Odgers Candice L, Caspi Avshalom, Broadbent Jonathan M, Dickson Nigel, Hancox Robert J, Harrington Honalee, Poulton Richie, Sears Malcolm R, Thomson W Murray, Moffitt Terrie E
Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, England.
Arch Gen Psychiatry. 2007 Apr;64(4):476-84. doi: 10.1001/archpsyc.64.4.476.
A cardinal feature of the DSM-IV diagnostic criteria for conduct disorder is the distinction between childhood- vs adolescent-onset subtypes. Whether such developmental subtypes exist in the population and have different prognoses should be rigorously tested to inform the DSM-V.
To evaluate the epidemiological validity of childhood- vs adolescent-onset conduct problems in a prospective birth cohort, and to assess whether life-course-persistent conduct problems are associated with a greater adult health burden.
DESIGN, SETTING, AND PARTICIPANTS: Our sample includes 526 male study members in the Dunedin Multidisciplinary Health and Development Study, a 1-year birth cohort (April 1, 1972, through March 30, 1973). Developmental trajectories were defined using prospective ratings of conduct problems at 7, 9, 11, 13, 15, 18, 21, and 26 years of age.
Health burden was assessed as mental and physical health problems at 32 years of age measured via diagnostic interviews and physical examinations.
We identified the following 4 developmental subtypes of conduct problems through general growth mixture modeling: (1) childhood-onset/life-course-persistent, (2) adolescent onset, (3) childhood limited, and (4) low. At 32 years of age, study members with the life-course-persistent subtype experienced the worst health burden. To a lesser extent, those with the adolescent-onset subtype also experienced health problems. A childhood-limited subtype not specified by DSM-IV was revealed; its adult health outcomes were within the range of the cohort norm.
Results support the epidemiological validity of the DSM-IV conduct disorder distinction based on age of onset but highlight the need to also consider long-term persistence to refine diagnosis. Preventing and treating conduct problems has the potential to reduce the adult health burden.
《精神疾病诊断与统计手册》第四版（DSM-IV）中品行障碍的主要诊断标准之一是区分儿童期起病型与青少年期起病型亚型。此类发育亚型是否存在于人群中以及是否具有不同的预后，应进行严格检验以为《精神疾病诊断与统计手册》第五版（DSM-V）提供参考依据。
评估前瞻性出生队列中儿童期起病型与青少年期起病型品行问题的流行病学效度，并评估终生持续性品行问题是否与更大的成人健康负担相关。
设计、地点与参与者：我们的样本包括达尼丁多学科健康与发展研究中的526名男性研究对象，这是一个为期1年的出生队列（1972年4月1日至1973年3月30日）。使用7岁、9岁、11岁、13岁、15岁、18岁、21岁和26岁时品行问题的前瞻性评分来定义发育轨迹。
通过诊断性访谈和体格检查评估32岁时的心理健康问题和身体健康问题，以此衡量健康负担。
我们通过一般生长混合模型确定了以下4种品行问题的发育亚型：（1）儿童期起病/终生持续性，（2）青少年期起病，（3）儿童期有限性，（4）低发。在32岁时，终生持续性亚型的研究对象健康负担最重。在较小程度上，青少年期起病型亚型的研究对象也存在健康问题。发现了一种未被DSM-IV明确规定的儿童期有限性亚型；其成人健康结局在队列正常范围内。
结果支持基于起病年龄的DSM-IV品行障碍区分的流行病学效度，但强调还需要考虑长期持续性以完善诊断。预防和治疗品行问题有可能减轻成人健康负担。
