The high societal costs of childhood conduct problems: evidence from administrative records up to age 38 in a longitudinal birth cohort

Abstract

Background: Children with conduct problems that persist into adulthood are at increased risk for future behavioral, health, and social problems. However, the longer term public service usage among these children has not been fully documented. To aid public health and intervention planning, adult service usage across criminal justice, health care, and social welfare domains is compared among all individuals from a representative cohort who followed different conduct problem trajectories from childhood into adulthood.

Methods: Participants are from the Dunedin Multidisciplinary Health and Development Study, a prospective, representative cohort of consecutive births (N = 1,037) from April 1972 to March 1973 in Dunedin, New Zealand. Regression analyses were used to compare levels of public service usage up to age 38, gathered via administrative and electronic medical records, between participants who displayed distinct subtypes of childhood conduct problems (low, childhood-limited, adolescent-onset, and life-course persistent).

Results: Children exhibiting life-course persistent conduct problems used significantly more services as adults than those with low levels of childhood conduct problems. Although this group comprised only 9.0% of the population, they accounted for 53.3% of all convictions, 15.7% of emergency department visits, 20.5% of prescription fills, 13.1% of injury claims, and 24.7% of welfare benefit months. Half of this group (50.0%) also accrued high service use across all three domains of criminal justice, health, and social welfare services, as compared to only 11.3% of those with low conduct problems (OR = 7.27, 95% CI = 4.42-12.0).

Conclusions: Conduct problems in childhood signal high future costs in terms of service utilization across multiple sectors. Future evaluations of interventions aimed at conduct problems should also track potential reductions in health burden and service usage that stretch into midlife.

Keywords: Conduct disorder; administrative data; electronic medical data; longitudinal study; service utilization.

Figure 1. Conduct problem trajectory groups identified among Dunedin Cohort study members

Illustration of conduct-problem trajectories reprinted with permission from Odgers et al., 2008, Development and Psychopathology. Study members (N=1,037) were classified as following one of four conduct-problem trajectories: Life-course persistent: 9.0%; Adolescent-onset: 18.7%; Childhood-limited: 22.0%; Low: 50.4%. Trajectories were originally identified separately among male study members (Life-course persistent: 10.5%; Adolescent-onset: 19.6%; Childhood-limited: 24.3%; Low: 45.6%; Odgers et al., 2007). Corresponding trajectories were also identified separately among female study members (Life-course persistent: 7.5%; Adolescent-onset: 17.4%; Childhood-limited: 20.0%; Low: 55.1%; Odgers et al., 2008).

Figure 2. Proportion of total convictions, health care, and social welfare service usage by conduct-problem trajectory group

Proportion of total service usage from approximately age 26 to age 38, by conduct-problem trajectory group. The top row shows the proportion of the study population that each conduct-problem trajectory comprises; subsequent rows show the proportion of a given type of service accounted for by each group.