BMJ 2001;323:191 ( 28 July )

Papers

Financial cost of social exclusion: follow up study of antisocial children into adulthood

Stephen Scott, senior lecturer, a Martin Knapp, professor, b Juliet Henderson, researcher, a Barbara Maughan, MRC external scientific staff. c

a Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London SE5 8AF, b Centre for the Economics of Mental Health, Institute of Psychiatry, c MRC Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry

Correspondence to: S Scott s.scott{at}iop.kcl.ac.uk

Objectives: To compare the cumulative costs of public services used through to adulthood by individuals with three levels of antisocial behaviour in childhood.
Design: Costs applied to data of 10 year old children from the inner London longitudinal study selectively followed up to adulthood.
Setting: Inner London borough.
Participants: 142 individuals divided into three groups in childhood: no problems, conduct problems, and conduct disorder.
Main outcome measures: Costs in 1998 prices for public services (excluding private, voluntary agency, indirect, and personal costs) used over and above basic universal provision.
Results: By age 28, costs for individuals with conduct disorder were 10.0 times higher than for those with no problems (95% confidence interval of bootstrap ratio 3.6 to 20.9) and 3.5 times higher than for those with conduct problems (1.7 to 6.2). Mean individual total costs were £70 019 for the conduct disorder group (bootstrap mean difference from no problem group £62 898; £22 692 to £117 896) and £24 324 (£16 707; £6594 to £28 149) for the conduct problem group, compared with £7423 for the no problem group. In all groups crime incurred the greatest cost, followed by extra educational provision, foster and residential care, and state benefits; health costs were smaller. Parental social class had a relatively small effect on antisocial behaviour, and although substantial independent contributions came from being male, having a low reading age, and attending more than two primary schools, conduct disorder still predicted the greatest cost.
Conclusions: Antisocial behaviour in childhood is a major predictor of how much an individual will cost society. The cost is large and falls on many agencies, yet few agencies contribute to prevention, which could be cost effective.


What is already known on this topic
Children who show substantial antisocial behaviour have poor social functioning as adults and are at high risk of social exclusion

Costs are available for particular items of public service such as receiving remedial education or appearing in court

What this study adds
Costs of antisocial behaviour incurred by individuals from childhood to adulthood were 10 times greater for those who were seriously antisocial in childhood than for those who were not

The costs fell on a wide range of agencies

Reduction of antisocial behaviour in childhood could result in large cost savings



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