Neuroanatomy of childhood disruptive behavior disorders

Our aims were to (1) examine possible neuroanatomical abnormalities associated with the Disruptive Behavior Disorders (DBDs) as a group and (2) assess neuroanatomical anomalies specific to each DBD (i.e., conduct disorder [CD] and oppositional defiant disorder). Cortical thickness analysis and voxel-based morphometry were analyzed in 47 8-year-old boys (22 DBDs with and without CD and/or ODD and 25 healthy controls) from Magnetic Resonance Imaging brain scans. DBD symptoms were assessed using the Dominic-R. In DBD subjects relative to controls, we found (1) a decreased overall mean cortical thickness; (2) thinning of the cingulate, prefrontal and insular cortices; and (3) decreased gray matter density (GMd) in the same brain regions. We also found that scores on the Dominic-R were negatively correlated with GMd in the prefrontal and precuneus/superior temporal regions. There was a subdiagnostic main effect for CD, related to thinning of the middle/medial frontal, and for ODD in the left rectal/orbitofrontal. Findings suggest that thinning and decreased GMd of the insula disorganizes prefrontal circuits, diminishing the inhibitory influence of the prefrontal cortex on anger, aggression, cruelty, and impulsivity, and increasing a person's likelihood of aggressive behavior. These findings have implications for pathophysiologic models of the DBDs, their diagnostic classification system, and for designing more effective intervention programs.     

Reactive aggression in boys with disruptive behavior disorders: behavior,physiology, and affect

This study examined responses to peer provocation in boys ages 9–13 years who met symptomatic criteria for ADHD-only, ODD/CD-only, comorbid ADHD/ODD/CD, or no diagnosis. Boys participated in a reaction-time game that included standardized verbal and behavioral provocation. Their behavioral, physiological, and affective responses to this task were measured. Results showed that groups did not differ following high levels of provocation because all boys behaved aggressively. However, following low provocation boys with comorbid ADHD/ODD/CD had higher levels of behavioral aggression, had greater heart rate acceleration, and were rated as angrier than all other boys. In addition, boys with comorbid ADHD/ODD/CD held a grudge longer than other children. Results suggest that boys with comorbid ADHD/ODD/CD are especially reactive to provocation from their peers.     

Instrumental and hostile aggression in childhood disruptive behavior disorders

An analogue task of instrumental and hostile aggression during a competitive game was evaluated in a sample of clinically-referred 8-to 12-year-old aggressive boys. Similar to a prior task in a normative sample (Having, Wallace, & La Forme, 1979), both types of aggression increased during provocation as compared to baseline, indicating the success of the provocation manipulation, with moderate correlations between the two aggressive responses. The aggressive group with attention-deficit hyperactivity disorder (ADHD) and the aggressive group without ADHD each had higher rates of instrumental aggression than controls. Only the aggressive/ADHD group had higher rates of hostile aggression than controls. Parent Child Behavior Checklist ratings indicated a modest but significant unique relationship between instrumental aggression and delinquency. The high rate of both types of aggression in the aggressive/ADHD group suggests that comorbid ADHD and aggression may result in qualitative differences in aggressive behavior. The high rate of hostile aggression in the aggressive-ADHD group supports theoretical assumptions regarding the relationship of hostile aggression to poor impulse control.This research was supported in part by grants to the first author from the Medical College of Pennsylvania, the Allegheny-Singer Research Institute, NIMH First Award (MH4682), and support from NICHD Mental Retardation Research Center Core Center Grant (DH26979); and NIMH grants (MH40364 and MH00590) awarded to the second author. The authors are grateful to Marianne Torchinsky and Abby Michaleski for assistance in data collection. Preliminary data were presented at the annual meetings of the Association for Advancement of Behavior Therapy, New York, November 1988, and the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, CA, January 1990.     

Anterior cingulate cortex findings in child disruptive behavior disorders.: A meta-analysis

The brain imaging literature suggests that child disruptive behavior disorders (DBD) are associated with structural and functional abnormalities of the anterior cingulate cortex (ACC).However, there is a lot of heterogeneity in findings in terms of direction of modifications identified until this point. The present study used a meta-analytic design to aggregate the empirical findings from the literature on functional and structural abnormalities of the ACC in children with DBD. A total of eight structural and functional brain imaging (sMRI and fMRI) studies were included and results obtained from a sample of 266 children show a large effect size (D = ?.98 (95% CI [? 1.18, ? 0.77]) in terms of reduced activation of the ACC in children presenting with DBD. Effects of ACC abnormality were moderated by: 1) the type of imaging used in the study (i.e., functional vs. structural); 2) the presence or absence of co-morbid attention deficit hyperactivity disorder (ADHD); 3) the mean age of the samples of children presenting with DBD. Overall, findings confirm functional impairments of the ACC in children with DBD and highlight the importance of using such neurological information to design innovative treatments.     

Reaction time indices of attention deficits in boys with disruptive behavior disorders

Boys with diagnoses in the disruptive behavior disorder (DBD) spectrum and normal controls were tested in two reaction time (RT) experiments. In Experiment I simple warned RT was measured and the length and regularity of the preparatory intervals were varied in order to study sustained attention in the sense of preparation. With age and IQ controlled, DBD boys had slower and more variable RT overall than controls and showed generally more pronounced effects of variations in the length and sequence of the preparatory intervals. The results suggest that DBD boys are subject to lapses of attention which are increased by a relatively long preparatory interval, and that they have a particular problem with temporal uncertainty. In Experiment II some aspects of selective attention were studied in a paradigm in which stimulus modality uncertainty and response selection were varied. DBD boys showed greater effects of modality uncertainty but not response selection than controls. No differences between subdiagnoses within the DBD spectrum could be demonstrated.     

Predicting bullying and victimization among early adolescents: Associations with disruptive behavior disorders

Bullying is a common problem faced by children and adolescents in schools. One hypothesis that needs to be examined regarding the causation of this problem is whether being a bully or a victim may stem from disparate underlying patterns of psychopathology. Results are particularly scarce regarding the association between bully‐victim problems and disruptive behavior disorders. The present study sought to investigate the association between DSM‐IV symptoms of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and bully‐victim problems in a sample of 202 adolescents, aged 12–15, attending two junior high schools in Cyprus, to determine whether these symptoms differentiate between bullies and victims and provide a new approach to the understanding of bully‐victim problems. Students completed measures of bullying, victimization, disruptive behavior disorder symptoms, and self‐esteem, along with demographic questions. On the basis of their responses, teenagers were classified as bullies, victims, or both bullies and victims. Those who were bully/victims reported greater CD symptomatology. CD and low self‐esteem were predictive of bullying, whereas ODD and low self‐esteem were predictive of victimization. Aggr. Behav. 30:520–533, 2004. © 2004 Wiley‐Liss, Inc.     

Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior

In the context of a school-based prevention of conduct disorder program, 7,231 first- through fourth-grade children were screened for cross-setting disruptive behavior. Frequencies of DSM-III-R psychiatric disorders and patterns of comorbidity were assessed. We also examined the association of psychiatric diagnosis with child and parent characteristics to determine differential risk based on diagnostic subgroups. Attention deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) were the most frequent diagnoses. Mood and anxiety disorders were infrequent as single diagnoses. Patterns of comorbidity demonstrated that both externalizing and internalizing disorders commonly cooccurred with ADHD. More severe degrees of psychopathology and psychosocial risk accrued to the subgroup of youths with ADHD plus a comorbid externalizing disorder.This study was supported by grant MN-46584 from the National Institute of Mental Health.     

Early disruptive behavior,IQ, and later school achievement and delinquent behavior

A series of structural equation models is developed to examine the relationship between early externalizing behaviors (conduct problems, attention deficit) and IQ measured at age 8 years, academic achievement over the period 10 to 13 years, and delinquent behavior to the age of 15 in a birth cohort of New Zealand children. These models indicated that early externalizing behaviors and IQ were related to later academic achievement and delinquent behavior by two quite distinct but highly correlated developmental sequences. In one sequence early conduct problems were predictive of later delinquency but were not directly related to later academic achievement. In the other sequence, attention deficit and IQ were prognostic of later school achievement but were not directly related to delinquency. Further, the apparent correlations between academic achievement and delinquency were adequately explained by the common and correlated effects of early behavior and IQ on later achievement and delinquency. These conclusions remained unchanged when the sample was stratified by gender, and when further explanatory factors were introduced into the model.This research was funded by grants from the Health Research Council of New Zealand, the Canterbury Medical Research Foundation and the National Child Health Research Foundation.     

ODD dimensions, ADHD, and callous-unemotional traits as predictors of treatment response in children with disruptive behavior disorders

To answer several questions pertinent to DSM-V, the authors examined the predictive validity of pretreatment oppositional defiant disorder (ODD) dimensions, attention-deficit/hyperactivity disorder (ADHD), and callous-unemotional (CU) traits in relation to several treatment outcomes in 177 children diagnosed with ODD or conduct disorder (CD). Multiple informants completed diagnostic interviews and rating scales at 6 assessment points (pretreatment to 3-year follow-up) to document emotional and behavioral outcomes. After controlling for pretreatment CD, the ODD dimension of hurtfulness was related to treatment-resistant CD, delinquent behaviors, and externalizing problems. In contrast, the ODD dimension tapping irritability was associated with treatment-resistant ODD, internalizing problems, and global functional impairment following treatment. Whereas pretreatment ADHD was associated with posttreatment ODD and social problems, it was unrelated to posttreatment CD symptoms and diagnosis. Contrary to predictions, CU traits were unrelated to any posttreatment outcomes after controlling for other covariates. These findings remained after controlling for measures of pretreatment global functional impairment.     

Affects, agency, and self-regulation: complexity theory in the treatment of children with anxiety and disruptive behavior disorders

In an increasingly unsettled and violent world, with swelling numbers of children who are abused, abandoned, or neglected, emotionally if not physically, and an increasing population of aggressive preschool children with anxiety and disruptive behavior disorders who cannot be contained in ordinary settings, psychoanalysts can make a contribution. Early intervention is essential. In very early childhood, new procedural memories for interacting with others and for regulating affects can be formed more easily than they can ever be again. Intervention should aim toward helping the child develop a sense of agency, establish moral standards, assume self-responsibility, and attain the capacity for emotional regulation. The principles of complex dynamic systems can inform psychoanalytic treatment strategies, as demonstrated with five children whose cases are presented.     

Teacher escape,avoidance, and countercontrol behaviors: Potential resoponses to disruptive and aggressive behaviors of students with severe behavior disorders

We develop hypothese based on the research literature regarding behavioral responses to aversive stimuli. Specifically, escape, avoidance, and countercontrol responses are presented as teacher behaviors which may occur in the presence of disruptive and aggressive behaviors (aversive stimuli) which, in part, characterize many students with severe behavior disorders (SBD). The potential for teacher escape, avoidance, and countercontrol responses to the detrimental for both teachers and students is presented, as well as suggestions for addressing aversive behaviors of students in ways to reduce the potential detrimental impact.     

Understanding the relations among gender,disinhibition, and disruptive behavior in adolescents

This study examined whether disinhibition shows similar relations with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) symptomatology among male and female adolescents. The mixed-incentive or punishment condition of Newman's go/no-go task was administered to 172 adolescents. As expected, ADHD symptoms in boys and girls were predictive of disinhibition (i.e., commission errors) in the mixed-incentive but not punishment condition. Also consistent with expectations, CD symptoms in boys were predictive of disinhibition in the mixed-incentive but not punishment condition. In contrast, CD symptoms in girls were not predictive of disinhibition in either condition. These findings are discussed in terms of implications for understanding sex differences in the etiology of ADHD and CD.     

Production and elimination of disruptive classroom behavior by systematically varying teacher's behavior

The effects of teacher behaviors on the classroom behaviors of children were investigated by systematically varying approving (praise, smiles, contacts, etc.) and disapproving (verbal reprimands, physical restraint, etc.) classes of teacher behavior. Measures were taken on both teacher and child behaviors. Each day a sample of 10 children was observed. The subject pool was a class of 28 well-behaved children in a middle-primary public school class. The results demonstrated that approving teacher responses served a positive reinforcing function in maintaining appropriate classroom behaviors. Disruptive behaviors increased each time approving teacher behavior was withdrawn. When the teacher's disapproving behaviors were tripled, increases appeared most markedly in the gross motor and noise-making categories of disruptive behavior. The findings emphasize again the important role of the teacher in producing, maintaining, and eliminating disruptive as well as pro-social classroom behavior.     

Associations between peer nominations, teacher ratings, self-reports, and observations of malicious and disruptive behavior

This study evaluates the validity of two aggression scales for predicting observations of malicious or disruptive behavior at school. Subgroups of a sample of 1,560 children (age 8.6+/-1.5 years) were assessed using (a) peer nominations of aggression, (b) teacher reports on the Teacher Report Form (TRF) of the Child Behavior Checklist (CBCL) Aggression scale and the peer nomination items, or (c) self-reports on the peer nomination items. Criteria were observations of physical, verbal, initiated, retaliatory, malicious, and disruptive behaviors. Teacher report peer nominations predicted observed physical, verbal, initiated, and retaliatory aggression and disruptive behavior. Peer nominations predicted physical aggression, verbal aggression, initiation and disruptive behavior, and TRFs predicted verbal, initiated, and disruptive behavior. Self-reports did not significantly predict any behavior. Implications for assessment of aggression are discussed.     

Effects of using self-recording and self-observation in reducing disruptive behavior

In an attempt to reduce the levels of disruptive behavior, six participants in a school for students with behavior disorders were shown edited videotapes depicting themselves appropriately engaged in classroom activities. The participants were first exposed to a training condition in which both appropriate and inappropriate behaviors of a peer were either observed or observed and recorded. In the intervention condition, the participants either self-observed and self-recorded their behaviors from videotape or simply observed themselves on videotape. The results showed idiosyncratic effects across both conditions. Measures of treatment integrity and treatment acceptability were also conducted. The results of this study are compared with similar research investigating self-observation interventions.