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RESEARCH: Ian Colman, Joseph Murray, Rosemary A Abbott, Barbara Maughan, Diana Kuh, Tim J Croudace, and Peter B Jones Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort BMJ 2009; 338: a2981 [Abstract] [Full text]

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Overly dire predictions

Joan McClusky   (11 January 2009)

Predictions of dire consequences

Ian Colman, Rosemary A. Abbott and Peter B. Jones   (18 February 2009)

Overly dire predictions 11 January 2009
Joan McClusky, Medical writer New York, NY 10003 Send response to journal: Re: Overly dire predictions	In re the conclusion by Colman et al that "Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life." This seems an overly dire and alarmist conclusion based on looking at their own data. There were no adult symptoms of depression or anxiety in about half of those with externalizing behaviors, mild or severe, in adolescence, compared to 45% of those without such behaviors. Over 80% of those in all 3 groups had no problems with alcohol abuse as adults, and over 70% in all 3 groups did not have nervous trouble. Over 87% of those with externalizing behaviors were NOT teenage parents, compared to 93% without the behaviors. Over 60% of those with mild behaviors and half of those with severe behaviors were still in their first marriage. Slightly more than half of those without externalizing behaviors, about about half of those with mild externalizing behaviors and 40% with severe behaviors had no problems in relationships with others. 90% of all 3 groups have never been unemployed. About three-quarters of those with no or mild behaviors and 50% with severe behaviors have never had financial difficulties. And about half of those with mild and a third of those with severe behaviors got their educational qualifications compared to 70% with no behaviors. The point is not that these behaviors do not have long-term effects for some children. But many--by some measures a majority--had outcomes as good as those without any behaviors. To predict that any child with these behaviors will have multiple lifelong problems does a great disservice to the interesting findings of the study, Competing interests: None declared
Predictions of dire consequences 18 February 2009
Ian Colman, Assistant Professor University of Alberta School of Public Health, Rosemary A. Abbott and Peter B. Jones Send response to journal: Re: Predictions of dire consequences	To the editor: Joan McClusky makes the point that many individuals in our study of adolescent conduct problems in the 1946 British birth cohort had positive outcomes as adults. We agree with this sentiment, with some reservations. Many adolescents with conduct problems in this cohort managed to avoid poor outcomes, and they may lead successful adult lives. We would hesitate, however, before painting the future for these adolescents with a rosy brush. First, as we mention in the paper (1), the outcomes that we present are likely an under-estimate of the true picture of poor outcomes for adolescents with conduct difficulties. We showed in our analysis that those with the worst conduct problems were more likely to drop out of the study. It is expected that those individuals would also have the worst outcomes as adults, which contributes to an underestimation of the prevalence of problems in adulthood. In addition, we have only captured several of our poor outcomes at specific times in adulthood. For example, we report on unemployment at ages 36, 43 and 53. This is not a comprehensive picture of employment throughout adult life, but rather an indication that was useful for comparing groups. Consequently, the prevalence of problems in adult life must be higher than what we report given the gaps in some of our measures. Given this, we can’t support McClusky’s suggestion that a majority of adolescents with conduct problems lead successful adult lives, particularly when a majority of the adolescents with either mild or severe conduct problems in our study left school with no qualifications at all. Furthermore, the size of our groups of adolescents with conduct problems was very large. Our group with mild conduct problems comprised almost 30% of our population-based cohort, and our group with severe conduct problems comprised almost 10% of the cohort. When you consider that the group with mild conduct problems was approximately twice as likely to suffer overall life adversity, and the severe group was three times as likely, the size of the groups is of utmost importance. These adolescents create an enormous burden on public systems through crime and increased use of welfare, special education and healthcare (2). Dire predictions seem appropriate given our group of adolescents with conduct problems included almost 40% of the population. As Joan McClusky points out, many adolescents with conduct problems avoid poor outcomes and may have successful adult lives. More research is needed to investigate why certain adolescents are able to get their lives on a positive track, and such research should direct policy decisions regarding treatment and intervention for adolescents with conduct difficulties. (1) Colman I, Murray J, Abbott RA, Maughan B, Kuh D, Croudace TJ, Jones PB. Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. British Medical Journal 2009;338:208-211 (2) Scott S, Knapp M, Henderson J, Maughan B. Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 2001;323:191. Competing interests: None declared