Developmental Origins of Chronic Physical Aggression: A Bio-Psycho-Social Model for the Next Generation of Preventive Interventions

Association of a Crime Prevention Program for Boys With Mortality 72 Years After the Intervention: Follow-up of a Randomized Clinical Trial

IMPORTANCE

Mortality is an important outcome in evaluating crime prevention programs, but little is known about the effects on mortality during the full life course.

OBJECTIVE

To determine the long-term outcomes of a crime prevention program on mortality and whether the iatrogenic effects on mortality observed in middle age persist or change in old age.

DESIGN

This longitudinal follow-up was conducted in a cohort of boys included in a matched-pair randomized clinical trial (the Cambridge-Somerville Youth Study). Six hundred fifty boys aged 5 to 13 years who lived and attended public and parochial schools in working-class areas of Cambridge and Somerville, Massachusetts, and were identified as at risk for antisocial behavior were matched by age and demographic characteristics. One member of each pair was randomly allocated to the treatment condition. The original trial was performed from June 1, 1939, to December 1945. Follow-up in the present analysis was performed from January 2016 through June 2018.

INTERVENTIONS

Treatment group participants received individual counseling through a range of activities and home visits for an extended duration (mean, 5.5 years). Control group participants received no special services.

MAIN OUTCOMES AND MEASURES

The 4 outcomes of interest include age at mortality, mortality at latest follow-up, premature mortality (younger than 40 years), and cause of mortality (natural vs unnatural).

RESULTS

In the original analysis, 650 participants were matched and randomized to treatment or control conditions, of whom 506 were retained in the analysis (mean [SD] age, 9.8 [1.7] years). Through early 2018, records for 488 participants (96.4%) were located. A total of 446 participants were confirmed dead (88.1%) and 42 alive (8.3%). Matched-pairs analyses showed no significant differences between the treatment and control groups for mortality at latest follow-up (relative risk [RR], 1.05; 95% CI, 0.99-1.11), premature mortality (RR, 1.15; 95% CI, 0.55-2.43), or cause of mortality (RR, 1.19; 95% CI, 0.65-2.18) (P > .05 for all). Cox proportional hazard regression indicated no difference in time to death between groups (hazard ratio, 1.18; 95% CI, 0.98-1.41; P = .09).

CONCLUSIONS AND RELEVANCE

Iatrogenic effects on mortality were not detected in this long-term follow-up. The longitudinal analysis provides information on the utility of life-long assessments of crime prevention programs and draws attention to the need for quality-of-life assessments of participants and their children.

Adult outcomes of childhood disruptive disorders in offspring of depressed and healthy parents

BACKGROUND

Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders.

METHOD

Offspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested.

RESULTS

Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group.

LIMITATIONS

Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began.

CONCLUSION

If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.

The aggressive child

Aggression in children is a common transdiagnostic symptom associated with a wide range of developmental and mental health problems. It emerges early and without intervention, may increase in severity as the child grows stronger. Aggressive children are more likely to experience physical and mental illness, unemployment, poverty and forensic problems as adults. Strategies to prevent aggression must address risk factors: low maternal education, adolescent pregnancy, in utero exposure to tobacco and alcohol, poverty, coercive parenting, childhood maltreatment and bullying victimisation. The aggressive child requires a comprehensive assessment to identify and manage underlying or comorbid problems, to understand the reasons for the aggressive behaviour and to detect modifiable factors that exacerbate or perpetuate the aggression. Psychosocial interventions include parenting skills training and child-directed cognitive behavioural therapy, whereas pharmacotherapy may be used to treat underlying developmental or mental health problems or to manage the aggression.

A Multicomponent Early Intervention Program and Trajectories of Behavior, Cognition, and Health

OBJECTIVES

To investigate the developmental impact of a prenatal-to-age-5 multicomponent early intervention program targeting families living in low socioeconomic conditions.

METHODS

Pregnant women from a disadvantaged Irish community were randomly assigned into a treatment group (home visits, baby massage, and parenting program; n = 115) or control group (n = 118). Children's behavioral problems (externalizing, internalizing), cognitive skills (general, vocabulary), and health service use (number of health clinic visits), were regularly assessed (6 months to 4 years of age). Children's developmental trajectories were modeled by using latent class growth analyses to test whether certain subgroups benefited more than others.

RESULTS

High and low developmental trajectories were identified for each outcome. Treated children were more likely to follow the high-level trajectory for cognition (odds ratio = 2.89; 95% confidence interval = 1.55-5.50) and vocabulary skills (odds ratio = 2.02; 95% confidence interval = 1.08-3.82). There were no differences by treatment condition in the risk of belonging to a high externalizing or high health clinic visit trajectory. However, within the high externalizing trajectory, treated children had lower scores than controls (Hedges' g range (2-4 years) = 0.45-0.58; P < .05) and, within the high health clinic visit trajectory, only children in the control group experienced an increasing number of visits.

CONCLUSIONS

This program revealed moderate positive impacts on trajectories of cognitive development and number of health clinic visits for all children, whereas positive impacts on externalizing behavior problems were restricted to children with the most severe problems.