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Parenting practices and attention-deficit/hyperactivity disorder: new findings suggest partial specificity of effects. J Am Acad Child Adolesc Psychiatry 2009; 48:146-54. [PMID: 19065110 PMCID: PMC2827638 DOI: 10.1097/chi.0b013e31819176d0] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine the relations of attention-deficit/hyperactivity disorder (ADHD) diagnosis and symptom domains with parenting practices. METHOD One hundred eighty-one children (ages 6-12 years) were assessed for ADHD and non-ADHD status via parent semistructured clinical interview (Diagnostic Interview Schedule for Children-IV) and parent and teacher standardized ratings. They included controls (n = 52), ADHD Inattentive type (n = 24), and ADHD Combined type (n = 71) as well as "not otherwise specified" cases (included in regressions only). Parents completed the Alabama Parenting Questionnaire and a structured interview (the Diagnostic Interview Schedule-IV) about their own ADHD symptoms. Symptom counts were created for oppositional defiant disorder (ODD), conduct disorder (CD), inattention, and hyperactivity-impulsivity to complement categorical analyses. RESULTS In categorical analysis, maternal inconsistent discipline was associated with ADHD Combined type, even with child ODD and CD diagnosis and parent ADHD symptoms statistically controlled. Paternal low involvement was associated with ADHD regardless of subtype, even with ODD and CD covaried; however, the effect was marginal when paternal ADHD was covaried. In dimensional analysis of symptom counts, maternal inconsistent discipline was related to all behavior domains but none uniquely. Paternal low involvement and inconsistent discipline were related uniquely with child inattention and not other behavioral domains. CONCLUSIONS Specific aspects of parenting are related to ADHD apart from ODD or CD and are not fully attributable to parental ADHD.
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152
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Loeber R, Burke J, Pardini DA. Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. J Child Psychol Psychiatry 2009; 50:133-42. [PMID: 19220596 DOI: 10.1111/j.1469-7610.2008.02011.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper presents a few perspectives on oppositional defiant disorder (ODD), conduct disorder (CD), and early forms of psychopathy. The developmental changes and stability of each, and the interrelationship between the three conditions are reviewed, and correlates and predictors are highlighted. The paper also examines effective interventions for each of the three conditions and makes recommendations for future research.
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Affiliation(s)
- Rolf Loeber
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. USA.
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153
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Parsing the familiality of oppositional defiant disorder from that of conduct disorder: a familial risk analysis. J Psychiatr Res 2009; 43:345-52. [PMID: 18455189 PMCID: PMC2664684 DOI: 10.1016/j.jpsychires.2008.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 03/14/2008] [Accepted: 03/25/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Family risk analysis can provide an improved understanding of the association between attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), attending to the comorbidity with conduct disorder (CD). METHODS We compared rates of psychiatric disorders in relatives of 78 control probands without ODD and CD (Control, N=265), relatives of 10 control probands with ODD and without CD (ODD, N=37), relatives of 19 ADHD probands without ODD and CD (ADHD, N=71), relatives of 38 ADHD probands with ODD and without CD (ADHD+ODD, N=130), and relatives of 50 ADHD probands with ODD and CD (ADHD+ODD+CD, N=170). RESULTS Rates of ADHD were significantly higher in all three ADHD groups compared to the Control group, while rates of ODD were significantly higher in all three ODD groups compared to the Control group. Evidence for co-segregation was found in the ADHD+ODD group. Rates of mood disorders, anxiety disorders, and addictions in the relatives were significantly elevated only in the ADHD+ODD+CD group. CONCLUSIONS ADHD and ODD are familial disorders, and ADHD plus ODD outside the context of CD may mark a familial subtype of ADHD. ODD and CD confer different familial risks, providing further support for the hypothesis that ODD and CD are separate disorders.
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154
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Abstract
This study examined whether personality differences might account for meaningful heterogeneity within and across DSM-IV diagnostic categories for disruptive adolescent boys. In a broader study of personality pathology in adolescence, a national sample of 293 clinicians completed the Shedler-Westen Assessment Procedure 200-A on randomly selected outpatients aged 14 to 18 in their care. Of 138 boys in the sample, 71 had a diagnosis of Disruptive Behavior Disorders or a history of arrests. Q-factor analysis identified 3 personality subtypes within this subsample: psychopathic (n = 28), social outcast (n = 22), and impulsive delinquent (n = 17). The subtypes differed on external criterion variables indicative of a valid taxonomic distinction, notably personality ratings, clinician-report child behavior checklist subscale scores, and etiologic variables. Personality subtypes converged with subtypes of delinquent boys identified by longitudinal research, and they showed substantial incremental validity in predicting adaptive functioning beyond Disruptive Behavior Disorders diagnoses. Results suggest that dimensional personality assessment in disruptive/delinquent adolescent boys provides information beyond existing diagnoses that may prove useful in prevention, clinical conceptualization, and treatment.
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155
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Hirshfeld-Becker DR, Petty C, Micco JA, Henin A, Park J, Beilin A, Rosenbaum JF, Biederman J. Disruptive behavior disorders in offspring of parents with major depression: associations with parental behavior disorders. J Affect Disord 2008; 111:176-84. [PMID: 18378320 PMCID: PMC2602871 DOI: 10.1016/j.jad.2008.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 02/11/2008] [Accepted: 02/13/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although the offspring of parents with major depressive disorder (MDD) are at increased risk to develop disruptive behavior disorders (DBD) in addition to MDD, it remains unclear whether this heightened risk is due to MDD or to comorbid DBD in the parents. METHOD In a secondary analysis of longitudinal data from offspring at risk for MDD and panic disorder and comparison children, we stratified 169 children of parents who had been treated for MDD based upon presence (n=50) or absence (n=119) of parental history of DBD (ADHD, oppositional disorder, and conduct disorder) and contrasted them with children of parents with DBD but without MDD (n=19) and children whose parents had neither MDD nor DBD (n=106). The children had been assessed in middle childhood using structured diagnostic interviews. RESULTS Offspring of parents with MDD + DBD had significantly higher rates of MDD, DBD in general, and ADHD in particular, compared with offspring of parents with MDD alone. Offspring of parents with MDD + DBD also had higher rates of mania than controls. Both parental MDD and DBD conferred independent risk for MDD and DBD in the offspring. However, only parental DBD conferred independent risk for conduct disorder and ADHD and only parental MDD conferred independent risk for oppositional defiant disorder. CONCLUSION Elevated rates of DBD in the offspring of parents with MDD appear to be due in part to the presence of DBD in the parents. Further studies of samples not selected on the basis of parental panic disorder are needed to confirm these results.
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Affiliation(s)
- Dina R Hirshfeld-Becker
- Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, United States.
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156
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The longitudinal course of comorbid oppositional defiant disorder in girls with attention-deficit/hyperactivity disorder: findings from a controlled 5-year prospective longitudinal follow-up study. J Dev Behav Pediatr 2008; 29:501-7. [PMID: 19077845 PMCID: PMC2849719 DOI: 10.1097/dbp.0b013e318190b290] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A better understanding of the long-term scope and impact of the comorbidity with oppositional defiant disorder (ODD) in girls with attention-deficit/hyperactivity disorder (ADHD) has important clinical and public health implications. However, most of the available information on the subject derives from predominantly male samples. This study evaluated the longitudinal course and impact of comorbid ODD in a large sample of girls with ADHD. METHODS Subjects were pediatrically and psychiatrically referred girls with and without ADHD assessed blindly at baseline (mean age = 11.6 years), and 5 years later (mean age = 16.6 years) by mid to late adolescence. The subjects' diagnostic status of ADHD with and without comorbid ODD at baseline was used to define three groups (controls [N = 107], ADHD [N = 77], ADHD + ODD [N = 37]). Outcomes were examined using logistic regression (for binary outcomes) and linear regression (for continuous outcomes). RESULTS Compared with girls who had ADHD only, those with ADHD + ODD at baseline had a significantly increased risk for ODD and major depression at follow-up. Both groups of girls with ADHD had an increased risk for conduct disorder and bipolar disorder at follow-up. CONCLUSIONS These longitudinal findings in girls with ADHD support and extend previously reported findings in boys indicating that ODD heralds a compromised outcome for girls with ADHD in adolescence.
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157
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Connor DF, Doerfler LA. ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or nondistinct disruptive behavior disorders? J Atten Disord 2008; 12:126-34. [PMID: 17934178 DOI: 10.1177/1087054707308486] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In children with ADHD who have comorbid disruptive behavior diagnoses distinctions between oppositional defiant disorder (ODD) and conduct disorder (CD) remain unclear. The authors investigate differences between ODD and CD in a large clinical sample of children with ADHD. METHOD Consecutively referred and systematically assessed male children and adolescents with either ADHD (n = 65), ADHD with ODD (n = 85), or ADHD with CD (n = 50) were compared using structured diagnostic interviews and parent, teacher, and clinician rating scales. RESULTS In children with ADHD, significant differences emerged between ODD and CD in the domains of delinquency, overt aggression, and ADHD symptom severity; ADHD with CD was most severe, followed by ADHD with ODD, and ADHD had the least severe symptoms. Distinctions between ADHD with CD and the other two groups were found for parenting, treatment history, and school variables. CONCLUSION Within the limits of a cross-sectional methodology, results support clinically meaningful distinctions between ODD and CD in children with ADHD.
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Affiliation(s)
- Daniel F Connor
- University of Connecticut Medical School, Farmington, CT 06030-1410, USA.
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158
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The effects of childhood disruptive disorder comorbidity on P3 event-related brain potentials in preadolescents with ADHD. Biol Psychol 2008; 79:329-36. [PMID: 18762228 DOI: 10.1016/j.biopsycho.2008.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 06/26/2008] [Accepted: 08/04/2008] [Indexed: 11/21/2022]
Abstract
The present study examined the degree to which the P300 component of the visual brain event-related potential and associated task performance deficits often observed in children with attention-deficit hyperactivity disorder (ADHD) are attributable to comorbid childhood disruptive disorders using a community sample of 11-year olds from the Minnesota Twin Family Study. Subjects were divided into "ADHD-pure" (ADHD without oppositional defiant disorder, ODD, or conduct disorder, CD), "ADHD-comorbid" (ADHD with ODD or CD), and comparison (no childhood disruptive disorder) groups using DSM-III-R diagnoses. Results showed that ADHD-comorbid but not ADHD-pure subjects displayed significant P3 amplitude reduction and poorer task performance compared to controls. No group effects for P3 latency or reaction time were seen. Although ADHD-comorbid children had marginally more ADHD symptoms compared to ADHD-pure children, this did not account for their reduced P3, suggesting that the observed neurobehavioral deficits reflected the effects of co-occurring childhood disruptive disorders.
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159
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Biederman J, Ball SW, Monuteaux MC, Kaiser R, Faraone SV. CBCL clinical scales discriminate ADHD youth with structured-interview derived diagnosis of oppositional defiant disorder (ODD). J Atten Disord 2008; 12:76-82. [PMID: 17494835 DOI: 10.1177/1087054707299404] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the association between the clinical scales of the child behavior checklist (CBCL) and the comorbid diagnosis of oppositional defiant disorder (ODD) in a large sample of youth with attention deficit hyperactivity disorder (ADHD). METHOD The sample consisted of 101 girls and 106 boys ages 6 to17 with ADHD. Conditional probability analysis was used to examine the correspondence between CBCL Clinical Scales with the structured-interview derived diagnosis of ODD. RESULTS Conditional probability analysis showed that the CBCL Aggression Scale best predicted a structured-interview derived diagnosis of ODD in boys and girls with ADHD. CONCLUSION These findings suggest that the CBCL Aggression Scale could serve as a rapid and cost-effective screening instrument to help identify cases likely to meet clinical criteria for ODD in the context of ADHD
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA 02114, USA.
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160
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Biederman J, Petty CR, Dolan C, Hughes S, Mick E, Monuteaux MC, Faraone SV. The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychol Med 2008; 38:1027-1036. [PMID: 18205967 DOI: 10.1017/s0033291707002668] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications. METHOD Subjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan-Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age. RESULTS ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder. CONCLUSIONS These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.
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Affiliation(s)
- J Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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161
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Christiansen H, Chen W, Oades RD, Asherson P, Taylor EA, Lasky-Su J, Zhou K, Banaschewski T, Buschgens C, Franke B, Gabriels I, Manor I, Marco R, Müller UC, Mulligan A, Psychogiou L, Rommelse NNJ, Uebel H, Buitelaar J, Ebstein RP, Eisenberg J, Gill M, Miranda A, Mulas F, Roeyers H, Rothenberger A, Sergeant JA, Sonuga-Barke EJS, Steinhausen HC, Thompson M, Faraone SV. Co-transmission of conduct problems with attention-deficit/hyperactivity disorder: familial evidence for a distinct disorder. J Neural Transm (Vienna) 2008; 115:163-75. [PMID: 18200434 DOI: 10.1007/s00702-007-0837-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
Abstract
Common disorders of childhood and adolescence are attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). For one to two cases in three diagnosed with ADHD the disorders may be comorbid. However, whether comorbid conduct problems (CP) represents a separate disorder or a severe form of ADHD remains controversial. We investigated familial recurrence patterns of the pure or comorbid condition in families with at least two children and one definite case of DSM-IV ADHDct (combined-type) as part of the International Multicentre ADHD Genetics Study (IMAGE). Using case diagnoses (PACS, parental account) and symptom ratings (Parent/Teacher Strengths and Difficulties [SDQ], and Conners Questionnaires [CPTRS]) we studied 1009 cases (241 with ADHDonly and 768 with ADHD + CP), and their 1591 siblings. CP was defined as > or =4 on the SDQ conduct-subscale, and T > or = 65, on Conners' oppositional-score. Multinomial logistic regression was used to ascertain recurrence risks of the pure and comorbid conditions in the siblings as predicted by the status of the cases. There was a higher relative risk to develop ADHD + CP for siblings of cases with ADHD + CP (RRR = 4.9; 95%CI: 2.59-9.41); p < 0.001) than with ADHDonly. Rates of ADHDonly in siblings of cases with ADHD + CP were lower but significant (RRR = 2.9; 95%CI: 1.6-5.3, p < 0.001). Children with ADHD + CP scored higher on the Conners ADHDct symptom-scales than those with ADHDonly. Our finding that ADHD + CP can represent a familial distinct subtype possibly with a distinct genetic etiology is consistent with a high risk for cosegregation. Further, ADHD + CP can be a more severe disorder than ADHDonly with symptoms stable from childhood through adolescence. The findings provide partial support for the ICD-10 distinction between hyperkinetic disorder (F90.0) and hyperkinetic conduct disorder (F90.1).
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Affiliation(s)
- H Christiansen
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
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162
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Mayes SD, Calhoun SL. Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder. Child Neuropsychol 2008; 13:469-93. [PMID: 17852125 DOI: 10.1080/09297040601112773] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Learning, attention, graphomotor, and processing speed scores were analyzed in 149 typical control children and 886 clinical children with normal intelligence. Nonsignificant differences were found between control children and children with anxiety, depression, and oppositional-defiant disorder. Control children performed better than children with ADHD and autism in all areas. Children with ADHD and autism did not differ, except that children with ADHD had greater learning problems. Attention, graphomotor, and speed weaknesses were likely to coexist, the majority of children with autism and ADHD had weaknesses in all three areas, and these scores contributed significantly to the prediction of academic achievement.
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Affiliation(s)
- Susan Dickerson Mayes
- Department of Psychiatry, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA.
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163
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Hammerness P, Harpold T, Petty C, Menard C, Zar-Kessler C, Biederman J. Characterizing non-OCD anxiety disorders in psychiatrically referred children and adolescents. J Affect Disord 2008; 105:213-9. [PMID: 17572506 DOI: 10.1016/j.jad.2007.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 04/26/2007] [Accepted: 05/15/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND To characterize childhood and adolescent anxiety disorders in a psychiatric clinic. METHODS Subjects were 1375 youth referred to a pediatric psychopharmacology program at a major academic center from 1991-2002. DSM-III-R diagnoses were obtained by Schedule for Affective Disorders and Schizophrenia for School-Age Children. RESULTS Of 1375 referred youth, 794 had at least one non-obsessive-compulsive anxiety disorder, and 581 psychiatric comparison subjects had at least one disruptive behavior disorder and no anxiety disorders. There were 367 (46%) youth with one anxiety disorder, 224 (28%) with two disorders. Most prevalent were separation anxiety (49%), and overanxious disorder (47%). Mean ages of onset ranged from simple phobia (4.1) to panic disorder (8.5). Risk analyses revealed anxiety disorders significantly increased risk for anxiety and mood disorders. CONCLUSIONS The full complement of anxiety disorders occurs in youth.
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Affiliation(s)
- Paul Hammerness
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Boston, MA 02138, United States.
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164
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Lapalme M, Déry M. [Characteristics associated with conduct disorder, oppositional defiant disorder and comorbidity]. SANTE MENTALE AU QUEBEC 2008; 33:185-206. [PMID: 19370263 DOI: 10.7202/019674ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of the study is to determine whether pattern of association with psychological, social and family correlates are similar for oppositional defiant disorder (ODD), conduct disorder (CD), and ODD + CD. Participants were 336 boys and girls (age range from 6 to 13 years) in treatment for disruptive behaviour disorders including 123 children with ODD, 39 with CD "only", and 174 with ODD + CD. Results showed that parent's antisocial personality and poor supervision characterized children with CD whereas children with ODD presented with more attention deficit/hyperactivity symptoms and inconsistent discipline. All these correlates characterized children with ODD + CD. These results suggest the importance of taking into account these differences between groups in children treatment.
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Affiliation(s)
- Mélanie Lapalme
- Centre de recherche de l'Institut Philippe-Pinel de Montréal
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165
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Abstract
Primary care physicians are often the first health care providers to have contact with depressed children and adolescents. This article discusses the epidemiology, clinical features, comorbid conditions, risk and protective factors, treatment modalities, and clinical course of early-onset depression.
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Affiliation(s)
- Joseph L Calles
- College of Human Medicine, Michigan State University, Department of Psychiatry, A236 East Fee Hall, East Lansing, MI 48824, USA.
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166
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Emond A, Ormel J, Veenstra R, Oldehinkel AJ. Preschool behavioral and social-cognitive problems as predictors of (Pre)adolescent disruptive behavior. Child Psychiatry Hum Dev 2007; 38:221-36. [PMID: 17476586 PMCID: PMC2778718 DOI: 10.1007/s10578-007-0058-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 04/06/2007] [Indexed: 11/27/2022]
Abstract
This article describes preschool social understanding and difficult behaviors (hot temper, disobedience, bossiness and bullying) as predictors of oppositional defiant disorder (ODD) and aggressive conduct disorder (ACD) in a Dutch population sample of (pre)adolescents (N = 1943), measured at age 10-12 and at age 13-15. ODD and ACD were assessed by the Child Behavior Checklist and the Youth Self-Report, preschool behavior was evaluated by the parental questionnaire [Symbol: see text]How was your child as a preschooler? (age 4-5)'. Adjusted for each other, all difficult preschool behaviors except bullying were associated with adolescent ODD, while only bullying significantly predicted adolescent ACD. Furthermore, the results suggest a qualitative difference between ODD and ACD in terms of the social component of the disorders: poor preschool social understanding was associated with the development of ACD but not of ODD; and poor social understanding interacted with difficult preschool behaviors to predict later ACD but not ODD. The associations did not differ between boys and girls, and were roughly similar for preadolescent (age 10-12) and early adolescent (age 13-15) outcomes. The finding that poor social understanding was implicated in the development of ACD but not in the development of ODD may help to demarcate the individuality of each disorder and offer leads for (differential) treatment strategies.
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Affiliation(s)
- Alice Emond
- Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences,
University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen, 9700 RB The Netherlands
| | - Johan Ormel
- Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences,
University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen, 9700 RB The Netherlands
| | - René Veenstra
- Department of Sociology, University of Groningen, and Interuniversity Center for Social Science Theory and Methodology, Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences,
University Medical Center Groningen, University of Groningen, P.O. Box 30001, Groningen, 9700 RB The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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167
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Costin J, Chambers SM. Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clin Child Psychol Psychiatry 2007; 12:511-24. [PMID: 18095534 DOI: 10.1177/1359104507080979] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Parent Management Training (PMT) has been shown to be an empirically supported intervention in ameliorating antisocial behaviour problems. Less evidence is available to demonstrate the effectiveness of PMT in routine public-health-oriented community-based settings where the presence of comorbid disorders complicates the picture. The current study was undertaken to investigate the effectiveness of PMT as a treatment for primary school-age children with Oppositional Defiant Disorder (ODD) and comorbid disorders offered by clinical staff as part of clinical practice. An Australian sample of 94 parents of children diagnosed with ODD by structured interview was provided with eight sessions of PMT. Measures used to assess changes in child behaviour symptoms were the Eyberg Child Behavior Inventory, the Parent Stress Index Child Domain, and the Child Behavior Checklist. Clinically relevant and statistically significant outcome results were found at posttreatment and at 5 months follow-up. There was a reduction in child symptomatology but no evidence of any effect of comorbidity on outcome. These findings are important for the clinical field as they show that PMT is a robust intervention suitable for routine clinical practice even when comorbid disorders are present in addition to ODD.
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Affiliation(s)
- Jan Costin
- Eastern Health Child and Adolescent Mental Health Service, Victoria, Australia.
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168
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Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr 2007; 28:302-7. [PMID: 17700082 DOI: 10.1097/dbp.0b013e3180327917] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the association between attention-deficit/hyperactivity disorder (ADHD) and eating disorders in a large adolescent population of girls with and without ADHD. METHOD We estimated the incidence of lifetime eating disorders (either anorexia or bulimia nervosa) using Cox proportional hazard survival models. Comparisons between ADHD girls with and without eating disorders were then made on measures of comorbidity, course of ADHD, and growth and puberty. RESULTS ADHD girls were 3.6 times more likely to meet criteria for an eating disorder throughout the follow-up period compared to control females. Girls with eating disorders had significantly higher rates of major depression, anxiety disorders, and disruptive behavior disorder compared to ADHD girls without eating disorders. Girls with ADHD and eating disorders had a significantly earlier mean age at menarche than other ADHD girls. No other differences in correlates of ADHD were detected between ADHD girls with and without eating disorders. CONCLUSIONS ADHD significantly increases the risk of eating disorders. The presence of an eating disorder in girls with ADHD heightens the risk of additional morbidity and dysfunction.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry 2007; 48:703-13. [PMID: 17593151 DOI: 10.1111/j.1469-7610.2007.01733.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oppositional defiant disorder (ODD) is a leading cause of referral for youth mental health services; yet, many uncertainties exist about ODD given it is rarely examined as a distinct psychiatric disorder. We examined the lifetime prevalence, onset, persistence, and correlates of ODD. METHODS Lifetime prevalence of ODD and 18 other DSM-IV disorders was assessed in a nationally representative sample of adult respondents (n = 3,199) in the National Comorbidity Survey Replication. Retrospective age-of-onset reports were used to test temporal priorities with comorbid disorders. RESULTS Lifetime prevalence of ODD is estimated to be 10.2% (males = 11.2%; females = 9.2%). Of those with lifetime ODD, 92.4% meet criteria for at least one other lifetime DSM-IV disorder, including: mood (45.8%), anxiety (62.3%), impulse-control (68.2%), and substance use (47.2%) disorders. ODD is temporally primary in the vast majority of cases for most comorbid disorders. Both active and remitted ODD significantly predict subsequent onset of secondary disorders even after controlling for comorbid conduct disorder (CD). Early onset (before age 8) and comorbidity predict slow speed of recovery of ODD. CONCLUSIONS ODD is a common child- and adolescent-onset disorder associated with substantial risk of secondary mood, anxiety, impulse-control, and substance use disorders. These results support the study of ODD as a distinct disorder. Prospective and experimental studies are needed to further delineate the temporal and causal relations between ODD and related disorders.
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Affiliation(s)
- Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA.
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170
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Harpold T, Biederman J, Gignac M, Hammerness P, Surman C, Potter A, Mick E. Is oppositional defiant disorder a meaningful diagnosis in adults? Results from a large sample of adults with ADHD. J Nerv Ment Dis 2007; 195:601-5. [PMID: 17632251 DOI: 10.1097/nmd.0b013e318093f448] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the prevalence and clinical characteristics of oppositional defiant disorder (ODD) in a sample of clinically referred adults with attention deficit hyperactivity disorder (ADHD). Subjects were consecutively referred adults with a DSM-III R/IV diagnosis of ADHD with or without ODD. Nearly half of subjects (43%) had a history of ODD. Subjects with a childhood history of ODD had increased risk for bipolar disorder, multiple anxiety disorders, and substance use disorders relative to the ADHD subjects without ODD. We concluded, as in children with ODD, adults with a childhood history of ODD have high rates of psychiatric comorbidity and more impaired psychosocial functioning than those without this condition. A better understanding of the course, phenomenology, and clinical significance of ODD in adults is needed to better understand therapeutic approaches for this disorder.
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Affiliation(s)
- Theresa Harpold
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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171
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Jensen PS, Buitelaar J, Pandina GJ, Binder C, Haas M. Management of psychiatric disorders in children and adolescents with atypical antipsychotics: a systematic review of published clinical trials. Eur Child Adolesc Psychiatry 2007; 16:104-20. [PMID: 17075688 DOI: 10.1007/s00787-006-0580-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
We aimed to provide a descriptive review of treatment studies of atypical antipsychotics in paediatric psychiatric disorders. A systematic review of the literature used Medline and EMBASE databases to identify clinical trials of atypical antipsychotics in children and adolescents between 1994 and 2006. Trials were limited to double-blind studies and open-label studies of > or = 8 weeks duration that included > or = 20 patients. Nineteen double-blind and 22 open-label studies were identified. Studies included use of clozapine, olanzapine, quetiapine, risperidone, and ziprasidone in the treatment of disruptive behavioural disorders (DBDs), pervasive developmental disorders (PDDs), tic disorder, psychotic disorders, and mania. These medications generally reduced the severity of a variety of psychiatric symptoms in children and adolescents. Less frequent adverse events included extrapyramidal symptoms, hyperglycaemia and diabetes, and endocrine effects. The review of published scientific data suggests that most of the atypical antipsychotics, excluding clozapine, have a favourable risk/benefit profile and effectively reduce disabling behaviours in paediatric psychiatric patients. While there is a body of evidence published of treatment of DBDs and PDDs, there is a lack of controlled data to guide clinical practice for the use of atypical antipsychotics for paediatric psychotic disorders and bipolar disorder. While there have been studies with duration up to 2 years, no definitive data are available that suggest long-term safety; additional studies are warranted.
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Affiliation(s)
- Peter S Jensen
- Center for the Advancement of Children's Mental Health, Columbia University, New York State Psychiatric Institute, New York, NY, USA
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172
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Connor DF. Pharmacological Treatment of ODD Symptoms in ADHD Children: A Brief Review. ACTA ACUST UNITED AC 2007. [DOI: 10.1521/adhd.2007.15.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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173
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Steiner H, Remsing L. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:126-141. [PMID: 17195736 DOI: 10.1097/01.chi.0000246060.62706.af] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oppositional defiant disorder (ODD) is a common clinical problem in children and adolescents. Oppositionality and associated types of aggressive behavior are among the most common referral problems in child psychiatry. Grouped among the disruptive behavior disorders, ODD is frequently comorbid with other psychiatric conditions and often precedes the development of conduct disorder (CD), substance abuse, and severely delinquent behavior. Youth with ODD may also have specific CD behaviors, such as aggression. Although compared with CD there exists a smaller and less sophisticated empirical database for ODD, this parameter draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD. The etiology of ODD is complex and its development is based on a cumulative risk/protective factor model that combines biological, psychological, and social factors. Recommended treatment is multimodal and extensive, involving individual and family psychotherapeutic approaches, medication, and sociotherapy. Methodologically sound controlled clinical trials are lacking.
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174
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Wolff JC, Ollendick TH. The Comorbidity of Conduct Problems and Depression in Childhood and Adolescence. Clin Child Fam Psychol Rev 2006; 9:201-20. [PMID: 17053962 DOI: 10.1007/s10567-006-0011-3] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An extensive body of research documents the high prevalence of comorbidity among child and adolescent disorders in general and between conduct problems and depression in particular. These problems co-occur at significantly higher rates than would be expected by chance and their comorbidity may have significant implications for nosology, treatment, and prognosis. Four main hypotheses have been put forth to account for these high rates of comorbidity. First, comorbidity may be a result of shortcomings associated with referral or informant biases. Second, comorbidity may be an artifact of overlapping definitional criteria. Third, one disorder may cause the other disorder by influencing the developmental trajectory and placing an individual at increased risk for further difficulties. Finally, comorbidity between two disorders may be explained by shared underlying causal or risk factors. The purpose of this review is to explore these possibilities, concentrating primarily on the common risk factors of parent psychopathology, emotion regulation, and cognitive biases that may underlie the co-occurrence of these two disorders. Based on our review, we propose a model for the development of comorbidity between these two disorders.
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Affiliation(s)
- Jennifer C Wolff
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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175
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Sukhodolsky DG, Cardona L, Martin A. Characterizing aggressive and noncompliant behaviors in a children's psychiatric inpatient setting. Child Psychiatry Hum Dev 2006; 36:177-93. [PMID: 16228146 DOI: 10.1007/s10578-005-3494-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8+/-2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were rated weekly using the Modified Overt Aggression Scale (MOAS) and the Disruptive Behavior Rating Scale (DBRS) between November 1, 2002 and June 30, 2003. Moderate to high correlations were observed between the four types of aggression (verbal, and physical against self, others, or objects) and noncompliant behavior. In hierarchical regression analyses, only mental retardation emerged as a significant predictor of aggression and noncompliance. Aggression and noncompliance were associated with different characteristics of inpatient treatment. Aggressive behavior was significantly associated with the use of restraints and seclusion, and noncompliant behavior with length of hospitalization and number of psychiatric medications at time of discharge. Modifying milieu interventions for youths with mental retardation, and adapting behavioral interventions empirically proven to target noncompliance may be effective loci for reducing aggression in child psychiatric inpatient units.
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Affiliation(s)
- Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520-7900, USA.
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176
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Biederman J, Mick E, Faraone SV, Wozniak J, Spencer T, Pandina G. Risperidone for the treatment of affective symptoms in children with disruptive behavior disorder: a post hoc analysis of data from a 6-week, multicenter, randomized, double-blind, parallel-arm study. Clin Ther 2006; 28:794-800. [PMID: 16861101 DOI: 10.1016/s0149-2918(06)00132-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2006] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite the increasing recognition of bipolar disorder in childhood, there have been no controlled, randomized clinical trials of atypical antipsychotics in this population. Preliminary data from open-label trials in children suggest that these agents might be effective in treating pediatric bipolar disorder, however. OBJECTIVE The purpose of this post hoc analysis of data from Aman et al was to determine the effects of risperidone in the management of affective symptoms in children with disruptive behavioral disorders (DBDs). METHODS This report presents a secondary analysis of a previously reported 6-week, multicenter, double-blind, randomized, parallel-arm trial comparing 6 weeks of administration of risperidone (flexible dosing starting at 0.02 mg . kg .1 . d(-1) and titrated up to 0.06 mg kg(-1) d(-1)) versus placebo in children with DBDs and subaverage intelligence. Twenty-four candidate affective symptoms of mania and depression were extracted from the 64-item Nisonger Child Behavior Rating Form (NCBRF). To define independent dimensions of mood-disorder psychopathology, these 24 symptoms were assigned 1 of 3 independent dimensions (symptoms of mania) based on loading: explosive irritability; agitated, expansive, grandiose; and depression. A fourth, nonaffective independent dimension encompassed a combination of nonaffec tive symptoms on the NCBRF Conduct Problem subscale. To assess treatment effect, each independent dimension was assigned a score derived from the sum of the symptoms that loaded on that dimension at weeks 2, 4, and 6 of study drug administration. RESULTS A total of 110 patients were included in the independent-dimension analysis (89 boys, 21 girls; risperidone, 49 patients; placebo, 61 patients; mean [SD] age, 8.6 [2.3] and 8.1 [2.4] years in the risperidone and placebo groups, respectively; mean [SD] weight, 33.9 [12.8] and 32.1 [12.0] kg in the risperidone and placebo groups, respectively). The treatment-effect analysis found that the mean scores of all 3 independent dimensions were significantly reduced with risperidone compared with placebo at weeks 2, 4, and 6 (all, P <or= 0.03). The effect sizes of improvement in these factors ranXged from 0.44 to 0.95 at end point. CONCLUSIONS The results of this post hoc analysis of affective symptoms of DBDs using data from a previously published randomized, double-blind clinical comparison of risperidone and placebo in the treatment of children with DBDs and subaverage intelligence suggest that risperidone was effective in treating the factors of explosive irritability; agitated, expansive, grandiose; and depression.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Program in Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Boston, 02114, USA.
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177
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Esposito-Smythers C, Birmaher B, Valeri S, Chiappetta L, Hunt J, Ryan N, Axelson D, Strober M, Leonard H, Sindelar H, Keller M. Child comorbidity, maternal mood disorder, and perceptions of family functioning among bipolar youth. J Am Acad Child Adolesc Psychiatry 2006; 45:955-964. [PMID: 16865038 DOI: 10.1097/01.chi.0000222785.11359.04] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between youth comorbid psychiatric disorders, maternal mood disorder, and perceptions of family cohesion and conflict among youth diagnosed with pediatric bipolar disorder (PBD). METHOD Three hundred eighty-nine bipolar youths and their parents completed a diagnostic interview and instruments assessing family psychiatric history and functioning. Family functioning was assessed with the Family Adaptability and Cohesion Scales-II and the Conflict Behavior Questionnaire. RESULTS The presence of a maternal mood disorder was associated with lower family cohesion. The presence of a youth externalizing disorder with or without a co-occurring anxiety disorder was also associated with lower family cohesion as well as higher family conflict. Furthermore, the negative relationship between maternal mood disorder and family functioning was stronger in the presence of a youth externalizing disorder. CONCLUSIONS Youth comorbidity and maternal mood disorders appear to be associated with worse family functioning among bipolar youths. Family-based treatments with bipolar youths may need to integrate treatment of youth comorbidity and address maternal mood disorder for optimal results.
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Affiliation(s)
- Christianne Esposito-Smythers
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles..
| | - Boris Birmaher
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Sylvia Valeri
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Laurel Chiappetta
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Jeffrey Hunt
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Neal Ryan
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - David Axelson
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Michael Strober
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Henrietta Leonard
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Holly Sindelar
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Martin Keller
- Drs. Esposito-Smythers, Valeri, Hunt, Leonard, Sindelar, and Keller are with the Department of Psychiatry, Brown Medical School, Providence, RI, and the Center for Alcohol and Addiction Studies, Bradley Hospital, Butler Hospital; Drs. Birmaher, Ryan, and Axelson and Ms. Chiappetta are with the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center; and Dr. Strober is with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
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Spencer TJ, Abikoff HB, Connor DF, Biederman J, Pliszka SR, Boellner S, Read SC, Pratt R. Efficacy and safety of mixed amphetamine salts extended release (adderall XR) in the management of oppositional defiant disorder with or without comorbid attention-deficit/hyperactivity disorder in school-aged children and adolescents: A 4-week, multicenter, randomized, double-blind, parallel-group, placebo-controlled, forced-dose-escalation study. Clin Ther 2006; 28:402-18. [PMID: 16750455 DOI: 10.1016/j.clinthera.2006.03.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oppositional defiant disorder (ODD)is associated with a high degree of impairment in social skills, family interaction, and academic functioning. Comorbid ODD is reportedly present in 40% to 70% of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE The goal of this study was to assess the efficacy and safety of mixed amphetamine salts extended release (MAS XR) for the treatment of ODD in children and adolescents aged 6 to 17 years. METHODS This was a 4-week, multicenter, randomized, double-blind, parallel-group, placebo-controlled, forced-dose-escalation study. Patients were randomized to receive active treatment with MAS XR 10, 20, 30, or 40 mg/d or placebo. The primary efficacy end point was the ODD subscale of the Swanson, Nolan, and Pelham-IV (SNAP-IV) parent rating. Primary safety measures included adverse events recorded at each visit and for 30 days after study drug discontinuation, and changes in vital signs, 12-lead electrocardiographic (ECG) findings, laboratory tests and physical examinations, and body weight. A post hoc efficacy reanalysis was completed based on the results for the per-protocol population. For this analysis, patients were divided into high and low baseline severity categories according to the dichotomized baseline ODD parent or teacher score or dichotomized baseline ADHD parent or teacher score (high defined as scores at the median or greater and low defined as scores less than the median). RESULTS A total of 308 children and adolescents (age range, 6-17 years; 213 males, 95 females) were randomized to receive active treatment with MAS XR 10 mg/d (n = 60) 20 mg/d (n = 58), 30 mg/d (n = 69), or 40 mg/d (n = 61) or placebo (n = 60). Of the 308 study patients, 244 (79.2%) had comorbid ADHD. A significant change from baseline in the ODD symptoms measured with the SNAP-IV parent rating subscale was found for the MAS XR 30-mg/d (-0.52; P < 0.001) and 40-mg/d (-0.56; P = 0.002) groups in the per-protocol analysis and for the MAS XR 30-mg/d group in the intent-to-treat analysis (-0.42; P < 0.005). Throughout the study, MAS XR was well tolerated in these children and adolescents with ODD, and most adverse events were mild to moderate in intensity. The most frequently reported adverse events occurring in MAS XR-treated patients were anorexia/decreased appetite (25.3%), insomnia (19.5%), headache (18.5%), and abdominal pain (10.7%). Statistically, but not clinically, significant decreases in body weight were seen with MAS XR (range, -1.1 to -3.5 lb; P < 0.001 vs placebo). Changes in laboratory values, ECG measurements, and physical and other vital signs were also not clinically significant. The post hoc reanalysis was based on the per-protocol population (n = 229). An assessment of the high baseline symptom severity subgroups showed a good response to MAS XR treatment for the SNAP-IV parent and teacher rating scales (both, P < 0.05). CONCLUSION This study found that higher doses ofMAS XR (30 and 40 mg) were effective and well tolerated in the management of ODD in these school aged children and adolescents in the presence or absence of ADHD.
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Affiliation(s)
- Thomas J Spencer
- Clinical and Research Program, Pediatric Psychopharmacology Research Unit, Massachusetts General Hospital and Harvard Medical School, Yawkey Center for Outpatient Care, Boston, Massachusetts 02114, USA.
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179
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Abstract
BACKGROUND ICD-10 and DSM-IV include similar criterial symptom lists for conduct disorder (CD) and oppositional defiant disorder (ODD), but while DSM-IV treats each list separately, ICD-10 considers them jointly. One consequence is that ICD-10 identifies a group of children with ODD subtype who do not receive a diagnosis under DSM-IV. METHODS We examined the characteristics of this group of children using the Great Smoky Mountains Study of children in the community aged 9-16. This study provided child and parent reports of symptoms and psychosocial impairment assessed with standardised diagnostic interviews. RESULTS Children who received an ICD-10 diagnosis but not a DSM-IV diagnosis showed broadly similar levels of psychiatric comorbidity, delinquent activity and psychosocial impairment to those who met DSM-IV criteria in both cross-sectional and longitudinal analyses. CONCLUSIONS These results indicate that DSM-IV excludes from diagnosis children who receive an ICD-10 diagnosis of CD (ODD sub-type), and who are substantially disturbed. Methods of redressing this situation are considered.
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Affiliation(s)
- Richard Rowe
- MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK.
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180
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Baving L, Rellum T, Laucht M, Schmidt MH. Children with oppositional-defiant disorder display deviant attentional processing independent of ADHD symptoms. J Neural Transm (Vienna) 2005; 113:685-93. [PMID: 16082512 DOI: 10.1007/s00702-005-0345-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 05/21/2005] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine neurophysiological correlates of attentional processing in children with oppositional-defiant disorder (ODD) independent of ADHD symptoms. METHOD Thirteen children with oppositional-defiant disorder without comorbid ADHD symptoms and 13 healthy control children (all 11 years) performed a cued Continuous Performance Test (CPT-AX). Event-related potentials (ERP) to cue and target stimuli were examined for group differences. RESULTS Children with ODD showed significantly reduced parietal P3a and P3b amplitudes to cues and to targets, compared with healthy controls. ERP amplitudes correlated with oppositional and aggressive behavior scores. CONCLUSIONS Event-related potentials revealed reduced orienting to cues and reduced executive target processing in children with ODD. These findings indicate that ODD children show neurophysiological deviances independent of ADHD comorbidity.
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Affiliation(s)
- L Baving
- Department of Child and Adolescent Psychiatry, University of Magdeburg, Germany.
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181
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Biederman J, Petty C, Faraone SV, Hirshfeld-Becker DR, Henin A, Rauf A, Scott M, Pollack M, Rosenbaum JF. Childhood antecedents to panic disorder in referred and nonreferred adults. J Child Adolesc Psychopharmacol 2005; 15:549-61. [PMID: 16190787 DOI: 10.1089/cap.2005.15.549] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We used a recursive partitioning method to examine antecedent childhood anxiety disorders in large samples of referred and nonreferred subjects with and without panic disorder. METHODS Referred subjects included adults treated for panic disorder (n = 131) and comparison adults with neither major anxiety nor mood disorders (n = 61). The nonreferred adult group derived from an opportunistic sample originally ascertained through family studies of probands with and without attention-deficit/hyperactivity disorder (ADHD), yielding 58 adults with panic disorder and 587 who were free of major anxiety and mood disorders. RESULTS The majority of referred (65%) and nonreferred (52%) adults with panic disorder had antecedent childhood anxiety or disruptive behavior disorders. Classification and Regression Trees (CART) analysis showed that both separation anxiety disorder and overanxious disorder were independent predictors of subsequent panic disorder in both referred and nonreferred samples. CONCLUSIONS These results confirm and extend previously reported findings by documenting that childhood anxiety disorders are important antecedent risk factors for panic disorder, independently of referral bias.
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Affiliation(s)
- Joseph Biederman
- Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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182
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Newcorn JH, Spencer TJ, Biederman J, Milton DR, Michelson D. Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:240-8. [PMID: 15725968 DOI: 10.1097/00004583-200503000-00008] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine (1) moderating effects of oppositional defiant disorder (ODD) on attention-deficit/hyperactivity disorder (ADHD) treatment response and (2) responses of ODD symptoms to atomoxetine. METHOD Children and adolescents (ages 8-18) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine (fixed dosing: 0.5, 1.2, or 1.8 mg/kg/day, b.i.d.) under randomized, double-blind conditions. Among patients with lifetime diagnostic information (n = 293), 39% were diagnosed with comorbid ODD and 61% were not. Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version, investigator-administered and -scored; Conners' Parent Rating Scale-Revised Short Form; Clinical Global Impressions Severity of ADHD Scale; and the parent-rated Child Health Questionnaire. RESULTS Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD, ODD, and quality-of-life measures. Treatment response was similar in youths with and without ODD, except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day. In contrast, youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day. CONCLUSIONS Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD, although the comorbid group may require higher doses.
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Affiliation(s)
- Jeffrey H Newcorn
- Department of Psychiatry, Mount Sinai School of Medicine, New York 10029, USA.
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183
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Greene RW, Ablon JS, Goring JC, Raezer-Blakely L, Markey J, Monuteaux MC, Henin A, Edwards G, Rabbitt S. Effectiveness of collaborative problem solving in affectively dysregulated children with oppositional-defiant disorder: initial findings. J Consult Clin Psychol 2005; 72:1157-64. [PMID: 15612861 DOI: 10.1037/0022-006x.72.6.1157] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oppositional-defiant disorder (ODD) refers to a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures. Research has shown that children with ODD and comorbid mood disorders may be at particular risk for long-term adverse outcomes, including conduct disorder. In this study, the authors examined the effectiveness of a cognitive-behavioral model of intervention--called collaborative problem solving (CPS)--in comparison with parent training (PT) in 47 affectively dysregulated children with ODD. Results indicate that CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up. These improvements were in all instances equivalent, and in many instances superior, to the improvements produced by PT. Implications of these findings for further research on and treatment selection in children with ODD are discussed.
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Affiliation(s)
- Ross W Greene
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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184
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Abstract
Poor outcomes in ADHD may be related to problematic social functioning and consequences of social rejection. This study examines how ADHD symptom expression affects mood and social rejection. Working from findings in depression that describe maintenance through negative interpersonal interactions, the authors seek to examine this theory's applicability to poor outcomes in ADHD. In a completely randomized design, 130 participants are exposed to one of several videotape segments that include displays of ADHD, depression, and social anxiety. A normal control is also used. All abnormal videotapes are met with greater rejection than the control. Displays of ADHD elicit similar levels of rejection to those elicited by displays of depression. Additionally, ADHD elicits greater levels of hostile mood, whereas depression elicits high levels of depression and fatigue. Implications for an interpersonal theory of vulnerability in ADHD are discussed along with implications for future research, prevention, and intervention.
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Affiliation(s)
- James F Paulson
- Center for Pediatric Research, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, VA 23510, USA.
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185
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Serra-Pinheiro MA, Schmitz M, Mattos P, Souza I. Transtorno desafiador de oposição: uma revisão de correlatos neurobiológicos e ambientais, comorbidades, tratamento e prognóstico. BRAZILIAN JOURNAL OF PSYCHIATRY 2004; 26:273-6. [PMID: 15729463 DOI: 10.1590/s1516-44462004000400013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transtorno desafiador de oposição (TDO) é uma entidade diagnóstica independente, mas é freqüentemente estudada em conjunto com transtorno de déficit de atenção/hiperatividade (TDAH) ou com transtorno de conduta (TC). O objetivo deste artigo é o de fazer uma revisão das evidências existentes, obtidas por meio da base de dados PubMed, sobre achados neurobiológicos no transtorno desafiador de oposição, funcionamento familiar e escolar, comorbidades, prognóstico e opções terapêuticas para transtorno desafiador de oposição. A evidência de correlatos hormonais, genéticos e neurofuncionais de transtorno desafiador de oposição, a conexão com a família, as relações e desempenho escolares, a associação com transtornos do humor, ansiosos e disruptivos, o risco de evolução para transtorno de conduta e de persistência de sintomas de transtorno desafiador de oposição são descritos. Uma revisão do efeito da Terapia Cognitivo-Comportamental e tratamento farmacológico é apresentada. A análise das evidências disponíveis mostra que o impacto de transtorno desafiador de oposição não deve ser ignorado e que o transtorno desafiador de oposição deve ser devidamente abordado. O impacto do tratamento de transtorno desafiador de oposição no prognóstico de longo prazo dos pacientes ainda precisa ser determinado.
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186
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Pavuluri MN, Graczyk PA, Henry DB, Carbray JA, Heidenreich J, Miklowitz DJ. Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results. J Am Acad Child Adolesc Psychiatry 2004; 43:528-37. [PMID: 15100559 DOI: 10.1097/00004583-200405000-00006] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe child- and family-focused cognitive-behavioral therapy (CFF-CBT), a new developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) that is intended for use along with medication. CFF-CBT integrates principles of family-focused therapy with those of CBT. The theoretical framework is based on (1). the specific problems of children and families coping with bipolar disorder, (2). a biological theory of excessive reactivity, and (3). the role of environmental stressors in outcome. CFF-CBT actively engages parents and children over 12 hour-long sessions. METHOD An exploratory investigation was conducted to determine the feasibility of CFF-CBT. Participants included 34 patients with PBD (mean age 11.33 years, SD = 3.06) who were treated with CFF-CBT plus medication in a specialty clinic. Treatment integrity, adherence, and parent satisfaction were assessed. Symptom severity and functioning were evaluated before and after treatment using the severity scales of the Clinical Global Impression Scales for Bipolar Disorder (CGI-BP) and the Children's Global Assessment Scale (CGAS) respectively. RESULTS On completion of therapy, patients with PBD showed significant reductions in severity scores on all CGI-BP scales and significantly higher CGAS scores compared to pretreatment results. High levels of treatment integrity, adherence, and satisfaction were achieved. CONCLUSIONS CFF-CBT has a strong theoretical and conceptual foundation and represents a promising approach to the treatment of PBD. Preliminary results support the potential feasibility of the intervention.
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187
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Greene RW, Ablon JS, Goring JC. A transactional model of oppositional behavior: underpinnings of the Collaborative Problem Solving approach. J Psychosom Res 2003; 55:67-75. [PMID: 12842233 DOI: 10.1016/s0022-3999(02)00585-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oppositional defiant disorder (ODD) refers to a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures. ODD is one of the most common (and debilitating) comorbid disorders within Tourette's disorder (TD). Diverse psychosocial treatment approaches have been applied to children's ODD-related behaviors. In this paper, the authors articulate a transactional developmental conceptualization of oppositional behavior and describe a cognitive-behavioral model of intervention-called collaborative problem solving (CPS)-emanating from this conceptualization. The specific goals of the CPS approach are to help adults (1). understand the specific adult and child characteristics contributing to the development of a child's oppositional behavior; (2). become cognizant of three basic strategies for handling unmet expectations, including (a). imposition of adult will, (b). CPS, and (c). removing the expectation; (3). recognize the impact of each of these three approaches on parent-child interactions; and (4). become proficient, along with their children, at CPS as a means of resolving disagreements and defusing potentially conflictual situations so as to reduce oppositional episodes and improve parent-child compatibility. Summary data from an initial study documenting the effectiveness of the CPS approach (in comparison to the standard of care) are also presented.
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Affiliation(s)
- Ross W Greene
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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