Course and prognosis

Of those with early-onset conduct disorder (before 8 years of age) about half persist with serious problems into adulthood. Of those with adolescent onset, the great majority (over 85 per cent) desist in their antisocial behaviour by their early twenties.

Many of the factors that predict poor outcome are associated with early onset (Table.. ...1).

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Table 1 Factors predicting poor outcome

To detect protective factors, children who do well despite adverse risk factors have been studied. However, these so-called 'resilient' children have been shown to have lower levels of risk factors, for example a boy with antisocial behaviour and low IQ living in a rough neighbourhood but with supportive concerned parents. Protective factors are mostly the opposite end of the spectrum of the same risk factor; thus good parenting and high IQ are protective. Nonetheless there are factors associated with resilience independent of known adverse influences. These include a good relationship with at least one adult, who does not necessarily have to be the parent, a sense of pride and self-esteem, and skills or competencies.

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