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Copyright © 2009 Massachussetts Medical Society. All rights reserved.

Problems often continue when adolescents with conduct disorder grow up

In a population-based study, many adolescents with externalizing behavior experienced poor outcomes as adults, but most did well.

Conduct disorder during adolescence is associated with long-term social and functional impairment, although most evidence comes from high-risk adolescents with severe externalizing behavior (hyperactivity, aggression). In a population-based study, investigators in the U.K. examined adult outcomes of 3652 adolescents who were enrolled in a birth-cohort study in 1946 and followed until age 53.

Based on teacher assessments at age 13 and 15 years, 9.5% of adolescents had severe externalizing behavior, 29.0% had mild externalizing behavior, and 62.0% did not have externalizing behavior. Adolescents with externalizing behavior were more likely as adults to report negative outcomes (e.g., symptoms of depression and anxiety, marital problems, financial problems) than those without externalizing behavior and to have worse scores on a global life adversity scale (reflecting mental health, alcohol and drug abuse, family life and relationships, social class, employment and education status). For example, 40% and 28% of those with severe and mild externalizing behavior, respectively, scored in the highest quartile (most adversity) on the global adversity scale, compared with 17% of those without externalizing behavior.


These disturbing results indicate that externalizing behavior during adolescence is associated with substantial impairment in adulthood. Some caveats should be noted: The …

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