Debate: Oppositional defiant disorder is a real disorder

Commentary: Optimism for the future of research on disruptive behaviors - an appreciation of good science as illustrated by Nobakht, Steinsbekk & Wichstrom (2023)

This paper by Nobakht, Steinsbekk & Wichstrom (2023) is a model of good science in the study of oppositional defiant disorder and conduct disorder. Their approach illustrates a thoughtful research design, statistical modeling sufficient to empirically evaluate developmental processes, and a full consideration of the theoretical implications of their work. This contrasts with a broad history of research on ODD and CD that far too often has only reified biased assumptions about these phenomena rather than rigorously scrutinizing them. Their demonstration of a unidirectional developmental flow of influence from ODD to interparental aggression, and thence to CD highlights a set of complicated developmental processes involving these disorders and their environment. It expands on evidence of the toll that ODD exerts on parents and provides guidance for more specific intervention. Standards in developmental psychopathology research should include testing bidirectional processes and employing designs that could falsify rather than reify existing beliefs. Examining key mechanisms in such processes will more rapidly generate improvements in assessment and treatment.

Reciprocal relations between interparental aggression and symptoms of oppositional defiant and conduct disorders: a seven-wave cohort study of within-family effects from preschool to adolescence

BACKGROUND

Interparental aggression is believed to increase the risk of behavioral disorders in offspring, and offspring behavioral problems may forecast interparental aggression. However, these assumptions have yet to be put to a strong test. This study, therefore, examined whether increased interparental aggression predicted increased symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) from preschool to adolescence and vice versa.

METHODS

A sample (n = 1,077; 49.6% girls) from two birth cohorts of children in Trondheim, Norway, was assessed biennially from age 4 to 16. Children's symptoms of ODD and CD were assessed using semi-structured clinical interviews of parents (from age 4) and children (from age 8). One of the parents reported on their own and their partner's verbal and physical aggression. A random intercept cross-lagged model was estimated to test the within-family relations between interparental aggression, CD, and ODD symptoms.

RESULTS

Across development, increased interparental aggression predicted increased CD symptoms 2 years later, whereas an increased number of ODD symptoms forecasted increased interparental aggression.

CONCLUSIONS

The argumentative/defiant, aggressive, and vindictive behaviors seen in ODD are often directed toward parents and may take a toll on their relationship and possibly foster interparental aggression, whereas aggression between parents may promote symptoms of CD in their offspring, which commonly extend beyond the home. Incorporating effective and non-aggressive means to solve interparental conflict into parental management programs may reduce the development of symptoms of CDs in children.

The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment

Historically, much of the progress made in youth mental health research can be classified as focusing on externalizing problems, characterized by disruptive behavior (e.g. aggression, defiance), or internalizing problems, characterized by intense negative affect (e.g. depression, anxiety). Until recently, however, less attention has been given to topics that lie somewhere in between these domains, topics that we collectively refer to as the affective side of disruptive behavior. Like the far side of the moon, the affective side of disruptive behavior captures facets of the phenomenon that may be less obvious or commonly overlooked, but are nonetheless critical to understand. This affective side clarifies socially disruptive aspects of traditionally "externalizing" behavior by elucidating proximal causation via intense negative affect (traditionally "internalizing"). Such problems include irritability, frustration, anger, temper loss, emotional outbursts, and reactive aggression. Given a recent explosion of research in these areas, efforts toward integration are now needed. This special issue was developed to help address this need. Beyond the present introductory article, this collection includes 4 empirical articles on developmental psychopathology topics, 4 empirical articles on applied treatment/assessment topics, 1 evidence base update review article on measurement, and 2 future directions review articles concerning outbursts, mood, dispositions, and youth psychopathology more broadly. By deliberatively investigating the affective side of disruptive behavior, we hope these articles will help bring about better understanding, assessment, and treatment of these challenging problems, for the benefit of youth and families.

Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders

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.

Oppositional defiant disorder

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.

Editorial: Going through the slippery landscape of conduct disorder, oppositional defiant disorder and help for children in humanitarian crises

This editorial presents the contentious debate among authors from different disciplines on the problems of psychiatric diagnoses with conduct disorder, and opposition-defiant disorder as case illustrations. Furthermore, it provides an overview of opinions of experts on mental health interventions for adolescent refugees.