Intended for healthcare professionals


Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort

BMJ 2009; 338 doi: (Published 09 January 2009) Cite this as: BMJ 2009;338:a2981
  1. Ian Colman, assistant professor1,
  2. Joseph Murray, postdoctoral fellow2,
  3. Rosemary A Abbott, research associate3,
  4. Barbara Maughan, professor4,
  5. Diana Kuh, professor, director5,
  6. Tim J Croudace, senior lecturer3,
  7. Peter B Jones, psychiatrist, professor, head3
  1. 1School of Public Health, University of Alberta, 13-130D Clinical Sciences Building, Edmonton, AB, Canada T6G 2G3
  2. 2Institute of Criminology, University of Cambridge, Cambridge
  3. 3Department of Psychiatry, University of Cambridge, Cambridge
  4. 4MRC Social, Genetic and Developmental Psychiatry Centre, King’s College London Institute of Psychiatry, London
  5. 5Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, University College London Medical School, London
  1. Correspondence to: I Colman ian.colman{at}
  • Accepted 5 October 2008


Objective To describe long term outcomes associated with externalising behaviour in adolescence, defined in this study as conduct problems reported by a teacher, in a population based sample.

Design Longitudinal study from age 13-53.

Setting The Medical Research Council National Survey of Health and Development (the British 1946 birth cohort).

Participants 3652 survey members assessed by their teachers for symptoms of externalising behaviour at age 13 and 15.

Main outcome measures Mental disorder, alcohol abuse, relationship difficulties, highest level of education, social class, unemployment, and financial difficulties at ages 36-53.

Results 348 adolescents were identified with severe externalising behaviour, 1051 with mild externalising behaviour, and 2253 with no externalising behaviour. All negative outcomes measured in adulthood were more common in those with severe or mild externalising behaviour in adolescence, as rated by teachers, compared with those with no externalising behaviour. Adolescents with severe externalising behaviour were more likely to leave school without any qualifications (65.2%; adjusted odds ratio 4.0, 95% confidence interval 2.9 to 5.5), as were those with mild externalising behaviour (52.2%; 2.3, 1.9 to 2.8), compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%).

Conclusions Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.


  • Contributors: All authors contributed towards the conception and design of the project, interpretation of the results, and critical review of the manuscript. RAA performed the data analysis. IC designed the data analysis plan, wrote the manuscript, and is guarantor.

  • Funding: This work was supported by the Medical Research Council (BM, DK), National Institute of Health Research (PBJ), Wellcome Trust (PBJ), Stanley Medical Research Institute (PBJ), Sainsbury Centre for Mental Health (RAA), Smith Institute (RAA), British Academy (JM), and the Economic and Social Research Council (JM; grant number RES-000-22-2311). TJC is funded by a public health career scientist award from the UK Department of Health. IC is supported by a population health investigator award from the Alberta Heritage Foundation for Medical Research.

  • Competing interests: None declared.

  • Ethical approval: The National Survey of Health and Development has received ethical approval from the Central Manchester local research ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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