (e.g. Woodward et al., 2002) and similar outcomes (e.g. Brook and Newcomb, 1995, Caspi et al., 1998, Fergusson and Horwood, 1998, Tremblay et al., 1992, Woodward and Fergusson, 1999).

Although research into externalising disorders has established that individuals with these disorders are at increased risk of later adverse outcomes, a number of important issues remain to be addressed. One of these concerns the extent to which conduct problems and attentional problems make independent contributions to later developmental outcomes. Specifically, factor analytic and other research has established that conduct problems and attention deficit problems form two distinct albeit highly correlated developmental domains (Fergusson et al., 1991, Hinshaw, 1987). The high interrelation between conduct problems and attentional problems, in turn, raises issues about the ways in which these domains of behavior combine to influence developmental outcomes (Farrington et al., 1990, Fergusson et al., 1997, Hinshaw, 1987, Lynam, 1996, Molina and Pelham, 2003).

In general there have been three perspectives on this issue that are evident in the published literature. The first of these perspectives views conduct problems and attentional problems as being reflections of a more general dimension of externalising behavior and, as a consequence, assumes that children with either of these problems are at increased risk of a wide range of adverse outcomes including crime, substance use, and mental health and related problems (Farrington et al., 1990, Loeber et al., 1999, Molina and Pelham, 2003, White et al., 2001).

The second of these perspectives assumes that despite their high inter-correlation, conduct problems and attentional problems each have highly specific consequences for later development. This view leads to the dual pathway theory proposed by Fergusson and Horwood (Fergusson and Horwood, 1995). This theory argues that when due allowance is made for the inter-correlation between conduct and attentional problems: (a) early conduct problems are associated with later crime, substance use and mental health problems; (b) early attentional problems are related to subsequent educational underachievement. Dual pathway theory explains the higher rates of educational problems amongst those with conduct problems as being due to the effects of correlated attentional problems, and the higher rates of crime, substance use and mental health problems amongst children with attentional problems as being due to the effects of correlated conduct problems (Fergusson and Horwood, 1995, Fergusson et al., 1997, Rapport et al., 1999).

The third approach evident in the literature has assumed that conduct problems and attentional problems combine non-additively to influence later developmental outcomes so that children with both conduct problems and attentional problems are at higher risk of later adverse outcomes than one would expect from the additive combination of these problems (Flory et al., 2003, Lynam, 1996, Molina et al., 1999). This approach has been articulated most clearly by Lynam and his colleagues who have argued that children with both conduct and attentional problems are a distinct group who are at increased risk of adverse outcomes, particularly psychopathology (Flory et al., 2003, Lynam, 1996).

Resolving the ways in which conduct problems and attentional problems combine to influence later developmental outcomes is important from both a theoretical and clinical perspective. From a theoretical perspective, understanding the way in which early conduct and attentional problems influence later developmental outcomes may provide further construct validation of the distinctions between conduct and attentional problems. From the standpoint of clinical practice such research may be informative in establishing the longer-term prognosis of children with varying levels of early conduct and attentional problems.

This paper is part of a programme of research conducted by a consortium of longitudinal researchers. The principal aims of the programme are to use existing data sets to develop a clearer understanding of the developmental pathways leading to substance use, abuse and dependence in adolescence and adulthood. One component of this research is focussed on examining the extent to which early mental health is a precursor of later substance use, abuse and dependence. In this paper we use data gathered during the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand children to examine the linkages between behavioral adjustment in middle childhood and adolescence and later substance use outcomes from the perspective of the dual pathway model. The specific aims of the study were:

  • 1.

    To document the extent to which conduct and attentional problems in middle childhood (7–9 years) and adolescence (14–16 years) were related to the later use, abuse and dependence of tobacco, alcohol, cannabis and other illicit drugs.

  • 2.

    To examine the extent to which conduct and attentional problems in middle childhood and adolescence made independent contributions to later substance use, abuse and dependence when due allowance was made for the correlations between these problems and for potentially confounding factors.

Section snippets

Sample

The data reported here were gathered during the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of an unselected birth cohort of 1265 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 and 25 years. Data have been gathered from a combination of sources including: parental interviews;

Description of sample characteristics

Table 1 describes the characteristics of the sample at each outcome assessment (18, 21 and 25 years) and also provides summary statistics for the measures of behavior and covariates used in the analysis. The overall rates of substance use, abuse and dependence for each assessment period are summarized in Table 2.

Early conduct problems (7–9 years) and later substance use, abuse and dependence

Table 3 shows the measure of conduct problems classified into five groups ranging from those with none or few early conduct problems to those whose conduct problems placed them in the

Discussion

In this paper we have used data gathered over the course of a 25-year longitudinal study to examine linkages between early conduct and attentional difficulties and later substance use, abuse and dependence. The focus of the analysis was upon examining the ways in which early conduct and attentional problems combined to influence later substance use behaviors. The major findings and their implications are considered below.

In confirmation of previous research (Flory et al., 2003, Loeber et al.,

Acknowledgements

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.

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