Sex differences in oppositional defiant disorder

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms "deliberately annoys" and "blames others", presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girls.     

Prevalence, symptoms and distribution of oppositional defiant disorder

The purpose of this work was to determine the epidemiological evolution of the Oppositional Defiant Disorder (ODD) in adolescents, using a sample of Secondary School students of the region of Campo de Gibraltar (Cadiz). The students' age ranged from 12 to 16 years old. Two evaluations were completed, the first one during the school year 2001-2002 and the second one in the school year 2006-2007. The sample comprised 2310 students in the first study and 2351 students in the second one. We used a comparative-selective approach. The results of the comparison revealed a prevalence ranging from 3.77% to 3.83% of students with this disorder, maintaining the main symptoms and with some changes in its distribution as a function of the school grade. Indeed, the data showed more cases in the final courses (1st study) in contrast with a higher concentration of cases in the initial courses (2nd study). With regard to the frequency of ODD by sex, we found that whereas in the earlier study (2001-2002), the relationship between boys and girls was 3.5:1, in the school year 2006/2007, the number of boys with ODD quadrupled the number of girls.     

Developmental pathways in oppositional defiant disorder and conduct disorder

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) specifies a developmental relationship between oppositional defiant disorder (ODD) and conduct disorder (CD). Evidence for this link is mixed, however, and recent studies suggest that different symptom dimensions in ODD may have different outcomes. The authors examined links between ODD, CD, and their young adult outcomes in the Great Smoky Mountains Study (E. J. Costello et al., 1996), a longitudinal data set with over 8,000 observations of 1,420 individuals (56% male) covering ages 9-21 years. ODD was a significant predictor of later CD in boys but not in girls after control for comorbid CD and subthreshold CD symptomatology. Transitions between ODD and CD were less common than anticipated, however, particularly during adolescence. The authors examined characteristics and outcomes of children with pure ODD, pure CD, and combined CD/ODD. Alongside many similarities in childhood and adolescent correlates, key differences were also identified: CD largely predicted behavioral outcomes, whereas ODD showed stronger prediction to emotional disorders in early adult life. Factor analysis identified irritable and headstrong dimensions in ODD symptoms that showed differential prediction to later behavioral and emotional disorders. Overall, the results underscore the utility of retaining separate ODD and CD diagnoses in DSM-V.     

Factorial validity of the Conners' Parent Rating Scale-revised: short form with psychiatric outpatients

To assess the factorial validity of the 27-item Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S; Conners, 1997), 100 (50%) male and 100 (50%) female psychiatric outpatients between 5 and 16 years old were rated by a parent. A confirmatory factor analysis of the 18 item ratings from the CPRS-R:S Oppositional, Cognitive Problems, and Hyperactivity scales provided only tentative support for scoring these scales as Conners (1997) recommended. However, an exploratory principal-axis factor analysis with all 27 item ratings found 2 dimensions: 1 dimension was composed of the 6 items in the Oppositional scale, and other dimension contained the remaining 21 items. An attention deficit hyperactivity disorder (ADHD) Total Symptoms scale was constructed by summing the ratings for these 21 symptom ratings, and this scale was found to be as effective as the Hyperactivity scale was in discriminating between youth who were and were not eventually diagnosed with an ADHD. We discuss the results as providing an alternate way of scoring the CPRS-R:S to screen for an ADHD in child and adolescent psychiatric outpatients.     

Factors related to the comorbidity between oppositional defiant disorder and anxiety disorders in preschool children

Background and objectives: The aim of the study is to identify factors related to comorbid oppositional defiant disorder (ODD) and anxiety disorders (ADs). Design: A sample of 622 children was assessed longitudinally at 3 and 5 years of age. Methods: At baseline, there were 310 boys (49.8%), most participants were of Caucasian–white ethnicity (89.1%) and attended to public school (64.0%), and families’ socioeconomic status was 64.3% medium-high, 14.1% medium and 20.5% medium-low. Children diagnosed with ODD and/or AD were selected: n?=?103 at 3 years of age (44 ODD, 42 AD and 17 ODD?+?AD) and n?=?106 at 5 years of age (31 ODD, 60 AD and 15 ODD?+?AD). Results: High levels of the child’s negative affectivity and the mother’s aggressive behavior (versus AD), and high scores in the father’s psychopathology measurements (versus ODD) were related to the presence of comorbid ODD?+?AD at 3 years of age. High scores in approach-positive anticipation, fears (only in boys, in girls the reverse effect occurred) compared to ODD and AD independently and aggressive behavior (versus AD), and low scores for smiling and laughter (versus ODD only and AD only) were predictive of comorbidity at the 5 years of age. Conclusions: Temperament traits may be a common factor in explaining longitudinal ODD?+?AD comorbidity.     

The Eyberg Child Behavior Inventory: Factorial invariance in problem behaviors across gender and age

The Eyberg Child Behavior Inventory (ECBI) assesses problem behaviors in children, and is a widely used instrument in both clinical work and research. Evidence suggests that the short ECBI version, comprising 22 items, can be reduced into the three oblique factors: Oppositional defiant behavior; Conduct problem behavior; and Inattentive behavior. The present study aimed to evaluate this three‐factor model in a Norwegian sample of 554 children, and examine multi‐group invariance across gender and age. Consistent with previous research, results confirmed a tripartite model, with the same residual covariances and cross‐loading appearing across groups. Multi‐group confirmatory factor analysis demonstrated partial measurement invariance across gender and age. Overall, findings support a meaningful comparison of the short ECBI across gender and age. The study makes a contribution to the generalizability issue of the ECBI.     

Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders

To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children-III (WISC-III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC-III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.     

Interrater reliability of teacher rating scales for children with attention-deficit hyperactivity disorder

Interrater reliability of eight teacher rating scales designed to assess characteristics of attention-deficit hyperactivity disorder was investigated. Coteachers of 46 students completed the rating scales. The students, ages 8–17, were designated as having a Serious Emotional Disturbance. The resulting interrater reliability correlation coefficients ranged from .62 to .87. The percentage of variance shared between raters ranged from a low of 38.4% (the ACTeRS Oppositional factor and the CBCL-TRF Attention Problems factor) to 75.7% (ADHD Rating Scale). The percent of shared variance was higher for younger children. Kappa scores evaluating rater agreement were highest at the two standard deviations above the mean cutoff. The reliability coefficients were consistent with those reported in prior research.     

Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder

This paper compares the validity of DSM-III-R diagnoses of oppositional defiant disorder (ODD) and conduct disorder (CD) and an alternative option which is subdivided into three levels according to developmental sequence and severity: modified oppositional disorder (MODD), intermediate CD (ICD), and advanced CD (ACD). Using a sample of 177 boys followed over 3 years, both the DSM-III-R and the alternative diagnostic constructs are evaluated on three criteria: symptom discriminative validity, and diagnostic external and predictive validity. Most DSM-III-R ODD and CD symptoms discriminated between ODD and CD, but exceptions are noted. Additional analyses demonstrated considerable overlap among DSM-III-R oppositional symptoms. The majority of the symptoms proposed for the alternative option could be assigned to a specific level based on acceptable symptom discrimination. External validity lent support to the distinctions between DSM-III-R ODD and CD, and between MODD, ICD, and ACD. MODD was a better predictor than ODD of which boys received a later diagnosis of CD. Suggestions are made for the inclusion and exclusion of symptoms for developmentally based diagnoses of oppositional and conduct disorders.This research was supported by a grant from the John D. and Catherine R. MacArthur Foundation to the American Psychiatric Association, and grant 1-RO1-MH42529-04 from the National Institute of Mental Health. The authors are indebted to Paul Frick for his advice with some of the statistical analyses, and particularly to Ms. Judith Navratil for her expert help in data collection.     

Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children

Numerous studies have revealed autonomic underarousal in conduct-disordered adolescents and antisocial adults. It is unknown, however, whether similar autonomic markers are present in at-risk preschoolers. In this study, the authors compared autonomic profiles of 4- to 6-year-old children with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD; n = 18) with those of age-matched controls (n = 20). Children with ADHD and ODD exhibited fewer electrodermal responses and lengthened cardiac preejection periods at baseline and during reward. Although group differences were not found in baseline respiratory sinus arrhythmia, heart rate changes among ADHD and ODD participants were mediated exclusively by parasympathetic withdrawal, with no independent sympathetic contribution. Heart rate changes among controls were mediated by both autonomic branches. These results suggest that at-risk preschoolers are autonomically similar to older externalizing children.     

Social perception in children with fetal alcohol spectrum disorder

Although the profile of social cognitive difficulties is well recognized in children with certain neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), this profile is not as well established in other clinical pediatric populations. The objective of the present study is to examine patterns of social perception in children with fetal alcohol spectrum disorder (FASD) compared to typically-developing (TD) control children. A total of 56 children between 8 and 12 years of age—35 with FASD and 21 TD—completed the Reading the Mind in the Eyes Task – Children’s Version (RMET-C). The RMET-C accuracy scores were compared between groups and also by item difficulty and emotional valence. The relation between cognitive functioning, age, FASD severity, and RMET-C performance was also investigated. The children in the FASD group did not perform as well as the children in the TD group on the RMET-C Total score and Easy items, as well as the Positive, Negative, and Neutral emotional valence items. When age and IQ were investigated, there was a significant effect of age on the Positive items in the TD group, with scores increasing with age. With regard to FASD severity, children with alcohol-related neurodevelopmental disorder were outperformed by children with full/partial fetal alcohol syndrome on the Positive and Negative items. Overall, these results further the understanding of the social cognitive profile in children with FASD and how this profile relates to other childhood-onset neurodevelopmental disorders.     

Evidence for the construct validities of the Beck Youth Inventories with child psychiatric outpatients

To provide further information about the construct validities of the Beck Youth Inventories of Emotional and Social Impairment, these inventories were administered to 35 female and 65 male outpatients whose ages ranged from 7 to 12 years and who were diagnosed with various psychiatric disorders. The Children's Depression Inventory was also administered, and the children were rated by a parent with the Conners' Parent Rating Scale-Revised: Short Form. The scores on the former inventory were more positively correlated with the scores on the Beck Youth Depression Inventory (r =.81, p<.001) than with scores on the four other Beck Youth Inventories, and those on the Conners Oppositional scale were comparably correlated with the scores on the Beck Youth Disruptive Behavior (r=.49, p<.001) and Anger (r=.41, p<.001) Inventories. These latter correlations were higher than those for scores on the Oppositional scale with the scores on the three other Beck scales.     

Problem of item overlap between the psychopathy screening device and attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder rating scales

Content validity requires a clear definition of the construct of interest and the delineation of the construct from similar constructs. Content validity also requires that the items be representative of the construct as well as specific to the construct. An examination of the items on the Psychopathy Screening Device (PSD), a parent- and teacher-rating scale of childhood psychopathy, indicates significant overlap with the symptoms and associated features of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). The failure of the PSD to have unique items results in poor discriminant validity with ADHD, ODD, and CD rating scales. More careful attention to content validation guidelines is required to develop a more useful measure of childhood psychopathy.     

Effect of nutritional supplements on Attentional-Deficit Hyperactivity Disorder

This study reports the effects of two nutritional products upon the severity of symptoms in children with confirmed diagnoses of Attention-Deficit Hyperactivity Disorder (ADHD): a glyconutritional product containing saccharides known to be important in healthy functioning and a phytonutritional product containing flash-dried fruits and vegetables. Seventeen ADHD children were recruited from a local parent support group. Parents of five of the subjects did not have their children on methylphenidate. Of the remaining twelve, all on methylphenidate, six were left on prescribed doses (random assignment). The other six had their doses reduced by half after two weeks (study duration was six weeks). The subjects were assessed initially and three subsequent times over a period of six weeks (longitudinal nonrandomized design). The behavior disorder items for ADHD, Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) as listed in the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) (American Psychiatric Association, 1994) were rated by teachers and parents on a 3-point scale. Also included was a Side Effects Scale described by Barkley (1990). The children received the glyconutritional supplement for the entire six weeks. After three weeks, the phytonutritional supplement was added to the diet to increase the probability of positive results. The glyconutritional supplement decreased the number and severity of ADHD, associated ODD and CD symptoms, and side effects in all groups during the first two weeks of the study. There was little further reduction with the addition of the phytonutritional supplement. The three study groups did not differ statistically in degree of reduction over observations. Present results suggest that symptoms of ADHD may be reduced by the addition to the diet of saccharides used by the body in glycoconjugate synthesis.     

Factor Structure and Discriminative Validity of the Eyberg Child Behavior Inventory With Young Children

This study examined the factor structure and discriminative validity of the Eyberg Child Behavior Inventory (ECBI) with community-based and clinic-referred samples of young children (2–6 years). In the community sample, confirmatory factor analysis indicated a three-factor structure with components reflecting Inattentive, Oppositional Defiant, and Conduct Problem Behavior. In the clinic sample, component scores differentiated children with specific behavior problems from children without significant externalizing symptoms. However, component scores did not differentiate within the externalizing spectrum. The data suggest that ECBI components may be useful to screen community-based and clinic-referred young children for externalizing symptoms, but may be less useful to identify children with specific behavior problems.     

Reduction in children's symptoms of attention deficit hyperactivity disorder and oppositional defiant disorder during individual tutoring as compared with classroom instruction

Children who display symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in classrooms are reputed to display fewer symptoms in one-on-one interaction. We tested this hypothesis with children who received tutoring for reading and behavior problems. We selected 30 children whose teacher-rated ADHD symptoms fit a pattern consistent with DSM criteria for the diagnosis. Teachers rated the frequency of symptoms in classrooms before and after tutoring. Tutors rated the frequency of the same behaviors during individual tutoring sessions. Children's ADHD symptoms, as well as oppositional symptoms, were significantly lower in the tutoring sessions than in the classrooms. The effect sizes for the difference between behavior in classrooms and in individual tutoring ranged from 0.7 to 2.5 standard deviations. These effect sizes appear as large as those reported for the effect of stimulant medication on ADHD symptoms. All 30 children at preintervention fit the pattern for ADHD using teachers' ratings of classroom behavior; 87% of them did not meet those DSM criteria using tutors' ratings of behavior in individual sessions. The confound of different raters for the two different settings must be resolved by another study with a new design.     

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family,parenting, and behavioral correlates

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.     

Mind the gap: assessing impairment among children affected by proposed revisions to the diagnostic criteria for oppositional defiant disorder

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) workgroup for disruptive behavior disorders is considering adopting a frequency threshold for symptoms of oppositional defiant disorder (ODD). In the present study, the impact of substituting the term "often" with a specific age-based frequency on impairment and prognosis among preschool children was tested in a longitudinal design. Mutually exclusive groups were created to identify children who met criteria for ODD based on a symptom threshold of "often," as in Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-4), and those that met criteria for ODD based on a threshold of "1-2 times per day," which approximated the proposal for DSM-5. Comparisons of these groups to each other and to nondiagnosed peers determined the impact of changing the symptom threshold on impairment and prognosis. Close to one-third of children who met DSM-4 criteria for ODD did not meet criteria under the alternative diagnosis; African American children were overrepresented in this group. Preschoolers who met DSM-4, but not the alternative criteria, had higher rates of ODD, conduct disorder (CD), and were more impaired than their nondiagnosed peers at baseline and follow-up. Preschoolers meeting DSM-4 criteria were less impaired than children meeting the alternative ODD criteria at baseline according to parent, but not according to teacher report. No differences could be detected between those meeting DSM-4 and those meeting the alternative criteria in rate of ODD, CD, or impairment at follow-up. Among clinically referred preschool children, changing the symptom threshold for ODD could result in a sizable group of children who would no longer meet diagnostic criteria, despite demonstrating significant morbidity concurrently and prospectively.     

Atypical categorization in children with high-functioning autism spectrum disorder

Children with autism spectrum disorder process many perceptual and social events differently from typically developing children, suggesting that they may also form and recognize categories differently. We used a dot pattern categorization task and prototype comparison modeling to compare categorical processing in children with high-functioning autism spectrum disorder and matched typical controls. We were interested in whether there were differences in how children with autism use average similarity information about a category to make decisions. During testing, the group with autism spectrum disorder endorsed prototypes less and was seemingly less sensitive to differences between to-be-categorized items and the prototype. The findings suggest that individuals with high-functioning autism spectrum disorder are less likely to use overall average similarity when forming categories or making categorical decisions. Such differences in category formation and use may negatively impact processing of socially relevant information, such as facial expressions. A supplemental appendix for this article may be downloaded from http://pbr.psychonomic-journals.org/content/supplemental.     

Identification of Developmentally Appropriate Screening Items for Disruptive Behavior Problems in Preschoolers

Screening preschool-aged children for disruptive behavior disorders is a key step in early intervention. The study goal was to identify screening items with excellent measurement properties at sub-clinical to clinical levels of disruptive behavior problems within the developmental context of preschool-aged children. Parents/caregivers of preschool-aged children (N?=?900) were recruited from four pediatric primary care settings. Participants (mean age?=?31, SD?=?8) were predominantly female (87 %), either white (55 %) or African-American (42 %), and biological parents (88 %) of the target children. In this cross-sectional survey, participants completed a sociodemographic questionnaire and two parent-report behavioral rating scales: the PSC-17 and the BPI. Item response theory analyses provided item parameter estimates and information functions for 18 externalizing subscale items, revealing their quality of measurement along the continuum of disruptive behaviors in preschool-aged children. Of 18 investigated items, 5 items measured only low levels of disruptive behaviors among preschool-aged children. The remaining 13 items measured sub-clinical to clinical levels of disruptive behavior problems (i.e., >1.5 SD); however, 5 of these items offered less information, suggesting unreliable measurement. The remaining 8 items had high discrimination and difficulty parameters, offering considerable measurement information at sub-clinical to clinical levels of disruptive behavior problems. Behaviors measured by the 8 selected parent-report items were consistent with those identified in recent efforts to distinguish developmentally typical misbehaviors from clinically concerning behaviors among preschool-aged children. These items may have clinical utility in screening young children for disruptive behavior disorders.