儿童对立违抗性障碍研究的进展及启示

随着基因技术及生物工程技术的迅速发展,人们逐渐发现与冲动行为相关基因的存在,研究认为DA、5-HT、MAO等基因多态性与冲动行为有关,从而进一步认识到ODD与遗传因素有关且属于多基因遗传.对儿童对立违抗性障碍(ODD)的生物学机制及社会心理应激因素进行了系统的分析,对进一步探讨ODD的发病机制有所启示.     

儿童对立违抗性障碍研究的进展及启示

随着基因技术及生物工程技术的迅速发展,人们逐渐发现与冲动行为相关基因的存在,研究认为DA、5-HT、MAO等基因多态性与冲动行为有关,从而进一步认识到ODD与遗传因素有关且属于多基因遗传。对儿童对立违抗性障碍(ODD)的生物学机制及社会心理应激因素进行了系统的分析,对进一步探讨ODD的发病机制有所启示。     

Dimensions of Oppositional Defiant Disorder in Young Children: Heterotypic Continuity with Anxiety and Depression

There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model.     

Trajectories of Oppositional Defiant Disorder Irritability Symptoms in Preschool Children

This study traces the developmental course of irritability symptoms in oppositional defiant disorder (ODD) from ages 3–5 and examines the psychopathological outcomes of the different trajectories at age 6. Method. A sample of 622 3-year-old preschoolers (311 were boys), followed up until age 6, was assessed yearly with a semi-structured diagnostic interview with parents and at age 6 with questionnaires answered by parents, teachers and children. Results. Growth-Mixture-Modeling yielded five trajectories of irritability levels for the whole sample (high-persistent 3.5 %, decreasing 3.8 %, increasing 2.6 %, low-persistent 44.1 % and null 46.0 %). Among the children who presented with ODD during preschool age, three trajectories of irritability symptoms resulted (high-persistent 31.9 %, decreasing 34.9 % and increasing 33.2 %). Null, low-persistent and decreasing irritability courses in the sample as a whole gave very similar discriminative capacity for children’s psychopathological state at age 6, while the increasing and high-persistent categories involved poorer clinical outcomes than the null course. For ODD children, the high-persistent and increasing trajectories of irritability predicted disruptive behavior disorders, comorbidity, high level of functional impairment, internalizing and externalizing problems and low anger control at age 6. Conclusions. Irritability identifies a subset of ODD children at high risk of poorer longitudinal psychopathological and functional outcomes. It might be clinically relevant to identify this subset of ODD children with a high number of irritability symptoms throughout development with a view to preventing comorbid and future adverse longitudinal outcomes.     

The Longitudinal Effects of Oppositional Defiant Disorder Symptoms on Academic and Occupational Functioning in the Transition to Young Adulthood

The young adult years are particularly important for accruing the education and work experience needed for long-term economic stability. We examine the effects of symptoms of ODD at baseline (i.e., T1 ages 12 to 18 years; N = 662; 48 % male) and of increases in these symptoms on academic and occupational functioning in young adulthood (i.e., T6 ages 22 to 29 years; N = 478; 45 % male) using multiple measures; including achievement levels (i.e., educational attainment, occupational prestige, and income) and financial and work stress (i.e., debt, financial strain, and perceived workplace stress). Our findings show that both adolescent levels of and increases in symptoms of ODD influence academic and occupational functioning in young adulthood. We discuss the implications of ODD symptoms for accruing economic capital in young adulthood, as well as approaches to detecting and intervening that are needed to halt the potentially cascading effects of ODD symptoms.     

Paired-Associate Learning in Attention-Deficit/Hyperactivity Disorder as a Function of Hyperactivity-Impulsivity and Oppositional Defiant Disorder

A paired-associate learning (PAL) test was administered to 22 community volunteers without disruptive disorders and 197 children (7.5–13.5 years-old) presenting with the inattentive and combined subtypes of attention-deficit/hyperactivity disorder (ADHD) either in combination with or without oppositional defiant disorder (ODD). Participants were screened for learning disorders. In comparison to non-ADHD participants, children with ADHD achieved worse PAL and made errors rated as more acoustically and less semantically similar to the correct paired associates. These deficits were not related to hyperactivity–impulsivity or comorbid ODD. These results suggest that ADHD children are less competent at PAL and use less efficient learning strategies than their non-ADHD peers.     

Multiple Levels of Family Factors and Oppositional Defiant Disorder Symptoms Among Chinese Children

Family factors are closely associated with child developmental outcomes. This study examined the relationship of oppositional defiant disorder (ODD) symptoms and factors at whole family, dyadic, and individual levels in Chinese children. Participants, who were recruited from 14 primary schools in north, east, and south‐west China, included 80 father‐child dyads and 169 mother‐child dyads. Children in the participating dyads were previously diagnosed with ODD. Results revealed that family cohesion/adaptability was indirectly associated with ODD symptoms via parent–child relationship and child emotion regulation. Parent–child relationship affected ODD symptoms directly and indirectly through child emotion regulation. In addition, the effects of family cohesion/adaptability on parent emotion regulation and child emotion regulation were mediated by the parent–child relationship. The tested model provides a comprehensive framework of how family factors at multiple levels are related to child ODD symptoms and highlights the importance of understanding child emotional and behavioral problems within the family context, more specifically within the multiple levels of family relationships.     

Family Routine Moderates the Relation Between Child Impulsivity and Oppositional Defiant Disorder Symptoms

Although child impulsivity is associated with oppositional defiant disorder (ODD) symptoms, few studies have examined whether family processes moderate this association. To address this gap, we tested whether child-reported family routine moderated the relation between child hyperactivity/impulsivity (HI) and ODD symptoms among a sample of low-income, urban, ethnic-minority children (N = 87, 51% male). Child HI and ODD symptoms were assessed using parent and teacher reports. HI also was indexed by a laboratory task. Family routine was assessed using child self-report. Hierarchical regression analyses indicated that family routine moderated child HI. Among children with higher levels of teacher-reported HI symptoms, lower levels of family routine were associated with higher levels of teacher-reported ODD symptoms compared to children with lower levels of teacher-reported HI symptoms. Children who self-reported higher levels of family routine were rated as low on teacher-reported ODD symptoms, regardless of teacher-reported HI levels. Parent report and laboratory measures of child HI did not produce significant interactions. Lower levels of family routine may confer risk for ODD symptoms among low-income, urban, ethnic-minority children experiencing higher levels of HI.     

Phenomenology of Clinic-Referred Children and Adolescents with Oppositional Defiant Disorder and Comorbid Anxiety

This study examined profiles of clinic-referred youth with co-morbid oppositional defiant disorder (ODD) and anxiety disorders (ADs) compared to youth with ODD without ADs. One hundred and twenty seven clinic-referred youth with ODD (ages 7–14, 85.6 % Caucasian) were assessed through a multi-method, multi-informant approach. Global functioning, ODD symptom impairment, child internalizing symptoms, caregiver distress, and parent-child relationship quality were explored to test group differences based on AD diagnosis. Youth with ODD and comorbid ADs generally had higher levels of global impairment, internalizing symptoms, caregiver distress, and parent-child relationship problems as compared to youth with ODD only. These findings, which generally suggest greater impairment in the group of youth with ODD/AD, offer support for the presence of distinct clinical features in youth with ODD/AD compared to youth with ODD alone. Such findings may have important implications for assessment and treatment of ODD in youth. For example, interventions to target broader child internalizing symptoms, caregiver distress, and parent-child relationships may be particularly important in youth with ODD/AD profiles.     

Change in Maternal Stress for Families in Treatment for their Children with Oppositional Defiant Disorder

Our objective was to predict change in maternal stress over the course of a randomized clinical trial comparing the efficacy of two interventions for Oppositional Defiant Disorder (ODD): Parent Management Training and Collaborative & Proactive Solutions. In a secondary analysis of data collected from this randomized clinical trial, we examined whether children’s self-reported positive relations with their parents impacted responsiveness to treatment, which in turn impacted maternal stress. One hundred thirty-four children and their parents (38.1% female, ages 7–14, M age?=?9.51, SD?=?1.77) were tracked across three time points: pre-treatment; one-week post-treatment; and six-month post-treatment. Hierarchical linear models tested change in children’s reports of positive relations with parents, clinician reports of ODD severity, and maternal reports of parenting stress. Models then tested multilevel mediation from positive relations with parents, through ODD severity, onto maternal stress. Hypothesized indirect effects were supported such that children’s reports of positive views toward parents uniquely predicted reductions in ODD severity over time, which in turn uniquely predicted reductions in maternal stress. Results highlight the promise of potential secondary benefits for parents following interventions for children with oppositional problems. Furthermore, results underscore the importance of the parent–child relationship as both a protective factor and as an additional target to complement interventions for child disruptive behaviors.     

Parental Psychopathology Levels as a Moderator of Temperament and Oppositional Defiant Disorder Symptoms in Preschoolers

Oppositional Defiant Disorder (ODD) is among the most prevalent disorders in preschoolers. It has been linked to temperament, since characteristics such as elevated surgency and negative affect, as well as low levels of effortful control, contribute to the development of this disorder. Evidence also indicates that parental psychopathology can accentuate temperamental traits. Our aim was to assess whether the levels of psychopathology of mothers and fathers acts as a moderator of the relationship between temperament and ODD symptoms in preschoolers, both cross-sectionally at ages 3, 4 and 5, and longitudinally between ages 3 and 5. The sample included 550 children evaluated at ages 3, 4 and 5 through questionnaires and a semi-structured diagnostic interview with parents. Parents also answered a questionnaire about their own psychopathology. The results indicated that negative affect and effortful control are associated with higher levels of ODD symptoms in preschoolers. At child age 5, higher levels of paternal depression and anxiety increased the effect of low effortful control on ODD. High levels of negative affect and low levels of effortful control at age 3 were statistical predictors of ODD levels at age 5, and this relationship was also moderated by paternal anxiety and depression. The results have important clinical implications for the proper orientation of interventions, suggesting that interventions should integrate the paternal caregiver in the treatment.     

Toward a Transactional Conceptualization of Oppositional Defiant Disorder: Implications for Assessment and Treatment

The conceptualization and treatment of oppositional defiant disorder (ODD) has been characterized by surprising homogeneity. In this paper evidence is presented to underscore the heterogeneity within ODD, including research demonstrating (a) the distinction between reactive and proactive forms of aggression; (b) the importance of affective modulation and self-regulation, and associated cognitive skills, in the development of the skill of compliance; and (c) high levels of comorbidity between ODD and other disorders. The disparate pathways that give rise to oppositional behavior suggest that different children with ODD may require different forms of intervention. The necessity of a transactional conceptualization, of achieving a comprehensive understanding of the factors underlying the difficulties of individual children with ODD, and of matching intervention ingredients to the specific needs of different children and families is discussed.Ross W. Greene     

Trajectories of Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Symptoms as Precursors of Borderline Personality Disorder Symptoms in Adolescent Girls

Little empirical evidence exists regarding the developmental links between childhood psychopathology and borderline personality disorder (BPD) in adolescence. The current study addresses this gap by examining symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) as potential precursors. ADHD and BPD share clinical features of impulsivity, poor self-regulation, and executive dysfunction, while ODD and BPD share features of anger and interpersonal turmoil. The study is based on annual, longitudinal data from the two oldest cohorts in the Pittsburgh Girls Study (N = 1,233). We used piecewise latent growth curve models of ADHD and ODD scores from age 8 to 10 and 10 to 13 years to examine the prospective associations between dual trajectories of ADHD and ODD symptom severity and later BPD symptoms at age 14 in girls. To examine the specificity of these associations, we also included conduct disorder and depression symptom severity at age 14 as additional outcomes. We found that higher levels of ADHD and ODD scores at age 8 uniquely predicted BPD symptoms at age 14. Additionally, the rate of growth in ADHD scores from age 10 to 13 and the rate of growth in ODD scores from 8 to 10 uniquely predicted higher BPD symptoms at age 14. This study adds to the literature on the early development of BPD by providing the first longitudinal study to examine ADHD and ODD symptom trajectories as specific childhood precursors of BPD symptoms in adolescent girls.     

Impaired Neurocognitive Functions Affect Social Learning Processes in Oppositional Defiant Disorder and Conduct Disorder: Implications for Interventions

In this review, a conceptualization of oppositional defiant (ODD) and conduct disorder (CD) is presented according to which social learning processes in these disorders are affected by neurocognitive dysfunctions. Neurobiological studies in ODD and CD suggest that the ability to make associations between behaviors and negative and positive consequences is compromised in children and adolescents with these disorders due to reduced sensitivity to punishment and to reward. As a result, both learning of appropriate behavior and learning to refrain from inappropriate behavior may be affected. Likewise, problem solving is impaired due to deficiencies in inhibition, attention, cognitive flexibility, and decision making. Consequently, children and adolescents with ODD and CD may have difficulty learning to optimize their behavior in changeable environments. This conceptualization of ODD and CD is relevant for the improvement of the effect of psychological treatments. Behavioral and cognitive-behavioral interventions that have been shown to be modestly effective in ODD and CD are based on social learning. Limited effectiveness of these interventions may be caused by difficulties in social learning in children and adolescents with ODD and CD. However, although these impairments have been observed at a group level, the deficits in reward processing, punishment processing, and cognitive control mentioned above may not be present to the same extent in each individual with ODD and CD. Therefore, the neurocognitive characteristics in children and adolescents with ODD and CD should be assessed individually. Thus, instead of delivering interventions in a standardized way, these programs may benefit from an individualized approach that depends on the weaknesses and strengths of the neurocognitive characteristics of the child and the adolescent.     

Bridging the Divide Between Psychodynamic and Behavioral Approaches for Children with Oppositional Defiant Disorder

ABSTRACT

Oppositional defiant disorder (ODD) is one of the primary reasons youth are referred to mental health services. Disruptive behavior disorders such as ODD are heterogeneous in their presentation, developmental trajectories, and treatment needs. Given the high attrition rates in child psychotherapy in general, there is a need for a range of interventions tailored to meet the unique needs of each family to help increase familial engagement and positive outcomes for children with ODD.

This article outlines composite clinical case material of a child with ODD who was treated with Regulation Focused Psychotherapy for Children (RFP-C), a manualized, psychodynamic intervention for ODD. The case presented is then reconceptualized from a behavioral parent training perspective. This approach uses parent training to encourage positive parenting practices and reduce coercive reinforcement cycles. The case material and its reconceptualization are followed by a discussion of the distinctions between psychodynamic and behavioral approaches to children with ODD. An integrated psychotherapy approach is proposed, and the benefits and challenges of psychotherapy integration are discussed.     

The Cost of Oppositional Defiant Disorder and Disruptive Behavior: A Review of the Literature

This purpose of this paper is to review the literature on the treatment of Oppositional Defiant Disorder, with a specific focus on cost analyses. In general the literature shows that while there has been substantial research on Oppositional Defiant Disorder there has been little focus on the costs involved. A search of the major databases in psychology and the social sciences yielded only seven articles even marginally appropriate for a review of costs associated with Oppositional Defiant Disorder and related disruptive behavior. Interestingly, only two of these studies investigated treatment costs specifically associated with Oppositional Defiant Disorder. These studies showed that the treatment of Oppositional Defiant Disorder is much less expensive than the treatment of Conduct Disorder and family therapy is the most cost effective approach. Overall, the review showed that there is a dearth of literature related to treatment costs, which leads to the conclusion that much more research is needed on the cost of treating Oppositional Defiant Disorder.     

Assessment of Callous-Unemotional Traits in 6 to 12 Year-Old Children with Oppositional Defiant Disorder/Conduct Disorder by Parent Ratings

The factorial structure of the Inventory of Callous-Unemotional Traits (ICU; Frick 2004) has been inconsistent across previous studies using different rater versions (self-report, parent, teacher) and versions in different languages applied to both clinical and nonreferred samples predominantly of adolescents. The present study examined the factorial structure of the parent-report version of the ICU in a clinical sample of boys aged 6–12 years with Oppositional Defiant Disorder/Conduct Disorder (n?=?131) using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results from the CFA supported previous findings, but even the preferred model with three independent factors (Callousness, Uncaring, and Unemotional) showed inadequate model fit. Subsequent EFA revealed a three-factor model consisting of two new subscales (Callousness/Lack of Guilt or Remorse, Unconcerned about Performance) and the original subscale Unemotional. Internal consistencies of the three subscales and total score were satisfactory, and intercorrelations of the subscales were weak, except for a moderate correlation between the subscales Callousness/Lack of Guilt or Remorse and Unconcerned about Performance. The corresponding subscales of the original and new versions were highly correlated. As expected, the ICU subscale Callousness/Lack of Guilt or Remorse showed associations with other measures of aggressive and oppositional behavior. The other two ICU subscales were not associated with aggression or oppositional/antisocial behavior, but Unconcerned about Performance correlated with a measure of attention problems and Unemotional correlated with the internalizing problem withdrawn. The implications of these findings are discussed, especially as a callous unemotional specifier for the diagnosis of Conduct Disorder is included in DSM-5.     

Predicting Treatment Response for Oppositional Defiant and Conduct Disorder Using Pre-Treatment Adrenal and Gonadal Hormones

Variations in adrenal and gonadal hormone profiles have been linked to increased rates of oppositional defiant disorder (ODD) and conduct disorder (CD). These relationships suggest that certain hormone profiles may be related to how well children respond to psychological treatments for ODD and CD. The current study assessed whether pre-treatment profiles of adrenal and gonadal hormones predicted response to psychological treatment of ODD and CD. One hundred five children, 6–11?years old, participating in a randomized, clinical trial provided samples for cortisol, testosterone, dehydroepiandrosterone, and androstenedione. Diagnostic interviews of ODD and CD were administered up to 3?years post-treatment to track treatment response. Group-based trajectory modeling identified two trajectories of treatment response: (1) a High-response trajectory where children demonstrated lower rates of an ODD or CD diagnosis throughout follow-up, and (2) a Low-response trajectory where children demonstrated higher rates of an ODD or CD diagnosis throughout follow-up. Hierarchical logistic regression predicting treatment response demonstrated that children with higher pre-treatment concentrations of testosterone were four times more likely to be in the Low-response trajectory. No other significant relationship existed between pre-treatment hormone profiles and treatment response. These results suggest that higher concentrations of testosterone are related to how well children diagnosed with ODD or CD respond to psychological treatment over the course of 3?years.