Predicting prognosis for the conduct-problem boy: Can family history help?
Predicting prognosis for the conduct-problem boy: Can family history help?
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DOI：
10.1097/chi.0b013e31813c6c8d
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发表时间：
2007-10-01
影响因子：
13.3
通讯作者：
Moffitt, Terrie E.
中科院分区：
文献类型：
--
作者：
Odgers, Candice L.;Milne, Barry J.;Moffitt, Terrie E.
目的：许多患有行为障碍的儿童发展出终身持续的反社会行为;然而，其他儿童表现出儿童期限制或成年期限制的行为障碍症状，并逃避不良的成年结局。在儿科和青少年临床环境中前瞻性预测长期预后是困难的。改善预后预测将支持有限的治疗资源的明智分配。本研究旨在探讨精神疾病家族史是否能预测行为问题儿童的长期预后。方法：参与者是达尼丁研究的男性成员，该研究是一项由1,037名儿童（52%为男性）组成的出生队列。行为问题亚型是使用7至26岁之间的前瞻性评估定义的。家族史访谈评估了三代人的精神障碍：参与者的祖父母，父母和兄弟姐妹。结果如下：外化障碍的家族史区分生活过程中持续反社会的男性从其他行为问题的儿童，并增加了显着的增量效度超出家庭和儿童的风险因素。在我们的研究中，一个简单的三项母亲报告的酒精滥用家族史筛查与生命过程的持续预后相关，应在临床实践中进行评估。结论：外化障碍的家族史可区分为生活过程持续性与儿童期局限性和偶发性行为问题。简短的家族史问题可能有助于儿科临床医生完善品行障碍的诊断，并确定最需要治疗的儿童。
Objective: Many children with conduct disorder develop life-course persistent antisocial behavior; however, other children exhibit childhood-limited or adolescence-limited conduct disorder symptoms and escape poor adult outcomes. Prospective prediction of long-term prognosis in pediatric and adolescent clinical settings is difficult. Improved prognosis prediction would support wise allocation of limited treatment resources. The purpose of this article is to evaluate whether family history of psychiatric disorder can statically predict long-term prognosis among conduct-problem children. Method: Participants were male members of the Dunedin Study, a birth cohort of 1,037 children (52% male). Conduct-problem subtypes were defined using prospective assessments between ages 7 and 26 years. Family history interviews assessed mental disorders for three generations: the participants' grandparents, parents, and siblings. Results: Family history of externalizing disorders distinguished life-course persistent antisocial males from other conduct-problem children and added significant incremental validity beyond family and child risk factors. A simple three-item family history screen of maternal-reported alcohol abuse was associated with life-course persistent prognosis in our research setting and should be evaluated in clinical practice. Conclusions: Family history of externalizing disorders distinguished between life-course persistent versus childhood-limited and adolescent-onset conduct problems. Brief family history questions may assist clinicians in pediatric settings to refine the diagnosis of conduct disorder and identify children who most need treatment.