El animal digital “…De todas las imágenes son las imágenes animales

Increasingly the links between childhood mental health and the use of adult mental health services are being identified. Studies consistently report that important continuities between childhood, adolescent and adult disorders exist (eg Zeitlin, 1986), and there is considerable evidence to suggest that symptoms of ADHD/HD/hyperactivity or ODD/CD do not necessarily ameliorate with maturation (eg Brown & Borden, 1986). Furthermore, Moffitt

(1993) reported that the more persistent disorders that set their course from childhood through to adolescence and adulthood (“life course persistent”), are more damaging than those that develop latterly ie during adolescence (“adolescent-limited”). (Continuities between specific mental health problems are discussed in Section 2.2.) As noted previously, there are also strong associations between behavioural problems and poor educational

performance and/or psychosocial outcomes. As a consequence of the importance of school education and examination passes for entry to further education and future employment, this relationship has important ramifications for outcomes in adult life. Although this thesis does not directly measure what happens in adulthood, some of this literature is briefly considered in order to underpin the importance of academic success at school, and the early identification and appropriate allocation of treatment for behavioural problems to try and mitigate some of their deleterious effects.

Continuities between childhood disorder and psychosocial outcomes in adulthood are, however, likely to be complex. Some progress has been made in determining which features of childhood disorder predict different types of later behavioural and academic outcomes. For example, using longitudinal methodologies, Fergusson et al (1993, 1996), Fergusson & Norwood (1995b) and Fergusson & Norwood (1997) have consistently reported that whilst attention deficit problems are related to poor educational performance (eg early school leaving, grade retention, poor school grades), conduct problems are associated with a high risk of future criminality. Clearly, prospective follow-up studies are more likely to establish whether or not the occurrence of early associations increase the risk of developing poor outcomes in adulthood, and the direction that these might take. Nowever, according to Moffitt (1993), many of these studies have been limited by a failure to begin the research process early enough ie during infancy or even prenatally.

On balance, empirical evaluations have determined that the well documented peak for offending, that occurs during adolescence, is likely to reflect an increase in prevalence in the number of young people who come to the attention of the authorities for criminal behaviour. Moreover, the stability of antisocial acts and the larger proportion of males performing them, supports the links with early conduct problems, although manifestations of the disorder may change over time to reflect environmental and social changes that occur during the period of development (Moffitt,

1993). The prognosis for antisocial behaviour is poor, and it is typically associated with increased rates of drug and alcohol abuse, unemployment and/or unstable relationships, amongst young people who first exhibited conduct problems during their childhood years (eg Farrington, Loeber, Elliott, Hawkins et al., 1990). There is also some evidence that persistent antisocial

behaviours are committed by young people who also have

neuropsychological deficits, either verbal deficits (eg problem solving, expression of speech and writing, memory) or executive deficits (eg inattention and impulsivity) (Lynam, Moffitt & Stouthamer-Loeber, 1993). Such problems are likely to impinge directly on their levels educational performance and restrict their opportunities for the future.

The relationship between reading difficulties and associated low IQ is well established, and there is some evidence suggesting that these young people are more likely to complete fewer years at school and obtain less well paid jobs. Maughan, Gray, & Rutter (1985) followed up boys from the Rutter et al (1970) epidemiological survey conducted in London at the ages of 10, 14 and 18 (one year after leaving school). They found that while pure reading difficulties resulted in low levels of academic attainment and subsequent difficulties in obtaining and sustaining suitable employment, it was the associated behavioural problems (especially conduct) that resulted in early school leaving, lack of formal qualification and later job instability. They concluded that behaviour was the most disruptive factor and the most likely to influence the direction of difficulties experienced during early adulthood.

Further support for the impact of adolescent problems at school heavily influencing poor adult outcomes comes from LeBlanc (1994). He followed- up boys aged 12-16, and again two years later aged 14-18 using self report questionnaires against a number of school variables (eg poor grade average on two subjects, early school leaving) and family variables (eg SES, marital status, family dysfunction). He found that the most significant predictors of delinquency in adolescence were prior delinquent acts, school difficulties and poor parental relationships. However, only two variables continued to have

an impact on adult offending, namely school difficulties and parental attachment, although these were later substituted for job instability and problems with attachment to a spouse respectively.

Despite the strong association in the literature between ADHD/hyperactivity and impaired educational performance, comparatively few studies have investigated adult outcomes of this disorder, in terms of their subsequent occupational status using prospective longitudinal methodologies. However, Mannuzza et al (1997) prospectively followed-up two groups of 7-11 year old boys, one being probands (with high levels of hyperactivity on rating scales) and the other being controls, at the ages of 15 and 21. They reported considerably impaired outcomes for adults with a previous history of hyperactivity, when compared to controls, in terms of early school leaving, poor school attainment and lower occupational status. Limitations to the study include the omission of young people with either conduct problems or reading difficulties (Mannuzza et al., 1997). Both of these conditions have been found to contribute substantially to poor outcomes in adolescence and adulthood in terms of underachieving at school and increased risks of participating in criminal activities and high levels of unemployment respectively (eg Maughan et al., 1985; Fergusson et al., 1993).

This section underscores some of the long-term difficulties experienced by young people as a consequence of their early behaviour. These result in a range of problems during adolescence and many through to adulthood, including increased risks of psychiatric comorbidity, offending behaviour and impaired social relationships and higher levels of unemployment.

2.5.8 Efficacy of treatment for behaviour to improve