摘要：Objectives. We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice. Methods. We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment. Results. Additional public costs per child related to CD exceeded $70000 over a 7-year period. Conclusions. Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder. The high social costs of mental disorder and disease among adults are well documented. For example, in 1990, the costs of depression alone exceeded $43 billion in direct and indirect costs. 1 These costs are realized in the health and specialty mental health sector and extend into the workplace and beyond. By contrast, relatively little is known about costs of emotional and behavioral problems among children and youths. Much of the available research focuses on attention-related disorders and is limited to related health expenditures or education costs. 2 – 6 The economic costs of other mental disorders, such as conduct disorder (CD) and oppositional defiant disorder, have received relatively little attention. This research gap is particularly striking in light of the link between these disorders and costly behaviors, such as delinquency. For example, CD, or “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated,” 7 has been linked with criminal activities, illegal substance use and abuse, and problems associated with early sexual debut, such as unwanted pregnancies and sexually transmitted diseases. 8 , 9 To be diagnosed with CD, a youth must display at least 3 criteria from a list of criteria (listed in The Diagnostic and Statistical Manual of Mental Disorders ), which includes behaviors such as bullying, threatening, or intimidating others; being truant from school often; and frequently lying to get something or avoid obligations. The resulting costs to society are potentially enormous and extend over many years. Particularly salient to policymakers are the costs taxpayers incur in the short term. Those costs stem from the youths’ involvement in a variety of child-serving sectors, such as juvenile justice, child welfare, special education, and mental health services. For example, in a sample of children served in community mental health centers across the country, conduct-related diagnoses were the most common. Expenditures on services for these children can be quite large, totaling $13000 or more per child during a 6-month period. 10 We used data from the Fast Track study—a longitudinal study of youths residing in poor neighborhoods in 4 communities—to examine the public costs of early conduct problems. The Fast Track study provided the data on which our analyses were based. Those data provided information on system involvement only, and we supplemented that information with data on the costs of those services. We examined the effect of CD on public costs. Finally, we considered the implications of these expenditures and the implications for prevention research.
