The relation between the age at diagnosis of problem behaviors related to aggression and distal outcomes in Swedish children


Severe childhood aggressive behaviors are known to predict negative outcomes later in life; however, little is known about the effect of when in childhood aggression problems are diagnosed. While an earlier first diagnosis of problematic aggressive behavior might be associated with increased severity and, thus, worse outcomes, it is also possible that an earlier diagnosis affords an earlier start of treatment programs or indicates that greater attention is being paid to behavioral problems, thus resulting in attenuation of the severity of childhood aggression’s impact on distal outcomes. The current study analyzed data from the population-based Swedish Data Registries, which include data on all children formally diagnosed by the Swedish medical system with a wide range of aggression problems between ages 8 and 18 (N = 5816) during the years 1987–2013, along with a matched control. Time-to-event analyses investigated whether the age at time of diagnosis affects later life outcomes while controlling for relevant confounders. Results show that for both boys and girls, those with a later diagnosis had lower average incomes (regression coefficient b = − 0.055, p < 0.005) and a higher probability of having a criminal record (odds ratio 1.126, p < 0.005) than children with earlier diagnoses. The effect on suicide attempts was not significant after correcting for multiple testing (odds ratio 1.264, p = 0.016). Grade score was not significantly affected. The results warrant further research concerning the potential advantage of earlier diagnoses, especially concerning generalizability beyond the Swedish population.

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This work was supported in part by funding from the European Union Seventh Framework Program (FP7/2007–2013) under Grant agreement no 602768, and a Grant from the National Science Foundation (NSF) Graduate Research Fellowship Program under Grant no. DGE-1313583. The content is solely the responsibility of the authors and does not represent the official views of the EU or the NSF.

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Correspondence to Gitta Lubke.

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Campbell, I., Lundstrom, S., Larsson, H. et al. The relation between the age at diagnosis of problem behaviors related to aggression and distal outcomes in Swedish children. Eur Child Adolesc Psychiatry 28, 899–911 (2019).

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  • Childhood aggression
  • Conduct disorder
  • Time-to-event analysis
  • Swedish data registry