1. Department of Psychology University of Otago Dunedin, New Zealand Professor Richie Poulton, FRSNZ Director, Dunedin Multidisciplinary Health and Development Research Unit; Co-Director, National Centre for Lifecourse Research Lifecourse Windows of (specific) Opportunity

2. Our children need… the ability to think clearly and quickly; the ability to think clearly and quickly; to be adaptable; to be adaptable; to be rid of debilitating mental health or emotional problems; to be rid of debilitating mental health or emotional problems; to be physically fit and not encumbered with chronic physical ailments; and to be physically fit and not encumbered with chronic physical ailments; and to be effective social beings, who do not violate the rights of others, or worse, harm their fellow citizens. to be effective social beings, who do not violate the rights of others, or worse, harm their fellow citizens.

3. Retention in the Dunedin Study Age Year Number Percent* Birth1972-73 31975-761037100% 51977-78 991 96% 71979-80 954 92% 91981-82 955 92% 111983-84 925 90% 131985-86 850 82% 151987-88 976 95% 181990-91 993 97% 211993-94 992 97% 261998-99 980 96% 322004-05 972 96% 382010-12 961 95% * Percentage seen of those who were eligible (i.e. alive) at each age

4. Location of Study Members seen at age 38

5. Current research activities include studies of: SES inequalities - selection v causation SES inequalities - selection v causation Pathways to employment Pathways to employment Personality continuities across the life-course Personality continuities across the life-course Antisocial behaviour and criminality Antisocial behaviour and criminality Long-term consequences of childhood adversity Long-term consequences of childhood adversity Maori health/cultural identity Maori health/cultural identity Cognition and neuropsychology Cognition and neuropsychology Family health history study Family health history study Mental health (including substance abuse) Intimate relationships and domestic violence Oral health Sexual & reproductive health Cardiovascular risk factors Retinal imaging and endothelial function Respiratory health Next generation studies (age 3 and age 15 years)

6. Current research activities (contd) Blood based studies Blood based studies – Chlamydia trachomatis – Herpes immunity – Cardiovascular disease risk factors – Inflammatory biomarkers Genetic studies –Mental health phenotypes –Asthma/allergy –Cardiovascular risk factors –Periodontal disease Methodological studies Methodological studies – Comparison of Dunedin sample with national data – Attrition analyses

8. Perhaps ironically… is the best advertisement I know of for importance of the environment! The most cutting-edge genetic research

9. The question then becomes… When do we intervene; and When do we intervene; and with what with what to make the biggest difference?

10. What is the evidence base? The World Health Organisation’s “burden of disease framework” tells us that the three conditions associated with the greatest loss of life and productive years (i.e. living with a disability) are, in order: 1.cardiovascular disease; 2.cancer; and 3.mental health disorders 3.mental health disorders.

11. Mental Health Kim-Cohen, et al (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, Vol. 60, 709- 719. Poulton, et al (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: A 15-year longitudinal study. Archives of General Psychiatry, Vol. 57, 1053-1058.

12. The question then becomes… When do we intervene; and When do we intervene; and with what with what to make the biggest difference?

13. ¾ of adult patients of mental-health professionals have a juvenile disorder history 78% First Diagnosis: Ages 11-18 First Diagnosis: Age 26 10% 12%

14. The take home message an enormous amount of suffering borne by both the individual and the community; and an enormous amount of suffering borne by both the individual and the community; and a significant amount of lost productivity when viewed across the totality of a persons working life. a significant amount of lost productivity when viewed across the totality of a persons working life. Dealing with nascent or emerging mental health problems effectively, early on, could reduce:

15. Social Isolation Caspi, et al (2006). Socially isolated children 20 years later: risk of cardiovascular disease. Archives of Pediatrics & Adolescent Medicine, Vol. 160(8), 805-11.

16. Association Between Childhood Social Isolation and Adult Cardiovascular Multifactorial Risk Status

17. Booze & Drugs Odgers, et al (2008). Is it important to prevent early exposure to drugs and alcohol among adolescents? Psychological Science, Vol. 19(10), 1037-1044.

18. Effects of Early Substance Exposure on Adolescents' Adult Outcomes, Before and After Propensity-Score Matching

19. The influence of early-onset cannabis use on adult psychosis IS moderated by COMT genotype 54 148 9131148 151

20. Relative Poverty Poulton, et al (2002). Association between children's experience of socioeconomic disadvantage and adult health: a life-course study. Lancet, Vol. 360(9346), 1640-1645.

21. Effect of social mobility from child to adult

24. Self-Control Moffitt, et al (2011). A gradient of childhood self-control predicts health, wealth, and public safety. PNAS (Proceedings of the National Academy of Sciences of the USA), Vol. 108(7), 2693-2698. Moffitt, Poulton & Caspi. (2013). Lifelong Impact of Early Self-Control. American Scientist, Vol. 101(5), 352-359.

25. What is Self-control? Self-control is the ability to regulate one’s emotions, desires, and behaviours in the service of later rewards.  Think before you speak or act  Resist temptations  Give considered response instead of an impulsive one  Resist saying something inappropriate (or hurtful)  Resist ‘tit for tat’ (hurting someone because that person hurt you)  Resist jumping to conclusions

26. Childhood self-control (quintiles)

28. Acknowledgements This on-going research would not have been possible without the co-operation and commitment of the Study members, their families and friends over a long period of time. This on-going research would not have been possible without the co-operation and commitment of the Study members, their families and friends over a long period of time. Core funding for the Dunedin Multidisciplinary Health and Development Research Unit comes from the Health Research Council of New Zealand and the NZ Ministry of Business, Innovation & Employment (MBIE). Core funding for the Dunedin Multidisciplinary Health and Development Research Unit comes from the Health Research Council of New Zealand and the NZ Ministry of Business, Innovation & Employment (MBIE). For copies of research articles referred to in this presentation or other information on the Study, contact Jenny McArthur:  +64 3 479-8507  email: dmhdru@otago.ac.nz  +64 3 479-8507  email: dmhdru@otago.ac.nz http://www.otago.ac.nz/dunedin study