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Lu B, Fang Y, Cai J, Chen Z. Psychometric Evaluation of the Affective Reactivity Index Among Children and Adolescents in China: A Multi-Method Assessment Approach. Assessment 2024; 31:1020-1037. [PMID: 37837333 DOI: 10.1177/10731911231199424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The Affective Reactivity Index (ARI) is one of the most studied scales for assessing youth irritability, but little is known about its measurement performance in community populations. This study applied item response theory (IRT), network analysis, and classical test theory (CTT) to examine the psychometric properties of the ARI in a sample of n = 395 community-based children (Mage = 13.44, SD = 2.51) and n = 403 parents. In this sample, the ARI demonstrated good reliability, as well as convergent and concurrent validity. The one-factor structure was supported by both confirmatory factor analysis (CFA) and network analysis. IRT analysis revealed that the ARI effectively distinguished between various levels of irritability within the community population. Network analysis identified "Loses temper easily,""Gets angry frequently," and "Often loses temper" are central aspects of irritability. The findings support the ARI as a brief, reliable, and valid instrument to assess irritability in community children and adolescents.
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Affiliation(s)
- Boqing Lu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuan Fang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jimin Cai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhiyan Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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2
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Vance A, McGaw J, O'Meara A, Gone JP, Eades S. Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents. Aust N Z J Psychiatry 2024:48674241246441. [PMID: 38642027 DOI: 10.1177/00048674241246441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people. METHODS A total of 132 Indigenous and 247 non-Indigenous young people aged 6-16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms. RESULTS The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms. CONCLUSIONS High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.
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Affiliation(s)
- Alasdair Vance
- Academic Child Psychiatry Unit and Developmental Neuropsychiatry Program, The Royal Children's Hospital, The University of Melbourne, Parkville, VIC, Australia
- Wadja Aboriginal Family Place, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Janet McGaw
- Faculty of Architecture, Building and Planning, The University of Melbourne, Parkville, VIC, Australia
| | - Angel O'Meara
- Wadja Aboriginal Family Place, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Joseph P Gone
- Department of Anthropology and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Sandra Eades
- Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Population and Global Health, Parkville, VIC, Australia
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3
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Koerner S, Staginnus M, Cornwell H, Smaragdi A, González-Madruga K, Pauli R, Rogers JC, Gao Y, Chester S, Townend S, Bernhard A, Martinelli A, Kohls G, Raschle NM, Konrad K, Stadler C, Freitag CM, De Brito SA, Fairchild G. Does the Relationship between Age and Brain Structure Differ in Youth with Conduct Disorder? Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01178-w. [PMID: 38557727 DOI: 10.1007/s10802-024-01178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
Conduct disorder (CD) is characterised by persistent antisocial and aggressive behaviour and typically emerges in childhood or adolescence. Although several authors have proposed that CD is a neurodevelopmental disorder, very little evidence is available about brain development in this condition. Structural brain alterations have been observed in CD, and some indirect evidence for delayed brain maturation has been reported. However, no detailed analysis of age-related changes in brain structure in youth with CD has been conducted. Using cross-sectional MRI data, this study aimed to explore differences in brain maturation in youth with CD versus healthy controls to provide further understanding of the neurodevelopmental processes underlying CD. 291 CD cases (153 males) and 379 healthy controls (160 males) aged 9-18 years (Mage = 14.4) were selected from the European multisite FemNAT-CD study. Structural MRI scans were analysed using surface-based morphometry followed by application of the ENIGMA quality control protocols. An atlas-based approach was used to investigate group differences and test for group-by-age and group-by-age-by-sex interactions in cortical thickness, surface area and subcortical volumes. Relative to healthy controls, the CD group showed lower surface area across frontal, temporal and parietal regions as well as lower total surface area. No significant group-by-age or group-by-age-by-sex interactions were observed on any brain structure measure. These findings suggest that CD is associated with lower surface area across multiple cortical regions, but do not support the idea that CD is associated with delayed brain maturation, at least within the age bracket considered here.
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Affiliation(s)
- Sarah Koerner
- Department of Psychology, University of Bath, Bath, UK
| | | | | | | | | | - Ruth Pauli
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Jack C Rogers
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Yidian Gao
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Sally Chester
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Anne Martinelli
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
- School of Psychology, Fresenius University of Applied Sciences, Frankfurt, Germany
| | - Gregor Kohls
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Medical Faculty, TU Dresden, Dresden, Germany
| | - Nora Maria Raschle
- Jacobs Center for Productive Youth Development at the University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich (ZNZ), University and ETH Zurich, Zurich, Switzerland
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
- JARA- Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen and Research Centre Juelich, Juelich, Germany
| | - Christina Stadler
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital, University of Basel, Basel, Switzerland
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt Am Main, Germany
| | - Stephane A De Brito
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
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4
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Lopez JD, Daniels W, Joshi SV. Oppositional Defiant Disorder: Clinical Considerations and When to Worry. Pediatr Rev 2024; 45:132-142. [PMID: 38425161 DOI: 10.1542/pir.2022-005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Juan David Lopez
- San Francisco Department of Public Health, Children, Youth and Families, San Francisco, CA
| | - Whitney Daniels
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Shashank V Joshi
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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5
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Evans SC, Karlovich AR, Khurana S, Edelman A, Buza B, Riddle W, López-Sosa D. Evidence Base Update on the Assessment of Irritability, Anger, and Aggression in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:277-308. [PMID: 38275270 PMCID: PMC11042996 DOI: 10.1080/15374416.2023.2292041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Irritability, anger, and aggression have garnered significant attention from youth mental health researchers and clinicians; however, fundamental challenges of conceptualization and measurement persist. This article reviews the evidence base for assessing these transdiagnostic constructs in children and adolescents. METHOD We conducted a preregistered systematic review of the evidence behind instruments used to measure irritability, anger, aggression, and related problems in youth. Searches were conducted in PsycINFO and PubMed, identifying 4,664 unique articles. Eligibility criteria focused on self- and proxy-report measures with peer-reviewed psychometric evidence from studies in English with youths ages 3-18. Additional measures were found through ancillary search strategies (e.g. book chapters, review articles, test publishers). Measures were screened and coded by multiple raters with acceptable reliability. RESULTS Overall, 68 instruments met criteria for inclusion, with scales covering irritability (n = 15), anger (n = 19), aggression (n = 45), and/or general overt externalizing problems (n = 27). Regarding overall psychometric support, 6 measures (8.8%) were classified as Excellent, 46 (67.6%) were Good, and 16 (23.5%) were Adequate. Descriptive information (e.g. informants, scales, availability, translations) and psychometric properties (e.g. reliability, validity, norms) are summarized. CONCLUSIONS Numerous instruments for youth irritability, anger, and aggression exist with varying degrees of empirical support for specific applications. Although some measures were especially strong, none had uniformly excellent properties across all dimensions, signaling the need for further research in particular areas. Findings promote conceptual clarity while also producing a well-characterized toolkit for researchers and clinicians addressing transdiagnostic problems affecting youth.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Sakshi Khurana
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
- College of Education, DePaul University, Chicago, IL, USA
| | - Audrey Edelman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Bianca Buza
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - William Riddle
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Denise López-Sosa
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Hernandez ML, Garcia AM, Spiegel JA, Dick AS, Graziano PA. Multimodal Assessment of Emotion Dysregulation in Children with and without ADHD and Disruptive Behavior Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-16. [PMID: 38270592 DOI: 10.1080/15374416.2024.2303706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We sought to explore if specific domains of emotion dysregulation (emotion regulation [EREG], emotional reactivity/lability [EREL], emotion recognition/understanding [ERU], and callous-unemotional [CU] behaviors) were uniquely associated with diagnostic classifications. METHOD This study utilized a multimodal (parent/teacher [P/T] reports and behavioral observations) approach to examine emotion dysregulation in a sample of young children (68.7% boys; mean age = 5.47, SD = 0.77, 81.4% Latinx) with attention-deficit/hyperactivity disorder (ADHD Only; n = 46), ADHD + disruptive behavior disorders (ADHD+DBD; n = 129), and typically developing (TD) children (n = 148). RESULTS All three diagnostic groups were significantly different from one another on P/T reports of EREG, EREL and CU. For the ADHD+DBD group, P/T reported worse EREG and EREL, and higher mean scores of CU, compared to both ADHD Only and TD groups. The ADHD+DBD group also performed significantly worse than the TD group (but not the ADHD Only group) on observed measures of EREG, EREL and ERU. P/T reported EREG, EREL and CU for the ADHD Only group were significantly worse than the TD group. Using multinomial logistic regression, P/T reported EREG, EREL, and CU were significantly associated with diagnostic status above and beyond observed measures of emotion dysregulation. The model successfully classified children with ADHD+DBD (91.3%) and TD (95.9%); however, children in the ADHD Only group were correctly identified only 45.7% of time. CONCLUSION Our findings suggest that measures of emotion dysregulation may be particularly helpful in correctly identifying children with ADHD+DBD, but not necessarily children with ADHD Only.
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Affiliation(s)
| | | | | | - Anthony S Dick
- Department of Psychology, Florida International University
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7
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Burke JD, Butler EJ, Shaughnessy S, Karlovich AR, Evans SC. Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders. Assessment 2024; 31:75-93. [PMID: 37551425 DOI: 10.1177/10731911231188739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder-the Disruptive, Impulse Control and Conduct Disorders-can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases.
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8
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McDowell C, Rush J, Sukhawathanakul P. Does being defiant and irritable take a toll on physical health? Examining the covariation between symptoms of physical health and oppositional defiance across adolescence to young adulthood. Psychol Health 2023:1-17. [PMID: 37965947 DOI: 10.1080/08870446.2023.2280168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023]
Abstract
Objectives. While oppositional defiance is often considered a childhood behavioural problem, the negative impact of symptoms on relationships and emotional wellbeing may endure well into young adulthood and can affect overall physical health. However, little is known about the co - occurrence of oppositional defiance symptoms (ODS) and changes in physical health functioning, particularly during the transition to young adulthood. This study examines the coupled change between ODS and physical health symptoms during this critical developmental period to inform the long - term somatic manifestations of ODS.Methods. Participants (N = 662; 52% female) from the Victoria Healthy Youth Survey (V-HYS) were assessed for ten years across six biennial occasions from ages 12-18 to ages 22-30. A multilevel time -varying covariation model, disaggregating within- and between - person variability, examined whether change in ODS was systematically associated with change in physical health symptoms.Results. On average, individuals with higher ODS reported more physical health symptoms. Moreover, ODS also shared a significant within - person time - varying association with physical health, suggesting that the two symptom domains fluctuated together within - individuals across time, irrespective of between - person differences.Conclusion. This study provides a novel within- and between - person demonstration of the link between ODS and physical health symptoms from youth to young adulthood.
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Affiliation(s)
- Cynthia McDowell
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Jonathan Rush
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | - Paweena Sukhawathanakul
- Department of Psychology, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
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Leadbeater BJ, Merrin GJ, Contreras A, Ames ME. Trajectories of oppositional defiant disorder severity from adolescence to young adulthood and substance use, mental health, and behavioral problems. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2023; 32:224-235. [PMID: 38034412 PMCID: PMC10686226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/29/2023] [Indexed: 12/02/2023]
Abstract
Background Oppositional Defiant Disorder (ODD) is a disruptive behavioral disorder; however, increasing evidence emphasizes irritable mood as a primary symptom of ODD. Objectives This study investigated whether heterogeneous groups (classes) of individuals can be differentiated based on ODD sub-dimensions (irritability and defiance) or on overall ODD symptoms longitudinally. We also examine associations between ODD trajectory class and comorbid substance use (heavy episodic drinking, cannabis use), mental health (depression and anxiety) and behavioral symptoms (ADHD, aggression and substance use) in both adolescence and young adulthood (controlling for adolescent levels of each of these concerns). Method Data were from a randomly recruited community sample of 662 Canadian youth (T1 ages 12-18) followed biennially for 10 years (T6 ages 22-29). Results Growth mixture models revealed trajectories classes of ODD based on severity of symptoms. A three-class solution provided the best fit with Low (n = 119; 18%), Moderate (n = 473; 71.5%), and High (n = 70; 10.6%) ODD classes. Class trajectory differences were similarity based on symptoms severity (rather than type) for symptom sub-dimensions (irritability defiance). Adolescent and young adult substance use, mental health symptoms, and behavioral problems were significantly higher for the High ODD trajectory class compared to both other classes. Youth in the Moderate ODD trajectory class also showed higher comorbid symptoms in adolescence and young adulthood, compared to the Low ODD trajectory class. Conclusion Early identification of children and adolescents with high or moderate ODD symptoms and interventions that simultaneously address defiance and irritability are supported by the findings.
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Affiliation(s)
| | | | | | - Megan E Ames
- University of Victoria, Victoria, British Columbia
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10
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Evans SC, Shaughnessy S, Karlovich AR. Future Directions in Youth Irritability Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:716-734. [PMID: 37487108 DOI: 10.1080/15374416.2023.2209180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.
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Hawes DJ, Gardner F, Dadds MR, Frick PJ, Kimonis ER, Burke JD, Fairchild G. Oppositional defiant disorder. Nat Rev Dis Primers 2023; 9:31. [PMID: 37349322 DOI: 10.1038/s41572-023-00441-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/24/2023]
Abstract
Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.
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Affiliation(s)
- David J Hawes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Mark R Dadds
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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12
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Racz SJ, McMahon RJ, Gudmundsen G, McCauley E, Stoep AV. Latent classes of oppositional defiant disorder in adolescence and prediction to later psychopathology. Dev Psychopathol 2023; 35:730-748. [PMID: 35074036 PMCID: PMC9309185 DOI: 10.1017/s0954579421001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current conceptualizations of oppositional defiant disorder (ODD) place the symptoms of this disorder within three separate but related dimensions (i.e., angry/irritable mood, argumentative/defiant behavior, vindictiveness). Variable-centered models of these dimensions have yielded discrepant findings, limiting their clinical utility. The current study utilized person-centered latent class analysis based on self and parent report of ODD symptomatology from a community-based cohort study of 521 adolescents. We tested for sex, race, and age differences in the identified classes and investigated their ability to predict later symptoms of depression and conduct disorder (CD). Diagnostic information regarding ODD, depression, and CD were collected annually from adolescents (grades 6-9; 51.9% male; 48.7% White, 28.2% Black, 18.5% Asian) and a parent. Results provided evidence for three classes of ODD (high, medium, and low endorsement of symptoms), which demonstrated important developmental differences across time. Based on self-report, Black adolescents were more likely to be in the high and medium classes, while according to parent report, White adolescents were more likely to be in the high and medium classes. Membership in the high and medium classes predicted later increases in symptoms of depression and CD, with the high class showing the greatest risk for later psychopathology.
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Affiliation(s)
- Sarah J. Racz
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Robert J. McMahon
- Department of Psychology, Simon Fraser University, Burnaby, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Gretchen Gudmundsen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- St. Luke’s Children’s Hospital, Boise, ID, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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13
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Lindhiem O, Burke JD, Feldman JA, Kolko DJ, Pilkonis PA. Deficits in Parent Knowledge of Behavior Management Skills is Strongly Associated with CD Symptoms but Not ODD Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023; 45:18-26. [PMID: 36909951 PMCID: PMC10004159 DOI: 10.1007/s10862-022-09989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
We conducted secondary analyses of existing data to examine the association between parent scores on the Knowledge of Effective Parenting Test (KEPT) and child symptoms of Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Parent knowledge of behavior management skills and child behavior symptoms were assessed in a nationally representative sample of parents/guardians (N = 1,570) of children aged 5-12 from all 50 states. Results showed consistent and robust correlations between parent knowledge of behavior management skills and CD symptoms but not ODD symptoms. These findings suggest that parent knowledge of behavior management may be a greater risk factor for CD than ODD, with implications for taxonomy and understanding the etiology of these two disorders. We also discuss the implications of these findings for the prevention and treatment of these two disorders which are often grouped together in treatment trials.
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Kautz-Turnbull C, Rockhold M, Handley ED, Olson HC, Petrenko C. Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:577-588. [PMID: 36811189 PMCID: PMC10050124 DOI: 10.1111/acer.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) have high rates of adverse childhood experiences (ACEs). ACEs are associated with a wide range of health outcomes including difficulty with behavior regulation, an important intervention target. However, the effect of ACEs on different areas of behavior has not been well characterized in children with disabilities. This study describes ACEs in children with FASD and how they impact behavior problems. METHODS A convenience sample of 87 caregivers of children (aged 3 to 12) with FASD participating in an intervention study reported on their children's ACEs using the ACEs Questionnaire and behavior problems on the Eyberg Child Behavior Inventory (ECBI). A theorized three-factor structure of the ECBI (Oppositional Behavior, Attention Problems, and Conduct Problems) was investigated. Data were analyzed using Pearson correlations and linear regression. RESULTS On average, caregivers endorsed 3.10 (SD = 2.99) ACEs experienced by their children. The two most frequently endorsed ACE risk factors were having lived with a household member with a mental health disorder, followed by having lived with a household member with a substance use disorder. Higher total ACEs score significantly predicted a greater overall frequency of child behavior (intensity scale), but not whether the caregiver perceived the behavior to be a problem (problem scale) on the ECBI. No other variable significantly predicted the frequency of children's disruptive behavior. Exploratory regressions indicated that a higher ACEs score significantly predicted greater Conduct Problems. Total ACEs score was not associated with Attention Problems or Oppositional Behavior. DISCUSSION Children with FASD are at risk for ACEs, and those with higher ACEs had a greater frequency of problem behavior on the ECBI, especially conduct problems. Findings emphasize the need for trauma-informed clinical care for children with FASD and increased accessibility of care. Future research should examine potential mechanisms that underlie the relationship between ACEs and behavior problems to optimally inform interventions.
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Affiliation(s)
- Carson Kautz-Turnbull
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Madeline Rockhold
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Heather Carmichael Olson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christie Petrenko
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
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15
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Community-Delivered Collaborative and Proactive Solutions and Parent Management Training for Oppositional Youth: A Randomized Trial. Behav Ther 2023; 54:400-417. [PMID: 36858768 DOI: 10.1016/j.beth.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7-14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45-50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.
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16
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McKee LG, Yang Y, Highlander A, McCall M, Jones DJ. Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions. Clin Child Fam Psychol Rev 2023; 26:272-301. [PMID: 36385585 DOI: 10.1007/s10567-022-00419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
Behavior disorders (BDs) are common and costly, making prevention and early-intervention a clinical and public health imperative. Behavioral Parent Training (BPT) is the standard of care for early-onset (3-8 years old) BDs, yet effect sizes vary and wane with time suggesting the role of underlying factors accounting for variability in outcomes. The literature on emotion regulation (ER), which has been proposed as one such underlying factor, is reviewed here, including a brief overview of ER, theory and research linking ER, externalizing symptoms, and/or BDs, and still largely preliminary work exploring the role of parent and child ER in BPT outcomes. Research to date provides clues regarding the interrelationship of ER, BDs, and BPT; yet, determining whether adaptations to BPT targeting ER are necessary or useful, for whom such adaptations would be most important, and how those adaptations would be implemented requires addressing mixed findings and methodological limitations. To guide such work, we propose a conceptual model elucidating how standard BPT may impact ER and processes linked to ER, which we believe will be useful in organizing and advancing both basic and applied research in future work.
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Affiliation(s)
- Laura G McKee
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - April Highlander
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Madison McCall
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27599, USA.
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17
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Helleman A, Rubin RT, Gardner W, Lourie A, Taylor AN, Cochran J, Dorn LD, Susman E, Barrowman N, Bijelić V, Leininger L, Pajer K. Circadian cortisol secretion in adolescent girls with conduct disorder. Psychoneuroendocrinology 2023; 148:105972. [PMID: 36462295 PMCID: PMC10038075 DOI: 10.1016/j.psyneuen.2022.105972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Severe antisocial behavior in girls, best exemplified by conduct disorder (CD), is a serious clinical and public health problem. Treatment is difficult, particularly in girls with comorbid internalizing disorders. Identifying biological correlates may help to develop new treatments or diagnostic, prognostic, or treatment response biomarkers. Based on our earlier work and research from others occurring primarily in boys with severe antisocial behavior, it is possible that abnormalities in the hypothalamic pituitary adrenal (HPA) axis circadian cortisol cycle may be associated with female CD. Additionally, research suggests that the presence of comorbid internalizing disorders may be related to differences in cortisol secretion, compared to subjects who only have CD. Our study aimed: 1) to compare the circadian cortisol cycle in 98 girls with CD, 15-16 years of age to 47 girls without any psychiatric disorder (ND) and 2) to compare the cycle in girls with CD and comorbid internalizing disorders (CD + INT) to those without such comorbidity (CD Only). Salivary cortisol was collected over 24 h during weekdays at scheduled times, with protocol adherence measures in place. Unstructured covariance pattern modeling, controlling for effects of age, social class, IQ, and awakening time was used to analyze cortisol data. CD was associated with overall lower cortisol secretion (p = 0.03), but this difference was due to a lower volume of cortisol secreted 30 min after awakening (area under the curve with respect to ground, p = 0.01). Circadian cortisol secretion was no different in the CD+INT group compared to the CD Only group (p = 0.52). Our findings need to be replicated using current consensus guidelines for the assessment of the CAR. We also suggest two new avenues of research in this field.
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Affiliation(s)
| | - Robert T Rubin
- David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
| | - William Gardner
- CHEO Research Institute, Ottawa, Ontario, Canada; The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Andrea Lourie
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Anna N Taylor
- David Geffen School of Medicine at UCLA, Department of Neurobiology, Los Angeles, CA, USA
| | - Justinn Cochran
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Lorah D Dorn
- Cincinnati Children's Hospital Medical Center, Division of Adolescent Medicine, Cincinnati, OH, USA
| | - Elizabeth Susman
- College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | | | - Vid Bijelić
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Lisa Leininger
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA
| | - Kathleen Pajer
- CHEO Research Institute, Ottawa, Ontario, Canada; The Research Institute at Nationwide Children's Hospital, The Ohio State University, Department of Pediatrics, Columbus, OH, USA.
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18
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Donohue MR, Hoyniak CP, Tillman R, Barch DM, Luby J. Associations of observed callous-unemotional behaviors in early childhood with conduct problems and substance use over 14 years. Dev Psychopathol 2023; 35:421-432. [PMID: 36914291 PMCID: PMC10014890 DOI: 10.1017/s0954579421000791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Callous-unemotional (CU) behaviors (i.e., low concern and active disregard for others) uniquely predict severe conduct problems and substance use when present by late childhood. Less is known about the predictive utility of CU behaviors displayed in early childhood, when morality is developing and interventions may be more effective. Children aged 4-7 years (N = 246; 47.6% girls) completed an observational task wherein they were encouraged to tear an experimenter's valued photograph, and blind raters coded children's displayed CU behaviors. During the next 14 years, children's conduct problems (i.e., oppositional defiant and conduct symptoms) and age of onset of substance use were assessed. Compared to children displaying fewer CU behaviors, children displaying greater CU behaviors were 7.61 times more likely to meet criteria for a conduct disorder (n = 52) into early adulthood (95% CI, 2.96-19.59; p = <.0001), and their conduct problems were significantly more severe. Greater CU behaviors were associated with earlier onset of substance use (B = -.69, SE = .32, t = -2.14, p = .036). An ecologically valid observed indicator of early CU behavior was associated with substantially heightened risk for conduct problems and earlier onset substance use into adulthood. Early CU behavior is a powerful risk marker identifiable using a simple behavioral task which could be used to target children for early intervention.
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Affiliation(s)
- Meghan Rose Donohue
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, USA
| | - Caroline P Hoyniak
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, USA
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19
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Jungersen CM, Lonigan CJ. Dimensionality of Oppositional Defiant Disorder Symptoms Across Elementary-School Grades. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01474-w. [PMID: 36474129 DOI: 10.1007/s10578-022-01474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Various models of the dimensionality of behaviors associated with Oppositional Defiant Disorder (ODD) have been proposed or reported. Many of these models describe ODD-related behaviors in either two- or three-factor models. The purpose of the study was to determine which of the models of ODD-related behaviors demonstrated the best fit using teacher report of 15,521 children across eight grade levels and to examine measurement invariance of the model across grades. Confirmatory factor analyses were conducted to determine which of the models demonstrated best fit of teacher-reported ODD-related behaviors across eight grades. A two-factor model from a preliminary analysis of a subset of the current data demonstrated a better model fit than any of the existing six models examined and demonstrated measurement invariance across all grades. Across all of the models, affective and behavioral symptoms loaded onto separate factors, which may be an important consideration to inform future clinical and empirical work.
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Affiliation(s)
- Colleen M Jungersen
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA.
| | - Christopher J Lonigan
- Department of Psychology and Florida Center for Reading Research, Florida State University, Tallahassee, USA
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20
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Hai T, Swansburg R, Kahl CK, Frank H, Stone K, Lemay JF, MacMaster FP. Right Superior Frontal Gyrus Cortical Thickness in Pediatric ADHD. J Atten Disord 2022; 26:1895-1906. [PMID: 35815438 PMCID: PMC9605998 DOI: 10.1177/10870547221110918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We investigated the right Superior Frontal Gyrus (right-SFG) and Anterior Cingulate Cortex (ACC) in children with ADHD and their clinical relevance with Executive Function (EF) and ADHD symptom severity. METHODS About 26 children with ADHD and 24 typically developing children (TDC; 7‒16 years) underwent Magnetic Resonance Imaging (MRI) and completed an EF assessment battery. RESULTS Significantly thinner right-SFG in the ADHD group was found compared to the TDC group (t (48) = 2.81, p = .007, Cohen's d = 0.84). Linear regression models showed that 12.5% of inattention, 13.6% of hyperactivity, and 9.0% of EF variance was accounted for by the right-SFG thickness. CONCLUSIONS Differences in the right-SFG thickness were found in our ADHD group and were associated with parent ratings of inattentive and hyperactive symptoms as well with EF ratings. These results replicate previous findings of thinner right-SFG and are consistent with the delayed cortical maturation theory of ADHD.
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Affiliation(s)
- Tasmia Hai
- University of Calgary, AB, Canada,University of Alberta, Edmonton, Canada
| | | | | | | | | | | | - Frank P. MacMaster
- University of Calgary, AB, Canada,Addictions and Mental Health Strategic Clinical Network, Calgary, AB, Canada,Frank P. MacMaster, Child and Adolescent Imaging Research Program, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada.
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21
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Yu RA, Goulter N, McMahon RJ. Longitudinal Associations between Parental Warmth, Harsh Discipline, Child Emotion Regulation, and ODD Dimensions. Child Psychiatry Hum Dev 2022; 53:1266-1280. [PMID: 34148149 PMCID: PMC8684556 DOI: 10.1007/s10578-021-01205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Research has yet to investigate the mediating role of emotion regulation in the relation between parental warmth and harsh discipline with oppositional defiant disorder (ODD). Further, few studies have investigated ODD as both a unitary construct and as three distinct dimensions (anger, defiance, spitefulness). Thus, the present study aimed to investigate child emotion regulation (grade 2) as a mediator of the relation between parental warmth and harsh discipline (kindergarten, grade 1, grade 2) and ODD and its dimensions (grade 3). Participants included the high-risk and normative samples from the Fast Track project (N = 753, male = 58 %, Black = 46 %). Constructs were assessed using observation and parent and teacher reports. Although results demonstrated an absence of indirect effects, emotion regulation was negatively associated with overall ODD and anger and defiance, but not spitefulness. Findings illustrate how increased attention toward the study of ODD as distinct dimensions contributes to our ability to parse out heterogeneity among children with the disorder.
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Affiliation(s)
- Rachelle A Yu
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Natalie Goulter
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
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22
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Vance A, Winther J, McGaw J, White S. Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way. Aust N Z J Psychiatry 2022; 56:1455-1462. [PMID: 34875892 DOI: 10.1177/00048674211063819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. METHODS In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. RESULTS Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group. CONCLUSION Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.
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Affiliation(s)
- Alasdair Vance
- Developmental Neuropsychiatry Program, Academic Child Psychiatry Unit, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Wadja Aboriginal Family Place, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Jo Winther
- Developmental Neuropsychiatry Program, Academic Child Psychiatry Unit, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
- Wadja Aboriginal Family Place, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Janet McGaw
- Faculty of Architecture, Building and Planning, The University of Melbourne, Melbourne, VIC, Australia
| | - Selena White
- Wadja Aboriginal Family Place, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
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23
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Ezpeleta L, Penelo E, Navarro JB, de la Osa N, Trepat E. Co-developmental Trajectories of Defiant/Headstrong, Irritability, and Prosocial Emotions from Preschool Age to Early Adolescence. Child Psychiatry Hum Dev 2022; 53:908-918. [PMID: 33939109 DOI: 10.1007/s10578-021-01180-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
This study ascertains how the proposed subtypes and specifiers of oppositional defiant disorder (ODD) based on irritability and prosocial emotions co-develop and describes the clinical characteristics of the resultant classes. A sample of 488 community children was followed up from ages 3 to 12 years and assessed with categorical and dimensional measures answered by parents and teachers. Latent class growth analysis for three parallel processes [defiant/headstrong, irritability, and limited prosocial emotions (LPE)] identified a 4-class model with adequate entropy (.912) and posterior probabilities of class membership (≥ .921). Class 1 (n = 38, 7.9%) was made up of children with defiant/headstrong with chronic irritability and LPE. Class 2 (n = 128, 26.3%) was comprised of children with defiant/headstrong with chronic irritability and typical prosocial emotions. Class 3 (n = 101, 20.7%) clustered children with LPE without defiant/headstrong and without irritability. Class 4 (n = 220, 45.1%) included children with the lowest scores in all the processes. The classes were distinguishable and showed different clinical characteristics through development. These findings support the validity of ICD-11 ODD subtypes based on chronic irritability and may help to guide clinicians' decision-making regarding treating oppositionality in children.
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Affiliation(s)
- Lourdes Ezpeleta
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain.
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain.
| | - Eva Penelo
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències del Comportament, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Blas Navarro
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències del Comportament, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria de la Osa
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Esther Trepat
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
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24
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Balder T, Linden M. Embitterment - Conception of a Potential Moderator to Dysfunctional and Aggressive Behaviour in Children and Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:787-794. [PMID: 35958706 PMCID: PMC9360306 DOI: 10.1007/s40653-021-00407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 06/15/2023]
Abstract
Embitterment is an emotion which is known to everybody in reaction to injustice, humiliation, and breach of trust. Children and adolescents have an understanding of justice/injustice and fairness, violations of injustice, humiliation, and breach of trust are also stressors at a young age. In this conceptual paper it is argued that embitterment is also seen in children and adolescents, and that parents, educators and therapists should recognize this emotion. This could possibly help to early identify children at risk for severe dysfunctional and aggressive behaviours, when preventive interventions are still possible. The article concludes with concepts on how to diagnose and treat children with embitterment.
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Affiliation(s)
- Tim Balder
- Dept. of Psychosomatic Medicine, Charité University Medicine Berlin, CBF, Hs IIIA, Hindenburgdamm 30Rm 13/14, 12200 Berlin, Germany
| | - Michael Linden
- Dept. of Psychosomatic Medicine, Charité University Medicine Berlin, CBF, Hs IIIA, Hindenburgdamm 30Rm 13/14, 12200 Berlin, Germany
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25
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Ezpeleta L, Penelo E, Navarro JB, de la Osa N, Trepat E, Wichstrøm L. Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits. Res Child Adolesc Psychopathol 2022; 50:1179-1190. [PMID: 35290553 PMCID: PMC9525336 DOI: 10.1007/s10802-022-00910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 12/03/2022]
Abstract
Although irritability, headstrong/defiant behavior, and callous-unemotional traits (CU traits) often co-occur, the prospective associations between them are not well known. A general population sample of 622 children was followed up yearly from ages 3 to 12 years and assessed using dimensional measures of irritability, headstrong/defiant, and CU traits with teacher provided information. A random intercept cross-lagged panel model, accounting for all unmeasured time-invariant confounding using the children as their own controls, revealed cross-lagged reciprocal associations between increased headstrong/defiant and increased CU traits at all ages and a unidirectional association from headstrong/defiant to irritability. The findings are consistent with headstrong/defiant behavior and CU traits mutually influencing each other over time and headstrong/defiant behavior enhancing irritability. School-based intervention and prevention programs should take these findings into consideration. They also suggest that irritability acts as a distinct developmental dimension of headstrong/defiant and callous-unemotional behaviors and needs to be addressed independently.
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Affiliation(s)
- Lourdes Ezpeleta
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain.
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain.
| | - Eva Penelo
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Blas Navarro
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria de la Osa
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain
| | - Esther Trepat
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut. Edifici B, Universitat Autònoma de Barcelona, 08193, Barcelona, Bellaterra, Spain
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Gomez R, Stavropoulos V, Gomez A, Brown T, Watson S. Network analyses of Oppositional Defiant Disorder (ODD) symptoms in children. BMC Psychiatry 2022; 22:263. [PMID: 35418047 PMCID: PMC9009058 DOI: 10.1186/s12888-022-03892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers (N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.
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Affiliation(s)
- Rapson Gomez
- grid.1040.50000 0001 1091 4859Federation University, Ballarat, Australia
| | | | - Andre Gomez
- Wings Wellness Psychology Clinic, 116 Derrimut Road, Hoppers Crossing, Victoria 3029 Australia
| | - Taylor Brown
- grid.1019.90000 0001 0396 9544Victoria University, Footscray, Australia
| | - Shaun Watson
- grid.1040.50000 0001 1091 4859Federation University, Ballarat, Australia
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Understanding Phasic Irritability: Anger and Distress in Children's Temper Outbursts. Child Psychiatry Hum Dev 2022; 53:317-329. [PMID: 33547990 DOI: 10.1007/s10578-021-01126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Pediatric irritability can be highly impairing and is implicated in adverse outcomes. The phasic component, characterized by temper outbursts, is a frequent impetus to seek treatment. This study tested whether a previously described anger-distress model of tantrums applies to an outpatient sample of school-age children with clinically impairing temper outbursts (TO; 5.0-9.9 years; N = 86), and examined the clinical relevance of resulting factors through associations with measures of psychopathology, and differences between children with TO and two groups without: children with ADHD (n = 60) and healthy controls (n = 45). Factor analyses established a three-factor model: High Anger, Low Anger, Distress. These factors had unique associations with measures of irritability, externalizing problems, and internalizing problems in the TO group. Additionally, an interaction between groups and outburst factors emerged. Results provide evidence for the presence and clinical utility of the anger-distress model in children's outbursts and suggest avenues for future pediatric irritability research.
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Landgren V, Fernell E, Gillberg C, Landgren M, Johnson M. Deficits in attention, motor control and perception childhood to age 30 years: prospective case-control study of outcome predictors. BMJ Open 2022; 12:e054424. [PMID: 35301207 PMCID: PMC8932285 DOI: 10.1136/bmjopen-2021-054424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Investigate predictors of adverse outcome in children with and without attention-deficit/hyperactivity disorder (ADHD) combined with developmental coordination disorder (DCD) at 6 years of age. DESIGN Prospective population-based cohort study. SETTING Western Sweden. PARTICIPANTS From a screening-based population cohort of 589 individuals, 62 (11 female) diagnosed with ADHD+DCD at mean age 6.6 years, and a comparison group of 51 population-matched (10 female) children were followed prospectively. OUTCOME MEASURES Drawn from a clinical reassessment at age 9 years of 110 of the 113 individuals, neuropsychiatric symptoms, continuous performance test results and measures of motor function were used as predictors of outcome in linear regression models. Participants were followed in national registers up to 30-31 years of age for outcomes in adulthood. Predictors were regressed onto an adverse outcome score (range 0-7) comprising seven binary endpoints, and when applicable onto each continuous outcome separately (low educational attainment, low occupation level, psychiatric disorder, psychotropic medication prescription, sick pension, high dependence on social benefits and criminal conviction). RESULTS Of the 110 individuals, 3 had died. In univariable regression onto the adverse outcome score, the strongest predictors at age 9 years were symptoms of conduct disorder, oppositional defiant disorder, ADHD and motor dysfunction, with an R2 around 25%, followed by autistic traits (R2=15%) and depressive symptoms (R2=8%). Combining these six strongest predictors in a multivariable model yielded an adjusted R2=38%. Subgroup analyses were similar, except for a strong association of autistic traits with the adverse outcome score in females (n=20, R2=50%). CONCLUSION Several neurodevelopmental symptoms, including ADHD severity at age 9 years, accounted for a considerable amount of the variance in terms of adulthood adverse outcome. Broad neurodevelopmental profiling irrespective of diagnostic thresholds should inform research and clinical practice. The study highlights the importance of considering associated comorbidities and problems in ADHD.
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Affiliation(s)
- Valdemar Landgren
- Psychiatry, Skaraborg Hospital Skövde, Skövde, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Magnus Landgren
- Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden
| | - Mats Johnson
- Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
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29
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Mikolajewski AJ, Scheeringa MS. Links between Oppositional Defiant Disorder Dimensions, Psychophysiology, and Interpersonal versus Non-interpersonal Trauma. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022; 44:261-275. [PMID: 35669529 PMCID: PMC9165763 DOI: 10.1007/s10862-021-09930-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The etiology of oppositional defiant disorder (ODD) is not well understood but appears to have both biologically-based roots and can develop following adverse experiences. The current study is the first to examine the interaction between biologically-based factors and type of trauma experience (i.e., interpersonal and non-interpersonal) and associations with ODD. The psychophysiological factors included baseline resting heart rate, respiratory sinus arrhythmia (RSA), and cortisol. ODD was measured as two dimensions of irritable and defiant/vindictive. The sample included 330 children, 3-7 years-old, oversampled for a history of trauma. Results showed the interactions between baseline physiological arousal variables and trauma type in predicting ODD dimensions were not supported. However, the baseline RSA by trauma interaction was a significant predictor of defiance/vindictiveness among boys, but not girls, when interpersonal trauma was compared to controls. Several other gender differences emerged. Among boys, both interpersonal and non-interpersonal trauma were predictive of ODD dimensions; however, among girls, non-interpersonal trauma was not. Among girls, there was a significant negative bivariate relationship between baseline cortisol and irritability. Also, when the sample was restricted to those with interpersonal trauma only and controls, baseline RSA was negatively associated with irritability in girls only (controlling for trauma). Finally, retrospective reports revealed that children who met criteria for ODD diagnosis and experienced interpersonal trauma were more likely to exhibit ODD symptoms prior to their trauma compared to those who experienced non-interpersonal trauma. Results are discussed in the context of previous mixed findings, and avenues for future research are highlighted.
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Affiliation(s)
- Amy J Mikolajewski
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
| | - Michael S Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
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Kuhn M, Gonzalez E, Weil L, Izguttinov A, Walker S. Effectiveness of Child-Focused Interventions for Externalizing Behavior: a Rapid Evidence Review. Res Child Adolesc Psychopathol 2022; 50:987-1009. [PMID: 35212851 DOI: 10.1007/s10802-022-00904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Parent behavior management training (BMT) is well established as an effective, evidence-based treatment for children with externalizing behavior. Despite the wealth of data supporting BMT, many community providers use a variety of child-focused and non-directive interventions to target behavior problems. There is lack of clarity as to whether the evidence supporting child-focused externalizing treatments is sufficiently compelling to support offering these treatments rather than or in addition to BMT. This rapid evidence review compares the effectiveness of BMT with several common child-focused interventions for externalizing behavior including cognitive behavioral (CBT), social skill (SS), and play/dynamic (PT) approaches. PubMed, PsychINFO, and Web of Science were searched for English-language articles from year 2000 onwards for each intervention type. Inclusion criteria were child age (12 and under), presence of a child-focused behavioral treatment condition, and externalizing behavior as an outcome variable. A total of 30 studies met inclusion criteria and were coded (13 CBT, 10 SS, 7 PT). Results supported social skills interventions with accompanying BMT as effective in improving externalizing problems, with generally moderate effect sizes. Individual social skills interventions were promising but needing further evaluation compared to treatment as usual. CBT treatments with and without accompanying BMT showed moderate effects over waitlist but produced less consistently significant effects compared to more robust controls. Play therapy approaches showed inconsistent effects and require further evaluation. This review supports social skills plus BMT treatments as a child-focused intervention with probable efficacy for child externalizing problems. Implications for policy and community practice are discussed.
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Affiliation(s)
- M Kuhn
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA. .,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA.
| | - E Gonzalez
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA
| | - L Weil
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - A Izguttinov
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - S Walker
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
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31
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Konrad K, Kohls G, Baumann S, Bernhard A, Martinelli A, Ackermann K, Smaragdi A, Gonzalez-Madruga K, Wells A, Rogers JC, Pauli R, Clanton R, Baker R, Kersten L, Prätzlich M, Oldenhof H, Jansen L, Kleeven A, Bigorra A, Hervas A, Kerexeta-Lizeaga I, Sesma-Pardo E, Angel Gonzalez-Torres M, Siklósi R, Dochnal R, Kalogerakis Z, Pirlympou M, Papadakos L, Cornwell H, Scharke W, Dikeos D, Fernández-Rivas A, Popma A, Stadler C, Herpertz-Dahlmann B, De Brito SA, Fairchild G, Freitag CM. Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. J Child Psychol Psychiatry 2022; 63:218-228. [PMID: 34008879 DOI: 10.1111/jcpp.13428] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the 'gender paradox' and 'delayed-onset pathway' hypotheses of female CD. METHODS As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9-18 years), compared to 864 sex- and age-matched typically developing controls. RESULTS Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the 'gender paradox' hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the 'delayed-onset pathway' hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. CONCLUSIONS Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the 'gender paradox' and 'delayed-onset pathway' hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.
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Affiliation(s)
- Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany.,JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen & Research Centre Juelich, Juelich, Germany
| | - Gregor Kohls
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Baumann
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anne Martinelli
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Katharina Ackermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Areti Smaragdi
- Centre of Addiction and Mental Health, Toronto, ON, Canada
| | | | - Amy Wells
- School of Psychology, Cardiff University, Cardiff, Wales, UK
| | - Jack C Rogers
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Ruth Pauli
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Roberta Clanton
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Rosalind Baker
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Linda Kersten
- Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Martin Prätzlich
- Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Lucres Jansen
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke Kleeven
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Aitana Bigorra
- Child and Adolescent Mental Health Service, University Hospital Mutua Terrassa, Barcelona, Spain
| | - Amaia Hervas
- Child and Adolescent Mental Health Service, University Hospital Mutua Terrassa, Barcelona, Spain
| | | | - Eva Sesma-Pardo
- Psychiatric Service, Basurto University Hospital, Bilbao, Spain
| | | | - Réka Siklósi
- Pediatrics and Child Health Center, University of Szeged, Szeged, Hungary
| | - Roberta Dochnal
- Pediatrics and Child Health Center, University of Szeged, Szeged, Hungary
| | - Zacharias Kalogerakis
- Child and Adolescent Unit of the 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Mara Pirlympou
- Child and Adolescent Unit of the 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Papadakos
- Child and Adolescent Unit of the 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Wolfgang Scharke
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany.,Cognitive and Experimental Psychology, Institute of Psychology, RWTH Aachen University, Aachen, Germany
| | - Dimitris Dikeos
- Child and Adolescent Unit of the 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Arne Popma
- Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Christina Stadler
- Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany
| | - Stephane A De Brito
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Güler Aksu G, Kütük MÖ, Tufan AE, Sanberk S, Güzel E, Dağ P, Tan ME, Akyol B, Toros F. Correlates and predictors of re-incarceration among Turkish adolescent male offenders: A single-center, cross-sectional study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 80:101726. [PMID: 34924111 DOI: 10.1016/j.ijlp.2021.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/12/2021] [Accepted: 07/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adolescents involved in the legal system are known to be under elevated risk for repeat offending. There may be many reasons for recidivism. Specifically, we aim to investigate the clinical, socio-demographic, and familial factors and psychopathology among adolescents in a penal institution and to determine risk factors for re-incarceration. METHODS This single-center cross-sectional survey was conducted at Tarsus Closed Penal Institution for Children and Youth. This institution is for males only, and all male adolescents detained at the center within the study period were evaluated with semi-structured interviews (K-SADS-PL). The adolescents completed Meaning and Purpose of Life Scale, The EPOCH measure of Adolescent Well-being, Family Sense of Belonging Scale, Children's Alexithymia Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory for themselves. Descriptive and inferential analyses were used. P was set at 0.05. RESULTS Ninety adolescent offenders with a mean age of 16.6 years (S·D = 0.7) were enrolled. Mean age at first offense was 14.6 years (S·D = 2.1). The most common reason for offenses was reported as as being with peers who were offenders, too (57.8%). Most common diagnoses were substance use (36.7%), attention deficit/hyperactivity disorder (33.3%), and conduct disorder (26.7%). Rates of offending and conviction in first-degree relatives were 62.2% and 60.0%, respectively, and most of the adolescents had at least one peer with a criminal record (n = 71, 78.9%). Re-incarcerated adolescents had lower education, committed more violent crimes, and reported elevated use of substances, suicide attempts, and psychopathology. However, in regression analysis, age of onset was the sole predictor of re-incarceration. CONCLUSION Turkish male adolescents in forensic settings may be screened for externalizing disorders and referred for treatment. Re-incarcerated Turkish youth may be more susceptible to peer influence, substance use and externalizing disorders. It may be prudent to systematically screen offending youth for psychiatric disorders regardless of the individual's request for treatment and refer identified cases to treatment. Integration of child and adolescent psychiatrists with penal institutions serving youth may help in this regard.
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Affiliation(s)
- Gülen Güler Aksu
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey.
| | - Meryem Özlem Kütük
- Department of Child and Adolescent Psychiatry, Başkent University School of Medicine, Adana, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant İzzet Baysal University, Bolu, Turkey
| | - Satı Sanberk
- Child and Adolescent Psychiatrist, Private Practice, Adana, Turkey
| | - Esra Güzel
- Child and Adolescent Psychiatrist, Private Practice, Adana, Turkey
| | - Pelin Dağ
- Department of Child and Adolescent Psychiatry, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Muhammed Emin Tan
- Department of Child and Adolescent Psychiatry, Kırşehir Training and Research Hospital, kırşehir, Turkey
| | - Betül Akyol
- Department of Child and Adolescent Psychiatry, Başkent University School of Medicine, Adana, Turkey
| | - Fevziye Toros
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey
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Irritability, Defiant and Obsessive-Compulsive Problems Development from Childhood to Adolescence. J Youth Adolesc 2021; 51:1089-1105. [PMID: 34727300 PMCID: PMC9090682 DOI: 10.1007/s10964-021-01528-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/16/2021] [Indexed: 11/07/2022]
Abstract
Little is known about the coexistence of oppositionality and obsessive-compulsive problems (OCP) in community children and how it affects their development until adolescence to prevent possible dysfunctions. The co-development of oppositional defiant dimensions and OCP is studied in 563 children (49.7% female) from ages 6 to 13 years, assessed yearly with measures answered by parents and teachers. A 4-class model based on Latent Class Growth Analysis for three parallel processes (irritability, defiant, and OCP) was selected, which showed adequate fitting indexes. Class 1 (n = 349, 62.0%) children scored low on all the measures. Class 2 (n = 53, 9.4%) contained children with high OCP and low irritability and defiant. Class 3 (n = 108, 19.2%) clustered children with high irritability and defiant and low OCP. Class 4 (n = 53, 9.4%) clustered comorbid irritability, defiant, and OCP characteristics. The classes showed different clinical characteristics through development. The developmental co-occurrence of irritability and defiant plus obsessive-compulsive behaviors is frequent and adds severity through development regarding comorbidity, peer problems, executive functioning difficulties, and daily functioning. The identification of different classes when combining oppositional problems and OCP may be informative to prevent developmental dysfunctions and to promote good adjustment through development.
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Breda M, Ardizzone I. Irritability in developmental age: A narrative review of a dimension crossing paediatric psychopathology. Aust N Z J Psychiatry 2021; 55:1039-1048. [PMID: 34015947 DOI: 10.1177/00048674211011245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Irritability is an important theme in paediatric psychiatry considering its high frequency in developmental age, its association with negative outcomes and consequently significant public health impact. Present as main or associated feature of several psychiatric diagnoses, irritability represents a challenge for clinicians who try to understand its origin and role in developmental psychopathology. In this review we try to: (1) get an overview of this dimension and its relationship with each of the main neuropsychiatric disorders in paediatric population and (2) provide a summary of currently available instruments to assess irritability in children and adolescents. METHOD In this narrative review, an overview of irritability in children and adolescents is proposed focusing on selected literature. RESULTS Irritability as feature of many paediatric psychiatric conditions has been evaluated by many authors and included in classifications of paediatric psychiatric diseases. Framework of irritability evolved over time and dimension of irritability has been investigated using different tools and methodologies, both qualitative and quantitative. Metrics of irritability as clinical dimension are important in the diagnostic process of paediatric diseases. CONCLUSION Investigating the presence of irritability in all children with related disorders is mandatory if we consider the risk for functional impairment and affective and behavioural disorders associated with high levels of irritability. Using rigid threshold in developmental age to differentiate physiological from pathological irritability could lead many children having subthreshold levels of irritability to receive no diagnosis and, consequently, no treatment where instead a dimensional approach to irritability could allow to identify prodromal phase and prevent the evolution towards clinical pathological expressions.
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Affiliation(s)
- Maria Breda
- Department of Pediatrics and Pediatric Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Ignazio Ardizzone
- Department of Pediatrics and Pediatric Neuropsychiatry, Sapienza University of Rome, Rome, Italy
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Donohue MR, Hoyniak CP, Tillman R, Barch DM, Luby J. Callous-Unemotional Traits as an Intervention Target and Moderator of Parent-Child Interaction Therapy-Emotion Development Treatment for Preschool Depression and Conduct Problems. J Am Acad Child Adolesc Psychiatry 2021; 60:1394-1403. [PMID: 33865929 PMCID: PMC8689660 DOI: 10.1016/j.jaac.2021.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/19/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Callous-unemotional (CU) traits-characterized by low empathy, prosociality, and guilt-predict severe and persistent conduct problems. Although some interventions for conduct problems have been less effective in children with high levels of CU traits, studies have not examined whether CU traits interfere with treatment for other childhood disorders. Moreover, few treatments have demonstrated efficacy in decreasing CU traits themselves in early childhood. This study examined whether Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), a novel PCIT adaptation that promotes emotional competence with demonstrated efficacy in treating preschool-onset major depressive disorder and oppositional defiant disorder, was also effective in treating these disorders in children displaying higher levels of CU traits. The study also examined whether PCIT-ED treatment produced significant and sustained decreases in CU traits. METHOD This study examined 3- to 5-year-olds (N = 114) with preschool-onset major depressive disorder who completed the PCIT-ED trial. Children were randomly assigned to either immediate PCIT-ED treatment (n = 64) or a waitlist control condition (n = 50) in which they received the active treatment after 18 weeks. Psychiatric diagnoses and severity and CU traits in children were assessed at baseline, immediately after treatment, and 18 weeks after treatment completion. RESULTS Compared with the waitlist, PCIT-ED effectively reduced major depressive disorder and oppositional defiant disorder in preschoolers, regardless of initial levels of CU traits. Moreover, CU traits decreased from before to after treatment, and this treatment effect was sustained 18 weeks after treatment. CONCLUSION Results support that novel interventions that enhance emotional development display significant promise in treating CU traits-behaviors that left untreated predict severe conduct problems, criminality, and substance use. CLINICAL TRIAL REGISTRATION INFORMATION A Randomized Controlled Trial of PCIT-ED for Preschool Depression; https://clinicaltrials.gov; NCT02076425.
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Affiliation(s)
- Meghan Rose Donohue
- Drs. Donohue, Hoyniak, Barch, and Luby and Ms. Tillman are with Washington University School of Medicine, St. Louis, Missouri.
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Parenting and Sibling Relationships in Family with Disruptive Behavior Disorders. Are Non-Clinical Siblings More Vulnerable for Emotional and Behavioral Problems? Brain Sci 2021; 11:brainsci11101308. [PMID: 34679373 PMCID: PMC8534172 DOI: 10.3390/brainsci11101308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Disruptive Behavior Disorders (DBD) are the most common mental health disorders in the school-aged child population. Although harsh parenting is a key risk factor in the shaping of DBD, studies neglect the presence of siblings and differential parenting. This study aims to compare: (1) parenting style and sibling relationship in sibling dyads of clinical families, composed of a DBD child and a non-clinical sibling, with control families composed of two non-clinical siblings; (2) parenting style, sibling relationship, and emotional and behavioral problems in DBD child, non-clinical sibling, and non-clinical child of control group. Sixty-one families (composed of mother and sibling dyads), divided into clinical (n = 27) and control (n = 34) groups, completed the APQ, SRI, and CBCL questionnaires. Results indicated differential parenting in clinical families, compared to control group families, with higher negative parenting toward the DBD child than the sibling; no difference emerged in sibling relationship within sibling dyads (clinical vs. control). Finally, externalizing and internalizing problems were higher in DBD children and their siblings, compared to control, indicating DBD sibling psychopathology vulnerability. Findings suggest inclusion of siblings in the clinical assessment and rehabilitative intervention of DBD children, given that the promotion of positive parenting could improve mental health in the offspring.
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Dachew BA, Scott JG, Heron JE, Ayano G, Alati R. Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents. JAMA Netw Open 2021; 4:e2125854. [PMID: 34591106 PMCID: PMC8485171 DOI: 10.1001/jamanetworkopen.2021.25854] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE An association between perinatal maternal depression and risk of oppositional defiant disorder (ODD) in offspring has not been established. Identifying early determinants of ODD can help inform preventative intervention efforts. OBJECTIVE To investigate the association between maternal perinatal depressive symptoms and the risk of ODD in offspring aged 7 to 15 years. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal birth cohort study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), in Bristol, UK. All pregnant women residents in Avon, UK, with expected delivery dates from April 1, 1991, to December 31, 1992, were invited to participate in the study. The study cohort ranged from approximately 8000 (at 7 years of age) to 4000 (at 15 years of age) mother-offspring pairs. Data were analyzed from November 2020 to July 2021. MAIN OUTCOMES AND MEASURES Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) antenatally at 18 and 32 weeks of gestation and postnatally at 8 weeks and 8 months. This study primarily used a cutoff score of 12 or more on the EPDS to identify mothers with symptoms of depression, and the continuous EPDS scores were used to confirm the results of the main analyses. Offspring ODD at 7, 10, 13, and 15 years of age were diagnosed using the parent-reported Development and Well-Being Assessment. RESULTS Of 7994 mother-offspring pairs for whom data were available on offspring ODD at 7 years, 4102 offspring (51.3%) were boys. The mean (SD) age of mothers was 28.6 (4.6) years. Maternal antenatal depressive symptoms (measured at 32 weeks of gestation) were associated with offspring ODD (adjusted odds ratio [AOR], 1.75; 95% CI, 1.33-2.31). Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of ODD over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52). CONCLUSIONS AND RELEVANCE These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age.
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Affiliation(s)
| | - James G. Scott
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Australia
| | - Jon E. Heron
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Getinet Ayano
- School of Population Health, Curtin University, Perth, Australia
- Research Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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Mulraney M, Coghill D, Bishop C, Mehmed Y, Sciberras E, Sawyer M, Efron D, Hiscock H. A systematic review of the persistence of childhood mental health problems into adulthood. Neurosci Biobehav Rev 2021; 129:182-205. [PMID: 34363845 DOI: 10.1016/j.neubiorev.2021.07.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/18/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023]
Abstract
Many adult mental disorders have their origins in childhood yet our knowledge about this largely comes from studies assessing adults utilising retrospective recall of age of onset. In this systematic review we evaluate the current state of knowledge of how childhood exposure to mental health problems is associated with adult mental disorders using data from prospective longitudinal studies. We identified 40 studies that assessed mental health in childhood or adolescence and reassessed adults for mental disorders. Although there was substantial heterogeneity across studies in terms of methodology and findings, there was a clear pattern that experiencing mental health problems prior to 14 years of age increases risk of adult mental disorder. Importantly, elevated symptoms rather than diagnosis in childhood were generally more strongly associated with adult disorder. These findings provide strong support for the argument that prevention needs to be targeted to children in the primary school years and early intervention efforts to those who are beginning to experience elevated symptoms rather than waiting until a diagnosable disorder is evident.
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Affiliation(s)
- Melissa Mulraney
- Institute for Social Neuroscience, ISN Innovations, Ivanhoe, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia.
| | - David Coghill
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Caitlin Bishop
- School of Psychology, Deakin University, Geelong, Australia
| | - Yasemin Mehmed
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; School of Psychology, Deakin University, Geelong, Australia
| | - Michael Sawyer
- Women's and Children's Health Network, North Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia
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Roetman PJ, Siebelink BM, Vermeiren RRJM, Colins OF. Classes of Oppositional Defiant Disorder Behavior in Clinic-referred Children and Adolescents: Concurrent Features and Outcomes: Classification Des Comportements Dans le Trouble Oppositionnel Avec Provocation Chez Des Enfants et des Adolescents Aiguillés à Une Clinique: Caractéristiques Co-occurrentes et Résultats. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:657-666. [PMID: 33242997 PMCID: PMC8240001 DOI: 10.1177/0706743720974840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Oppositional defiant disorder (ODD) consists of irritable and oppositional behaviors, both of which are associated with different problems. However, it is unclear whether irritability and oppositionality enable classification of clinic-referred children and adolescents into mutually exclusive groups (e.g., high in oppositionality, low in irritability), and whether this classification is clinically meaningful. METHOD As part of a clinical protocol, ODD behaviors were assessed at referral through a comprehensive diagnostic interview and questionnaire. Parent- and teacher-reported ODD of 2,185 clinic-referred 5- to 18-year-olds (36.9% females) were used in latent class analysis. Resulting ODD classes were compared, concurrently at referral, and, longitudinally at the end of the diagnostic and treatment process, on various clinically relevant measures that were completed by various informants, including mental health problems, global functioning, and Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications. RESULTS Three classes emerged with high, moderate, and low levels of both irritability and oppositionality. At referral, the high class experienced the highest levels of mental health problems and DSM classifications. Importantly, all ODD classes defined at intake were predictive of diagnostic and treatment outcomes months later. Notably, the high class had higher rates of clinician-based classifications of ODD and conduct disorder, and the lowest levels of pre- and posttreatment global functioning. Additionally, the low class exhibited higher rates of generalized anxiety disorder and fear disorders. CONCLUSIONS Irritability and oppositionality co-occur in clinic-referred youths to such an extent that classification based on these behaviors does not add to clinical inference. Instead, findings suggest that the overall ODD severity at referral should be used as a guidance for treatment.
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Affiliation(s)
- Peter J Roetman
- The Department of Child and Adolescent Psychiatry, 4501Leiden University Medical Center, Oegstgeest, the Netherlands
| | - Berend M Siebelink
- The Department of Child and Adolescent Psychiatry, 4501Leiden University Medical Center, Oegstgeest, the Netherlands
| | - Robert R J M Vermeiren
- The Department of Child and Adolescent Psychiatry, 4501Leiden University Medical Center, Oegstgeest, the Netherlands.,Youz, Parnassia Group, The Hague, the Netherlands
| | - Olivier F Colins
- The Department of Special Needs Education, Ghent University, Belgium.,The Center for Criminological and Psychosocial Research, Örebro University, Sweden
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The Irritable and Oppositional Dimensions of Oppositional Defiant Disorder: Integral Factors in the Explanation of Affective and Behavioral Psychopathology. Child Adolesc Psychiatr Clin N Am 2021; 30:637-647. [PMID: 34053691 DOI: 10.1016/j.chc.2021.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Oppositional defiant disorder includes distinct but inseparable dimensions of chronic irritability and oppositional behavior. The dimensions have been identified in early childhood to adulthood, and show discriminant associations with internalizing and externalizing psychopathology. The introduction of disruptive mood dysregulation disorders and the requirements that it take precedence over oppositional defiant disorder diagnostically are not supported by evidence and introduce confusion about the structure and linkages of irritability and oppositional behavior, and obscure the importance of the behavioral dimension in explaining and predicting poor outcomes. A dimensional framework with irritability, oppositionality, callous-unemotional traits, and aggression may more fully describe antisocial outcomes.
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Measurement and correlates of irritability in clinically referred youth: Further examination of the Affective Reactivity Index. J Affect Disord 2021; 283:420-429. [PMID: 33243553 PMCID: PMC7954902 DOI: 10.1016/j.jad.2020.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/10/2020] [Accepted: 11/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research on youth irritability has proliferated in recent years, largely facilitated by items from existing measures and by key new instruments like the Affective Reactivity Index (ARI). The present study extends this literature by investigating the psychometric properties of the parent- and youth-report ARI and the correlates of irritability in an independent, clinically referred sample. METHOD Baseline assessment data were collected from 237 youths (ages 3-18; 36% female) and their parents, seen for outpatient therapy and/or assessment. We examined the ARI in terms of (1) its item, scale, and factor properties; (2) convergent/discriminant validity with internalizing, externalizing, and emotion regulation problems; (3) specificity of associations with reactive aggression, anger, dysregulation, and coping; and (4) robustness of associations after controlling for demographic variables (e.g., age, gender). RESULTS The ARI's internal consistency and unidimensional factor structure were acceptable or better, with some variation across items and informants. Irritability, as measured by parent- and youth-report, was associated with variables in the externalizing (inattention, hyperactivity, executive dysfunction, aggression), internalizing (anxiety, depression, suicidality), and emotion regulation domains. Associations with reactive aggression, anger, dysregulation, and coping problems were especially pronounced. Irritability's links with internalizing and externalizing problems remained robust after controlling for demographic covariates. LIMITATIONS The sample was limited in diversity and moderate in size. CONCLUSIONS Findings support the reliability and validity of the ARI for assessing parent- and youth-rated irritability among clinically referred youth. Future research is needed to understand variations in irritability's manifestations, measurement, and correlates across demographic groups.
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Child Mental Health Literacy Among Vietnamese and Cambodian Mothers. PSYCHOLOGICAL STUDIES 2021; 66:62-72. [DOI: 10.1007/s12646-020-00590-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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43
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Evans SC, Roberts MC, Keeley JW, Rebello TJ, de la Peña F, Lochman JE, Burke JD, Fite PJ, Ezpeleta L, Matthys W, Youngstrom EA, Matsumoto C, Andrews HF, Medina-Mora ME, Ayuso-Mateos JL, Khoury B, Kulygina M, Robles R, Sharan P, Zhao M, Reed GM. Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5. J Child Psychol Psychiatry 2021; 62:303-312. [PMID: 32396664 PMCID: PMC7657976 DOI: 10.1111/jcpp.13244] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches. METHODS Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. RESULTS Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. CONCLUSIONS The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Michael C. Roberts
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Jared W. Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tahilia J. Rebello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA;,Behavioral Health Services and Policy Research, Research Foundation for Mental Hygiene, New York, NY, USA
| | | | - John E. Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Jeffrey D. Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Paula J. Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Lourdes Ezpeleta
- Research Group Epidemiology and Diagnosis in Developmental Psychopathology, Autonomous University of Barcelona, Barcelona, Spain
| | - Walter Matthys
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | | | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mayya Kulygina
- Alekseev Mental Health Clinic №1, Moscow, Russian Federation
| | - Rebeca Robles
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Pratap Sharan
- Department of Psychiatry, ll India Institute of Medical Sciences, New Delhi, India
| | - Min Zhao
- Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA;,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Parental depression and conduct problems among Chinese migrant children with oppositional defiant disorder symptoms: Testing moderated mediation model. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Georgiopoulos AM, Christon LM, Filigno SS, Mueller A, Prieur MG, Boat TF, Smith BA. Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention. Pediatr Pulmonol 2021; 56 Suppl 1:S107-S122. [PMID: 32706527 DOI: 10.1002/ppul.24977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.
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Affiliation(s)
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Mueller
- Departments of Pulmonology and Social Work Services, Hartford Hospital, Hartford, Connecticut
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Beth A Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo--The State University of New York, Buffalo, New York
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Talia A, Duschinsky R, Mazzarella D, Hauschild S, Taubner S. Epistemic Trust and the Emergence of Conduct Problems: Aggression in the Service of Communication. Front Psychiatry 2021; 12:710011. [PMID: 34630177 PMCID: PMC8494977 DOI: 10.3389/fpsyt.2021.710011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Fonagy and colleagues have recently proposed that deficits in the capacity for epistemic trust (i. e., the expectation that interpersonal communication is relevant to the addressee) are fundamental to psychopathology. In this paper, we consider the implications of this hypothesis for understanding the role of aggression in conduct disorder and conduct problems more generally. Our main proposal is to view conduct problems not only as reflecting dysregulation, but as an adaptation that allows communication with others who are (or are perceived to be) unreliable. Our formulation hinges on two propositions. The first one is to view aggression as a modality of communication adapted to scenarios in which the communicator expects the audience to have low epistemic trust in the communicator. The second idea is to conceptualize the failed "unlearning of aggression" as reflecting a lack of interest in maintaining one's reputation as a communicator, which in turn stems from a lack of epistemic trust in other communicators. In this paper, we discuss these ideas and examine how they may account for the developmental pathways that lead young people to develop conduct problems.
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Affiliation(s)
- Alessandro Talia
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Robbie Duschinsky
- Primary Care Unit, University of Cambridge, Cambridge, United Kingdom
| | - Diana Mazzarella
- Cognitive Science Centre of the University of Neuchâtel, Neuchâtel, Switzerland
| | - Sophie Hauschild
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
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External validation of a bifactor model of oppositional defiant disorder. Mol Psychiatry 2021; 26:682-693. [PMID: 30538308 PMCID: PMC6814504 DOI: 10.1038/s41380-018-0294-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 08/23/2018] [Accepted: 09/11/2018] [Indexed: 11/09/2022]
Abstract
Dimensions of irritability and defiant behavior, though correlated within the structure of ODD, convey separable developmental risks through adolescence and adulthood. Irritability predicts depression and anxiety, whereas defiant behavior is a precursor to antisocial outcomes. Previously we demonstrated that a bifactor model comprising irritability and defiant behavior dimensions, in addition to a general factor, provided the best-fitting structure of ODD symptoms in five large datasets. Herein we extend our previous work by externally validating the bifactor model of ODD using multiple regression and multivariate behavior genetic analyses. We used parent ratings of DSM IV ODD symptoms, and symptom dimensions for ADHD (i.e., inattention and hyperactivity-impulsivity), conduct disorder (CD), depression/dysthymia, and generalized anxiety disorder (GAD) from 846 6-18-year-old twin pairs. We found that the ODD irritability factor was associated only with depression/dysthymia and GAD and the ODD defiant behavior factor was associated only with inattention, hyperactivity-impulsivity, and CD, whereas the ODD general factor was associated with all five symptom dimensions. Multivariate behavior genetic analyses found all five symptom dimensions shared genetic influences in common with the ODD general, irritability, and defiant behavior factors. In contrast, the defiant behavior factor shared genetic influences uniquely with inattention and hyperactivity-impulsivity, whereas the irritability factor shared genetic influences uniquely with depression/dysthymia and GAD, but not vice versa. This suggests that genes that influence irritability in early childhood also predispose to depression and anxiety in adolescence and adulthood. These multivariate genetic findings also support the external validity of the three ODD dimensions at the etiological level. Our study provides additional support for subtyping ODD based on these symptom dimensions, as in the revisions in the ICD-11, and suggests potential mechanisms underlying the development from ODD to behavioral or affective disorders.
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Hawes MT, Carlson GA, Finsaas MC, Olino TM, Seely JR, Klein DN. Dimensions of irritability in adolescents: longitudinal associations with psychopathology in adulthood. Psychol Med 2020; 50:2759-2767. [PMID: 31637980 DOI: 10.1017/s0033291719002903] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is an emerging consensus in developmental psychopathology that irritable youth are at risk for developing internalizing problems later in life. The current study explored if irritability in youth is multifactorial and the impact of irritability dimensions on psychopathology outcomes in adulthood. METHODS We conducted exploratory factor analysis on irritability symptom items from a semi-structured diagnostic interview administered to a community sample of adolescents (ages 14-19; 42.7% male; 89.1% white). The analysis identified two factors corresponding to items from the mood disorders v. the oppositional defiant disorder (ODD) (Leibenluft and Stoddard) sections of the interview. These factors were then entered together into regression models predicting psychopathology assessed at age 24 (N = 941) and again at age 30 (N = 816). All models controlled for concurrent psychopathology in youth. RESULTS The two irritability dimensions demonstrated different patterns of prospective relationships, with items from the ODD section primarily predicting externalizing psychopathology, items from the mood disorder sections predicting depression at age 24 but not 30, and both dimensions predicting borderline personality disorder symptoms. CONCLUSIONS These results suggest that the current standard of extracting and compositing irritability symptom items from diagnostic interviews masks distinct dimensions of irritability with different psychopathological outcomes. Additionally, these findings add nuance to the prevailing notion that irritability in youth is specifically linked to later internalizing problems. Further investigation using more sensitive and multifaceted measures of irritability are needed to parse the meaning and clinical implications of these dimensions.
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49
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Razmjoee M, Harnett PH, Shahaeian A. Language development mediates the relationship between gender and relational aggression: A study of Iranian preschool children. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maryam Razmjoee
- Special Education Department, College of Education, Shiraz University, Shiraz, Iran,
| | - Paul H. Harnett
- School of Psychology, The University of Queensland, Brisbane, Australia,
| | - Ameneh Shahaeian
- Learning Sciences Institute Australia, Australian Catholic University, Brisbane, Australia,
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50
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Görtz-Dorten A, Döpfner M. Störungen mit oppositionellem und trotzigem Verhalten und dissoziale Verhaltensstörungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:494-498. [PMID: 33196401 DOI: 10.1024/1422-4917/a000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Anja Görtz-Dorten
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Ausbildungsinstitut für Kinder- und Jugendlichenpsychotherapie am Klinikum der Universität zu Köln
| | - Manfred Döpfner
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Ausbildungsinstitut für Kinder- und Jugendlichenpsychotherapie am Klinikum der Universität zu Köln
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