Significance of Childhood Conduct Problems to Later Development of Conduct Disorder Among Children With ADHD: A Prospective Follow-Up Study

This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.     

Observed parenting behavior with teens: measurement invariance and predictive validity across race

Previous reports supporting measurement equality between European American and African American families have often focused on self-reported risk factors or observed parent behavior with young children. This study examines equality of measurement of observer ratings of parenting behavior with adolescents during structured tasks; mean levels of observed parenting; and predictive validity of teen self-reports of antisocial behaviors and beliefs using a sample of 163 African American and 168 European American families. Multiple-group confirmatory factor analyses supported measurement invariance across ethnic groups for four measures of observed parenting behavior: prosocial rewards, psychological costs, antisocial rewards, and problem solving. Some mean-level differences were found: African American parents exhibited lower levels of prosocial rewards, higher levels of psychological costs, and lower problem solving when compared to European Americans. No significant mean difference was found in rewards for antisocial behavior. Multigroup structural equation models suggested comparable relationships across race (predictive validity) between parenting constructs and youth antisocial constructs (i.e., drug initiation, positive drug attitudes, antisocial attitudes, problem behaviors) in all but one of the tested relationships. This study adds to existing evidence that family-based interventions targeting parenting behaviors can be generalized to African American families.     

To be or not to be: an exploration of ethnic identity development in context

This qualitative study focused on the intersection of personal and ethnic identities among forty African American, Puerto Rican, Dominican, and Chinese American high school students. The patterns in content indicated that for the Puerto Ricans, the intersection of their personal and social identities was a series of accommodations to a positive peer climate and a resistance to being Dominican. For the other ethnic groups, the intersection of their personal and social identities consisted of a process of resistance and accommodation to negative stereotypes projected on them by their peers and, for African Americans, themselves.     

Should Hispanic persons from different countries of origin be combined into one sample for analysis?

Hispanic respondents to 21 nationwide surveys were grouped on the basis of country of origin into Mexican Americans (n = 402), Puerto Ricans (n = 119), and Other Latin Americans (n = 105). Analysis showed no significant over-all differences among subgroups. No significant subgroup differences in work attitudes were found for women and only one for men. Analysis of subgroup attitudes across age, education, occupation, family income, and personal income also gave no significant differences. These results provide tentative evidence that Hispanic respondents from different countries of origin may be aggregated into a single sample for analysis. There may be no more reason to analyze their responses separately by country of origin than there is to do so for persons of European or African origin.     

Mother-Teacher Agreement on Preschoolers’ Symptoms of ODD and CD: Does Context matter?

The aims of this study were to examine mother-teacher agreement on oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms and diagnoses in preschool children; to determine if context is a source of disagreement; and to explore if sex, referral status, and age moderated agreement rates. Participants included 158 male and 139 female 3- to 5-year old preschool children, their mothers, and teachers. A structured interview, the Kiddie-Disruptive Behavior Disorder Schedule was used for maternal report and teachers completed the Early Childhood Inventory. Results indicated that mothers reported more symptoms and diagnoses of ODD and CD than teachers, and mother-teacher agreement on both ODD and CD symptoms and diagnoses was low. Level of mother-teacher agreement increased when reporting on behavior in the same context; however, the rates remain modest. Referral status increased the likelihood of mother and teacher agreement on several ODD and CD symptoms, as well as ODD and CD diagnosis. These data suggest that context plays a role in mother-teacher agreement in the assessment of young children's ODD and CD symptoms.     

Do Executive Function Deficits Differentiate Between Adolescents with ADHD and Oppositional Defiant/Conduct Disorder? A Neuropsychological Study Using the Six Elements Test and Hayling Sentence Completion Test

Two neuropsychological measures of executive functions—Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)—were administered to 110 adolescents, aged 12–15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35), ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.     

Conduct Disordered Youth in Group Care: An Examination of Negative Peer Influence

We examined the potential impact of negative peer influence within a treatment-focused residential care setting. Subjects were 712 youth consecutively admitted to a large residential treatment program (9–19 years of age). Based on Diagnostic Interview Schedule for Children (DISC) scores, 247 (35%) of these youth qualified for a Conduct Disorder diagnosis at admission. The dependent measures were the number of DISC Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) symptoms and the sum of Conduct Problem behaviors observed daily for each youth. Both the Conduct Problem Behaviors and the ODD/CD symptoms for both CD and non-CD groups decreased over time. Youth with a CD diagnosis or who were female improved at a faster rate than their peers. The data analyzed in this study do not support a negative peer influence effect for antisocial youth placed in a treatment-focused residential care setting.     

Severity of homelessness and adverse birth outcomes.

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.     

Maternal Antisocial Behavior, Parenting Practices, and Behavior Problems in Boys at Risk for Antisocial Behavior

We investigated the independent contributions of maternal history of antisocial behavior and parenting practices to the worsening course of sons' behavior problems in a sample of young urban boys at risk for antisocial behavior. Mothers reported on boys' behavior problems at baseline and one year later, as well as on their own history of antisocial behavior before and after age 15, and of lifetime depression and substance use disorders (provisional DSM-III-R diagnoses). Baseline reports of parenting practices were obtained. Lower involvement, lower monitoring, and higher levels of parent–child conflict and maternal Conduct Disorder (CD) before age 15 contributed to the worsening of boys' behavior problems one year later; mothers' symptoms of Antisocial Personality Disorder after age 15 did not. Mothers' lifetime history of Major Depression and Substance Use Disorder did not add to the worsening of boys' behavior problems after accounting for these other factors. Although maternal CD contributed directly to the worsening of boys' behavior problems, the effect of parenting was more substantial. We discuss clinical implications for prevention and treatment of children's antisocial behavior, and intergenerational implications of girls' early antisocial behavior.     

Ethnic minority adolescents and the use of community mental health care services

Examined the utilization rates, treatment dropout rates, and length of treatment for minority adolescents in the mental health care system. Data from the Los Angeles County Department of Mental Health from 1983 to 1988 were used. Ss were 853 African Americans, 704 Asian Americans, 964 Hispanics, and 670 whites. Analyses showed that Asian Americans and Hispanics are underrepresented in existing public mental health facilities while African Americans are overrepresented. For dropout rates, no ethnic differences are found between minority groups and whites; but, for length of treatment, Asian Americans tend to stay longer in treatment while African Americans tend to stay in treatment for a shorter period of time than whites. African Americans also have more outpatient episodes than whites. Implications of the results are discussed, and recommendations for future research are suggested.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

Counseling puerto ri cans: some cultural considerations

Puerto Ricans comprise a significant percentage of potential clients for many counselors. The migration of Puerto Ricans to the mainland over the years has created cultural differences between Puerto Ricans raised in Puerto Rico and those raised in the U.S., but both groups are at a disadvantage in the dominant American culture. Migration back to the island in recent years is creating some problems for Puerto Rico, so Puerto Ricans often find prejudice both here and there. In this article the author, who married into a Puerto Rican family, discusses some values and traits that characterize Puerto Ricans and the behaviors that emerge from these traits. He offers practical suggestions for those counselors who have Puerto Rican clients.     

Intersections Between Nativity, Ethnic Density, and Neighborhood SES: Using an Ethnic Enclave Framework to Explore Variation in Puerto Ricans’ Physical Health

Although past research has demonstrated a “health disadvantage” for Puerto Rican adults, very little is known about correlates of health among this group. Given Puerto Ricans’ unique experiences of migration and settlement, an ethnic enclave framework that integrates nativity, ethnic density, and neighborhood SES may offer insight into factors influencing Puerto Ricans’ health. This study uses a sample of 449 adult mainland- and island-born Puerto Ricans living in New York City and Chicago. The data, collected as a part of the MIDUS Survey of Minority Groups, are stratified by neighborhood ethnic density and neighborhood SES, allowing for the examination of the individual and joint influences of neighborhood characteristics on physical health. Results revealed that ethnic density and neighborhood SES were not independently or interactively related to physical health for mainland-born Puerto Ricans. However, the interaction between ethnic density and neighborhood SES was related to self-reported health, functional limitations, and health symptoms for island-born Puerto Ricans. Island-born Puerto Ricans living in ethnically dense, low SES neighborhoods reported worse health than island-born Puerto Ricans living in other types of neighborhoods. This may be a result of isolation from resources both within and outside the neighborhood.     

Agreement Between Parent and Teacher Ratings of Disruptive Behavior Disorders in Children with Clinically Diagnosed ADHD

This study investigated the agreement between parent and teacher ratings of DSM-IV symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and related disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A sample of 55 children in the age range of 6–12 years with clinically diagnosed ADHD participated in the study. Parents and teachers were asked to complete the Disruptive Behavior Disorder Rating Scale (DBDRS; W. E., Pelham, E. M., Gnagy, K. E., Greenslade, & R. Milich, 1992). No association was found between parent and teacher ratings of inattention and hyperactivity/impulsivity. However, moderate to high levels of agreement were obtained for ratings of symptoms that characterized ODD and CD. The observed low levels of agreement between parent and teacher ratings of ADHD symptoms may be attributed to different perceptions of the problem behavior by parents and teachers, medication effects, or the situation specificity of children's behavior. It is recommended that the diagnostic criterion of symptom pervasiveness for the diagnosis of ADHD be operationalized more clearly.     

Trajectories of Symptom Reduction and Engagement During Treatment for Childhood Behavior Disorders: Differences Across Settings

In this study, we examined trajectories of symptom reduction and family engagement during the modular treatment phase of a clinical trial for early-onset disruptive behavior disorders that was applied either in community settings or a clinic. Participants (N = 139) were 6–11 year-old children with diagnoses of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). Symptoms of ODD/CD and level of engagement were assessed at every session during the course of treatment. Overall, symptom reduction was characterized by a gradual decline in symptoms over the first 11 sessions followed by a flatter slope beginning with session 12. Clinic participants evidenced a greater decline in symptoms after session 11 compared to participants in community settings. Overall, engagement remained stable during the course of treatment. However, clinic participants had higher levels of engagement throughout treatment compared to participants in the community settings. These setting differences in level of engagement did not account for the differences in trajectories of symptom reduction across the treatment settings.     

Clinically Referred ODD Children with or without CD and Healthy Controls: Comparisons Across Contextual Domains

This study compares 6–11-year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder, either with (ODD + CD, n = 40) or without Conduct Disorder (ODD only; n = 136), to a matched sample of healthy control children (HC; n = 69). Multiple informants completed intake diagnostic interviews and self-reports to evaluate constructs examining the child’s functioning and contextual influences on functioning (e.g., parent, family, peer, community). ODD + CD and ODD only children were each distinguished from HCs by greater exposure to delinquent peers and lowered parental self-efficacy. In further comparisons to the HC group, ODD only status was associated with parental use of psychological aggression and more stressful life events, whereas ODD + CD status was associated with greater parental hostility. Relative to ODD alone status, ODD + CD status was comparable on all but one variable (greater parental hostility). Similar findings were reported using a subset of girls only. The characteristics that distinguish children with DBDs from controls and, in particular, ODD + CD from ODD only, bear implications for understanding and treating both CD and ODD.

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Smoking involvement during adolescence among African Americans and Puerto Ricans: risks to psychological and physical well-being in young adulthood

The major aim of this study was to examine the longitudinal association between adolescent smoking involvement and self-reported psychological and physical outcomes in young adulthood. Participants included 333 African Americans and 329 Puerto Ricans who were surveyed in 1990 in their New York City schools and interviewed in 1995 and 2000-2001, primarily in their homes. The psychological outcomes included ego integration, symptoms of depression, anxiety, and interpersonal difficulty. The physical health measures included a general health rating, number of illnesses, and symptoms of ill health. Also, three scales measured problems due to alcohol, marijuana, and other illicit drug use. Smoking involvement varied by age, sex, and ethnicity but not by socioeconomic status nor by late adolescent parental status. Analysis showed that the relationships between adolescent smoking involvement and psychological and physical health problems in young adulthood remained significant even with control on demographic factors, earlier levels of the outcome variables, and marijuana use. The relationships between smoking behavior and problems with alcohol, marijuana and other illicit drug use were particularly strong. Thus, adolescent smoking seems to have a wide range of clinical implications for young adulthood.     

School psychology: a public health framework: III. Managing disruptive behavior in schools: the value of a public health and evidence-based perspective

Schools typically adopt individualistic approaches to address disruptive behavior and meet the needs of students with disruptive behavior disorders (DBD) [i.e., Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD)]. These approaches are often not the most effective and have a limited impact on overall school climate. This article emphasizes the value of an evidence-based and public health perspective in managing disruptive behavior. Information about comprehensive school-based programs and classroom management techniques for disruptive behavior disorders is presented and the important role school psychologists can play in implementing these programs discussed.     

Negative Halo Effects in Parent Ratings of ADHD,ODD, and CD

Attention-deficit/hyperactivity disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are highly comorbid, with symptoms that share some similarities. The evidence-based diagnostic process for these disorders includes ratings from adults in the child’s life to assess behavior across settings, so it is important to understand how these raters think about potentially overlapping symptoms. Researchers have identified negative halo effects in ratings of ADHD and ODD symptoms, but ratings of CD have not been examined in these prior studies. Thus, the current study extended past research to examine negative halo effects in parent ratings of the predominantly hyperactive-impulsive presentation of ADHD (i.e., ADHD/HI), ODD, and CD. Parent participants read one of four vignettes that portrayed an 11-year-old boy displaying symptoms of ADHD/HI, ODD, CD, or typical development, and then completed a disruptive behavior scale. The general trend we found was that the presence of a relatively more severe disorder (i.e., CD) artificially inflated ratings of - or showed a negative halo effect for - the relatively less severe disorder (i.e., ADHD/HI), but with some nuance as discussed in the paper. These findings explain and validate how important it is that clinicians conduct evidence-based psychological assessments to decrease the chance of misdiagnosis.