The structure of childhood disruptive behaviors

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) frequently co-occur. Comorbidity of these 2 childhood disruptive behavior domains has not been satisfactorily explained at either a structural or etiological level. The current study evaluated a bifactor model, which allows for a "g" factor in addition to distinct component factors, in relation to other models to improve understanding of the structural relationship between ADHD and ODD. Participants were 548 children (321 boys, 227 girls) between the ages of 6 years and 18 years who participated in a comprehensive diagnostic assessment incorporating parent and teacher ratings of symptoms. Of these 548 children, 153 children were diagnosed with ADHD (without ODD), 114 children were diagnosed with ADHD + ODD, 26 children were diagnosed with ODD (without ADHD), and 239 children were classified as non-ADHD/ODD comparison children (including subthreshold cases). ADHD symptoms were assessed via parent report on a diagnostic interview and via parent and teacher report on the ADHD Rating Scale. ODD symptoms were assessed via teacher report. A bifactor model of disruptive behavior, comprising a "g" factor and the specific factors of ADHD and ODD, exhibited best fit, compared to 1-factor, 2-factor, 3-factor, and 2nd-order factor models of disruptive behaviors. It is concluded that a bifactor model of childhood disruptive behaviors is superior to existing models and may help explain common patterns of comorbidity between ADHD and ODD.     

Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site,cross-national study

This study used data from 6 sites and 3 countries to examine the developmental course of physical aggression in childhood and to analyze its linkage to violent and nonviolent offending outcomes in adolescence. The results indicate that among boys there is continuity in problem behavior from childhood to adolescence and that such continuity is especially acute when early problem behavior takes the form of physical aggression. Chronic physical aggression during the elementary school years specifically increases the risk for continued physical violence as well as other nonviolent forms of delinquency during adolescence. However, this conclusion is reserved primarily for boys, because the results indicate no clear linkage between childhood physical aggression and adolescent offending among female samples despite notable similarities across male and female samples in the developmental course of physical aggression in childhood.     

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.     

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.     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.     

Developmental sequences in the age of onset of disruptive child behaviors

Retrospective and prospective reports of the onset of disruptive child behaviors were analyzed in a sample of clinic-referred boys. The younger boys (ages 7–9 years), compared with the older boys (ages 10–12 years), showed the highest level of disruptive behavior and, judging from mothers' reports, had the fastest progression of onsets from less serious to more serious problem behaviors. Despite some overlap, developmental sequences in problem behavior within the domains of hyperactivity/inattention, oppositional behavior, and conduct problems were similar across the two age groups. This was also the case for developmental sequences of overt or confrontive problem behaviors and covert or concealing conduct problems. Sequences of the onset of oppositional behavior and conduct problems were validated through prospective data, based on the information from mothers, teachers, and boys themselves. The implications of the findings are discussed for the formulation of developmental pathways of behavior and the analysis of causal factors.     

Say-do correspondence to improve disruptive behaviors in adults with Down's syndrome

The most acknowledged strategies for the treatment of disruptive behaviours are those that are based on direct contingency management. Other procedures allow the therapist, or educational agent, not to be present in the context in which the behavioural change has to take place: the say-do correspondence training procedures, which have proven effective across behaviours and populations. Nevertheless, there is surprisingly little evidence of the effectiveness of such procedures with populations presenting developmental disabilities. This study describes the implementation of say-do correspondence training to modify 5 disruptive behaviours present in 5 adult subjects diagnosed with Down's syndrome, showing very positive results. The advantages of using say-do correspondence training procedures in developmental disabilities are discussed.     

Family involvement for children with disruptive behaviors: The role of parenting stress and motivational beliefs

Children with disruptive behaviors are at risk for adverse outcomes. Family involvement is a significant predictor of positive child behavior outcomes; however, little research has investigated parent psychological variables that influence family involvement for children with disruptive behaviors. This study investigated the role of parental motivational beliefs (i.e., role construction and efficacy) as a potential mechanism by which parenting stress impacts family involvement for families of children with disruptive behaviors. Results indicated that parent role construction mediated the relation between parenting stress and all aspects of family involvement examined (i.e., home-based involvement, school-based involvement, and home-school communication). Parent efficacy mediated the relation between parenting stress and home-based involvement only. Parents of children with disruptive behaviors reporting stress may experience negative beliefs about their role and efficacy to support their child's education, which may thereby negatively influence their actual involvement. Therefore, parent motivational beliefs may serve as an important point for intervention to support involvement of families of children with disruptive behavior.     

Presenting problems and assigned diagnoses among young Latino children with disruptive behaviors

It is unclear whether the behaviors that alert families to the need for services are those that classify children for the diagnoses they receive. This study describes the behaviors that Latina mothers from Cuba, Puerto Rico, and the Dominican Republic report to have induced them to seek services for their young children. Both qualitative and quantitative analyses were used. Results indicated that mothers most frequently cited behaviors that fell in the categories of Hyperactivity, Aggression/Temper Tantrums, and School Complaints as reasons for help seeking. Whereas aggression and self-injurious acts were most alarming to mothers, School Complaints appeared to be a strong motivator for help seeking. Children whose mothers cited school behavior as a reason for help seeking had significantly poorer global functioning and presented significantly higher care giving demands than peers. In addition, their mothers reported significantly more disciplinary laxity than the mothers of peers without School Complaints. Maternal narratives of children's behaviors moderately concurred with assigned diagnoses. Mothers overlooked inattentive behaviors in children with ADHD and reported much more aggression and oppositionality than might be expected from the number of diagnoses of ODD that were assigned.     

Pathways to suicidal behaviors in childhood

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N=87; M age=9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children's suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.     

Temporal effects of antecedent exercise on students' disruptive behaviors: An exploratory study

Although a growing body of literature indicates that antecedent exercise is effective at reducing disruptive behaviors, there is a paucity of research examining the temporal effects of antecedent exercise. The present investigation involved 4 students (age range 11 to 14 years) enrolled in a self-contained special education behavior classroom due to severe aggressive, disruptive, and oppositional behaviors. In an alternating treatment design with baseline, students were first exposed to baseline conditions and then to 2 experimental conditions (i.e., an antecedent exercise condition and a control condition) in a randomized fashion. Results indicated that 30 min of moderate to intense aerobic exercise resulted in approximately 90 min of behavioral improvements. In addition, there appeared to be an inverse relation between arousal levels and behavioral difficulties. The potential utility of antecedent exercise as a treatment alternative in schools for students with severe disruptive behavior is discussed.     

The association between persistent disruptive childhood behaviour and the psychopathic personality constellation in adolescence: A twin study

This study tested if persistent externalizing behaviour and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in childhood are associated with personality and behavioural aspects of the psychopathic personality constellation in adolescence. The target sample consisted of all 1,480 twin pairs born in Sweden between 1985 and 1986. Parent‐reported externalizing behaviour and ADHD symptoms were obtained when the participants were 8–9 and 13–14 years old. Personality and behavioural aspects of the psychopathic personality constellation were measured with self‐report questionnaires when the participants were 16–17 years old. Persistent externalizing behaviour in childhood was associated with both psychopathic personality and antisocial behaviour in adolescence. However, within twin‐pair analyses showed that genetic factors explained the association between persistent externalizing behaviour and psychopathic personality, while shared environmental factors explained the association between persistent externalizing and antisocial behaviours. We conclude that persistent externalizing behaviour is a genetically influenced precursor of psychopathic personality among boys.     

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.     

Factors associated with continuity and changes in disruptive behavior patterns between childhood and adolescence

The relationships between disruptive behaviors in middle childhood (7 to 9 years) and conduct disorder in adolescence (14 to 16 years) were studied in a birth cohort of New Zealand children. Latent class analysis suggested strong behavioral continuity, with children showing early disruptive behaviors having odds of adolescent conduct disorder that were over 16 times higher than children who did not display early disruptive behavior. Nonetheless, in the region of 12% of children showed a discontinuous history, with 5% of children showing an early onset of conduct problems and later remission while 7% showed later onset conduct problems. Children showing discontinuous histories of behavior problems came from backgrounds in which levels of risk were intermediate between those of children who showed a persistent pattern of conduct problems and those who were consistently nonproblem children. Peer factors played an influential role in behavioral change in adolescence, with individuals showing late onset of conduct problems having high rates of affiliation with delinquent peers but those showing remission of problem behaviors in adolescence having relatively low rates of such affiliations.This research was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation, and the Canterbury Medical Research Foundation.     

Development of disruptive behaviors in young children: A prospective population‐based cohort study

We know relatively little about the development of disruptive behaviors (DBs), and gender differences therein. The objective of this study was to describe the continuity and discontinuity in the degree to which young children in the general population are reported to exhibit specific DBs over time. Data came from the Québec Longitudinal Study of Child Development. First, the results show that relatively few children exhibit DBs on a frequent basis at 41 months of age. Second, the results show that a majority of children who exhibit a particular DB on a frequent basis at 41 months of age did not do so 1 year earlier. In addition, a majority of children who exhibited a particular DB on a frequent basis at 29 months of age no longer do so 1 year later. Third, gender differences in DBs (boys > girls) are either emerging or at least increasing in magnitude between 29 and 41 months of age. Consistent with the canalization of the behavioral development principle, children who exhibited DBs on a frequent basis at 29 months of age are less likely to stop doing so in the following year if they had exhibited the same behaviors at 17 months of age.     

Sex differences in childhood sexual abuse and suicide-related behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.     

Hyperactive and aggressive behaviors in childhood: Intertwined dimensions

The relationship between aggression and hyperactivity is unclear in childhood hyperkinesis. To examine the relationship between the two dimensions, a sample of 109 first-, second-, and third grade children who were rated as hyperactive were evaluated daily by their teachers for 12 consecutive school days on the Daily Behavior Checklist. Daily recordings were made on a total of 22 specific behaviors, 11 physically or verbally aggressive acts, and 11 acts of a restless or hyperactive nature. The Conners hyperactivity score correlated. 47 with daily aggression and .49 with daily hyperactivity. A subgroup of hyperactive children who exhibited both hyperactive and aggressive behaviors at rates greater than 98% of their classmates was selected. These children were rated significantly higher on the Conners scale than an alternate subgroup of hyperactive children who showed high rates of hyperactive but not aggressive behaviors. In view of heavy reliance on teacher ratings with the Conners scale in studies of hyperactivity, careful consideration of the potential confounding of hyperactivity and aggression is recommended. Implications for classification, longitudinal investigation, and evaluation of treatment of hyperactive children were discussed.