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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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DeGroot H, Silver J, Klein DN, Carlson GA. Parent and Teacher Ratings of Tonic and Phasic Irritability in a Clinical Sample. Res Child Adolesc Psychopathol 2024; 52:891-903. [PMID: 38236382 DOI: 10.1007/s10802-023-01151-z] [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: 11/09/2023] [Indexed: 01/19/2024]
Abstract
Research on tonic (persistently angry or grumpy mood) and phasic (temper tantrums/outbursts) irritability in youth has utilized community samples and information from parents and youth. We examined whether tonic and phasic irritability are empirically distinguishable and have similar correlates using teacher, in addition to parent, reports in a clinical sample of children and adolescents. The sample included youth aged 5-18 evaluated at a university outpatient clinic, with complete information from 2481 parents and 2449 teachers. We conducted confirmatory factor analysis (CFA) using items from several parent- and teacher-report inventories and examined concurrent associations with psychopathology and functioning. The CFA supported a two-factor model consistent with tonic and phasic irritability in both parent- and teacher-reports. Parent-reported tonic irritability was associated with higher rates of depression and anxiety disorders, suicidality, and antidepressant medication use. Teacher-reported tonic irritability was associated with elevated rates of depression and antidepressant use. Both parent- and teacher-reported phasic irritability were linked to higher rates of ADHD combined type, oppositional defiant/conduct disorders, and referral for rages. Parent- and teacher-reported tonic and phasic irritability were all associated with impaired social functioning. Parents and teachers can distinguish tonic and phasic irritability, which are associated with internalizing and externalizing problems, respectively. Findings were generally consistent across informants, and with prior studies using community samples.
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Affiliation(s)
- Harriet DeGroot
- University of Alabama Psychology Department, Tuscaloosa, AL, USA.
| | - Jamilah Silver
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
| | - Daniel N Klein
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
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Chavannes P, Gignac M. The Child Behavior Check List Usefulness in Screening for Severe Psychopathology in Youth: A Narrative Literature Review. J Atten Disord 2024; 28:608-613. [PMID: 38389275 DOI: 10.1177/10870547241228826] [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: 02/24/2024]
Abstract
OBJECTIVE This article will review the use of the CBCL to diagnose youth with psychopathological disorders focusing on: ADHD, Mood Disorders, Autism Spectrum disorders, and Disruptive Disorders. METHOD Using a narrative review approach, we investigate the usefulness of the CBCL as a screening tool to detect childhood onset psychopathology across different diagnostic syndromes. RESULTS The available literature supports the use of the CBCL for ADHD screening and as a measure of ADHD severity. While some studies support a specific profile linked with childhood bipolar disorder, replication studies for this profile found mixed results. The CBCL was also found to be useful in screening for patients presenting with Autism Spectrum Disorders, Conduct Disorder, and Childhood Bipolar Disorder all of which presents with more severely impaired scores. CONCLUSION The CBCL holds promise as a screening tool for childhood psychopathology.
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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. 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; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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Szkody E, Stearns M, McKinney C. Interpersonal Competence: A Mediator Between ODD Problems and Parent-Child Relationship Discord. Child Psychiatry Hum Dev 2023; 54:1510-1520. [PMID: 35426549 DOI: 10.1007/s10578-022-01356-1] [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] [Received: 07/24/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/03/2022]
Abstract
A central requirement of Oppositional Defiant Disorder (ODD) consists of difficulties with interpersonal relationships. As emerging adults' transition into adulthood and seek more autonomy from parents, it is important to examine how ODD problems and parent-child discord are indirectly associated through interpersonal competencies. The current study examined the indirect effects between ODD problems in emerging adults and parent-child discord through multiple interpersonal competencies as well as the additional differences among parent-child gender dyads. Emerging adults (N = 599 individuals aged 18 to 25 years; M = 19.60, SD = 1.40; 68% females) were recruited via an online research platform and completed online survey measures of ODD problems, parent-child relationship discord, and interpersonal competence. Indirect effects were significant for the mother-daughter dyad only. Additional results, limitations, and implications are discussed.
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Affiliation(s)
- Erica Szkody
- Mississippi State University, P. O. Box 6161, 39762, Mississippi State, MS, United States.
| | - Melanie Stearns
- Mississippi State University, P. O. Box 6161, 39762, Mississippi State, MS, United States
| | - Cliff McKinney
- Mississippi State University, P. O. Box 6161, 39762, Mississippi State, MS, United States
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Chad-Friedman E, Galano MM, Lemay EP, Olino TM, Klein DN, Dougherty LR. Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence. Dev Psychopathol 2023; 35:1371-1381. [PMID: 34955108 PMCID: PMC9234095 DOI: 10.1017/s0954579421001267] [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: 11/06/2022]
Abstract
INTRODUCTION This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. METHODS Children's irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. RESULTS Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. DISCUSSIONS Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.
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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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Cardinale EM, Bezek J, Morales S, Filippi C, Smith AR, Haller S, Valadez EA, Harrewijn A, Phillips D, Chronis-Tuscano A, Brotman MA, Fox NA, Pine DS, Leibenluft E, Kircanski K. Cross-sectional and Longitudinal Associations of Anxiety and Irritability With Adolescents' Neural Responses to Cognitive Conflict. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:436-444. [PMID: 35358745 PMCID: PMC9764223 DOI: 10.1016/j.bpsc.2022.03.007] [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: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Psychiatric symptoms are commonly comorbid in childhood. The ability to disentangle unique and shared correlates of comorbid symptoms facilitates personalized medicine. Cognitive control is implicated broadly in psychopathology, including in pediatric disorders characterized by anxiety and irritability. To disentangle cognitive control correlates of anxiety versus irritability, the current study leveraged both cross-sectional and longitudinal data from early childhood into adolescence. METHODS For this study, 89 participants were recruited from a large longitudinal research study on early-life temperament to investigate associations of developmental trajectories of anxiety and irritability symptoms (from ages 2 to 15) as well as associations of anxiety and irritability symptoms measured cross-sectionally at age 15 with neural substrates of conflict and error processing assessed at age 15 using the flanker task. RESULTS Results of whole-brain multivariate linear models revealed that anxiety at age 15 was uniquely associated with decreased neural response to conflict across multiple regions implicated in attentional control and conflict adaptation. Conversely, irritability at age 15 was uniquely associated with increased neural response to conflict in regions implicated in response inhibition. Developmental trajectories of anxiety and irritability interacted in relation to neural responses to both error and conflict. CONCLUSIONS Our findings suggest that neural correlates of conflict processing may relate uniquely to anxiety and irritability. Continued cross-symptom research on the neural correlates of cognitive control could stimulate advances in individualized treatment for anxiety and irritability during child and adolescent development.
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Affiliation(s)
| | - Jessica Bezek
- National Institute of Mental Health, Bethesda, Maryland
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland; Department of Psychology, University of Southern California, Los Angeles, California
| | | | | | - Simone Haller
- National Institute of Mental Health, Bethesda, Maryland
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Anita Harrewijn
- National Institute of Mental Health, Bethesda, Maryland; Department of Clinical Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Andrea Chronis-Tuscano
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Daniel S Pine
- National Institute of Mental Health, Bethesda, Maryland
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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: 3] [Impact Index Per Article: 1.5] [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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Evans SC, Corteselli KA, Edelman A, Scott H, Weisz JR. Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01301-8. [PMID: 35064392 DOI: 10.1007/s10578-021-01301-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Irritability is often described as a common problem affecting youth referred for mental health services; however, little is known about the prevalence and nature of irritability as a focus of treatment. We examined assessment data from a diverse sample of youths (N = 206; ages 7-15; 52% male, 48% female; 33% White, 27% Black, 25% Latinx) referred for outpatient treatment of emotional and behavioral concerns. Caregivers and youths completed nomothetic (standardized checklist) and idiographic (free response) measures at intake. Irritability was identified as a top problem (TP) in 58% of cases, commonly reported by caregivers (38%), youths (42%), or both (23%)-rates that were significantly greater than those of other TP domains (depression, anxiety, ADHD, conduct, and defiance). Further analyses identified clinical correlates of irritability TPs, with results supporting the incremental utility of multiple informants and methods. Findings suggest that irritability is among the most common problems for which families seek youth treatment.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | | | - Audrey Edelman
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Hannah Scott
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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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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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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13
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Evans SC, Wei MA, Harmon SL, Weisz JR. Modular Psychotherapy Outcomes for Youth With Different Latent Profiles of Irritability and Emotion Dysregulation. Front Psychiatry 2021; 12:618455. [PMID: 33935825 PMCID: PMC8086835 DOI: 10.3389/fpsyt.2021.618455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework. Method: We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates. Results: A two-class solution fit well, differentiating youth with high (n = 54) vs. low (n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT (n = 26) or CBT-Depression (n = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes. Conclusions: Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03153904.
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Affiliation(s)
- Spencer C. Evans
- Department of Psychology, Harvard University, Cambridge, MA, United States
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Melissa A. Wei
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Sherelle L. Harmon
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA, United States
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Dougherty LR, Galano MM, Chad-Friedman E, Olino TM, Bufferd SJ, Klein DN. Using Item Response Theory to Compare Irritability Measures in Early Adolescent and Childhood Samples. Assessment 2021; 28:918-927. [PMID: 32613838 PMCID: PMC8724905 DOI: 10.1177/1073191120936363] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Limited psychometric information is available to guide best practices for measuring youth irritability. This report compares performance of irritability measures using item response theory (IRT). Study 1 used a sample of 482 early adolescents and compared the parent- and youth-report affective reactivity index (ARI) and irritability factors derived from the parent-report Child Behavior Checklist (CBCL) and clinician-administered Kiddie Schedule for Affective Disorders (K-SADS). Study 2 combined data from three childhood samples (N = 811) and compared performance of the parent-report ARI and CBCL and the clinician-administered Preschool Age Psychiatric Assessment (PAPA). The ARI emerged as the best measure of childhood irritability across the developmental periods, while the CBCL and K-SADS provided an adequate amount of information in early adolescents. No measure reliably assessed irritability at modest severity levels. Using IRT across large pools of developmental samples and measures is needed to guide the field in the measurement of youth irritability.
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Affiliation(s)
| | - Maria M. Galano
- University of Maryland, College Park, MD USA
- University of Massachusetts, Amherst, MA USA
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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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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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Associations between classroom climate and children's externalizing symptoms: The moderating effect of kindergarten children's parasympathetic reactivity. Dev Psychopathol 2020; 32:661-672. [PMID: 31179951 DOI: 10.1017/s095457941900052x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Classrooms are key social settings that impact children's mental health, though individual differences in physiological reactivity may render children more or less susceptible to classroom environments. In a diverse sample of children from 19 kindergarten classrooms (N = 338, 48% female, M age = 5.32 years), we examined whether children's parasympathetic reactivity moderated the association between classroom climate and externalizing symptoms. Independent observers coded teachers' use of child-centered and teacher-directed instructional practices across classroom social and management domains. Children's respiratory sinus arrhythmia reactivity to challenge tasks was assessed in fall and a multi-informant measure of externalizing was collected in fall and spring. Both the social and the management domains of classroom climate significantly interacted with children's respiratory sinus arrhythmia reactivity to predict spring externalizing symptoms, controlling for fall symptoms. For more reactive children, as classrooms shifted toward greater proportional use of child-centered methods, externalizing symptoms declined, whereas greater use of teacher-dominated practices was associated with increased symptoms. Conversely, among less reactive children, exposure to more teacher-dominated classroom management practices was associated with lower externalizing. Consistent with the theory of biological sensitivity to context, considering variability in children's physiological reactivity aids understanding of the salience of the classroom environment for children's mental health.
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Ljungström BM, Kenne Sarenmalm E, Axberg U. Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study. Child Adolesc Psychiatry Ment Health 2020; 14:34. [PMID: 32944068 PMCID: PMC7491084 DOI: 10.1186/s13034-020-00339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 08/26/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Children with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down). METHOD Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test. RESULTS In the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior. CONCLUSIONS The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.
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Affiliation(s)
- Britt-Marie Ljungström
- grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Box 500, 405 30 Göteborg, Sweden
| | - Elisabeth Kenne Sarenmalm
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Box 400, 405 30 Göteborg, Sweden ,grid.416029.80000 0004 0624 0275Research and Development, Skaraborg Hospital, 541 85 Skövde, Sweden
| | - Ulf Axberg
- grid.463529.fFakultet for Sosialfag/Faculty of Social Studies, Familieterapi Og Systemisk Praksis/Family Therapy and Systemic Pratice, VID Vitenskapelige høgskole/VID Specialized University, Oslo, Norway ,grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Box 500, 405 30 Göteborg, Sweden
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Johnston OG, Cruess DG, Burke JD. Irritability and Behavioral Symptom Dimensions of Oppositional Defiant Disorder in Young Adults: Associations with DSM-5 Pathological Personality Traits. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09786-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Informant-specific reports of peer and teacher relationships buffer the effects of harsh parenting on children's oppositional defiant disorder during kindergarten. Dev Psychopathol 2020; 32:163-174. [PMID: 30458890 DOI: 10.1017/s0954579418001499] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Harsh and restrictive parenting are well-established contributors to the development of oppositional defiant disorder (ODD) among children. However, few studies have explored whether interpersonal relationships that develop outside the family environment attenuate the risk for ODD that is associated with harsh parenting. The current study tested multireporter measures of teacher-child closeness and peer acceptance as moderators of the association between harsh parenting and children's ODD as children's social worlds widen during the kindergarten year (N = 338 children, 48% girls, M age = 5.32 years). Harsh parenting interacted with peer nominations of peer acceptance and children's report of teacher-child closeness to predict children's ODD symptoms in the spring, adjusting for fall symptoms. Children exposed to harsh parenting exhibited greater symptom increases when they were less liked/accepted playmates and in the context of lower teacher-child closeness. However, harsh parenting was not associated with symptom change among children with higher levels of peer-nominated acceptance and those who reported closer relationships with teachers. There were no significant interactions using teacher's report of peer acceptance or teacher's report of teacher-child closeness. Findings highlight positive peer and teacher relationships as promising targets of intervention among children exposed to harsh parenting and support the importance of assessing multiple perspectives of children's social functioning.
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21
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Kaya C, Bezyak J, Chan F, Bengtson K, Hsu S. Autonomy Support, Life Satisfaction, and Quality of Life of Cancer Patients. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract. Previous research shows that perceived autonomy support is significantly associated with positive health outcomes for different clinical populations. However, there is not a standardized measurement tool that assesses perceived autonomy support for the Turkish population. This study translated the Health Care Climate Questionnaire (HCCQ), a perceived autonomy support measurement tool, into Turkish and investigated the factorial structure of the questionnaire with a group of patients with cancer. This study used a convenience-sampling method with 192 people with cancer. The participants were recruited from a major cancer institute and a non-profit organization in Turkey by research partners. Volunteer participants either filled out a hard copy of a survey packet or completed the survey packet through a secured online survey tool website (i.e., https://www.surveymonkey.com ). In addition, a closed Facebook group for cancer survivors in Turkey was used to advertise the study’s link. The results indicated the participants perceived a moderate level of autonomy support. In comparison to German and US populations, perceived autonomy support was low among Turkish cancer patients. The results also indicated that the HCCQ has a two-factor measurement structure. Correlations with external variables indicated that the scores of HCCQ were significantly positively associated with life satisfaction and quality of life of cancer patients and negatively associated with cancer related symptoms (e.g., fatigue).
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Affiliation(s)
- Cahit Kaya
- Department of Educational Sciences, Giresun University, Giresun, Turkey
| | - Jill Bezyak
- Department of Rehabilitation Counseling and Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Fong Chan
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, WI, USA
| | - Kevin Bengtson
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
| | - Sharon Hsu
- Institute on Disability, University of Memphis, TN, USA
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Zachary C, Jones DJ. The Role of Irritability in the Treatment of Behavior Disorders: A Review of Theory, Research, and a Proposed Framework. Clin Child Fam Psychol Rev 2020; 22:197-207. [PMID: 30617935 DOI: 10.1007/s10567-018-00272-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Research provides strong evidence that the symptoms of Oppositional Defiant Disorder (ODD) are comprised of at least two dimensions: irritability and defiance. Given that these two dimensions have distinct etiologies and long-term risk profiles, they may also warrant different treatment approaches. In particular, impaired emotion regulation plays a central role in the irritable dimension of ODD. As such, this subgroup of youth and their families may benefit from greater consideration of and attention to emotion-focused strategies than is standard in traditional Behavioral Parent Training (BPT) approaches. In support of this hypothesis, this review will (1) examine the etiological models guiding the theoretical approach to standard BPT; (2) evaluate theory and research on emotion socialization broadly and its role in the etiology and maintenance of irritability in children with BDs; (3) propose an emotion socialization-based etiological model for the irritable dimension of child oppositionality; and (4) argue for the use of emotion-focused parent training in the treatment of such youth. Clinical implications, gaps in the current state of the literature, and future directions for research will also be discussed.
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Affiliation(s)
- Chloe Zachary
- University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Deborah J Jones
- University of North Carolina at Chapel Hill, Chapel Hill, USA
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Levy T, Kronenberg S, Crosbie J, Schachar RJ. Attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidality in children: The mediating role of depression, irritability and anxiety symptoms. J Affect Disord 2020; 265:200-206. [PMID: 32090742 DOI: 10.1016/j.jad.2020.01.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 11/22/2019] [Accepted: 01/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with increased suicidality risk. Yet, potential mechanisms transmitting the effect of ADHD to suicidality remain unclear. We investigated whether depression, irritability and anxiety symptoms mediate between ADHD symptoms and suicidality. METHODS ADHD, depression, irritability and anxiety symptoms as well as suicidality (composited of suicidal ideation, attempts or self-harm) were measured in an outpatient clinic for ADHD (N = 1,516, 6-17 years old, 61.1% diagnosed with ADHD) using parent and teacher questionnaires. Multiple mediator models adjusted for age, sex and psychosocial adversities were constructed separately for parent- and teacher-report. RESULTS Parents reported higher rates of suicidality than did teachers (12.1% and 3.8%, p < .001). Suicidality was associated with parent (OR = 1.10, 95%CI: 1.07-1.14) and teacher (OR = 1.08, 95%CI: 1.03-1.15) reported ADHD symptoms. The association between ADHD symptoms and suicidality was mediated by both parent- and teacher-reported depression (39.1% and 45.3% of total effect, respectively) and irritability symptoms (36.8% and 38.4% of total effect, respectively). Anxiety symptoms mediated between ADHD and suicidality for parent- but not teacher-report (19.0% of total effect). No direct effect of ADHD symptoms was found once depression, irritability and anxiety were controlled. LIMITATIONS The cross-sectional design limits the ability to determine causal order between mediators and outcome. CONCLUSIONS Our results confirmed the association between ADHD symptoms and suicidality. However, this association was indirect and fully mediated by symptoms of depression, irritability and anxiety. Assessing these symptoms may enable an estimate of suicidality and help managing suicidal risk in ADHD.
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Affiliation(s)
- Tomer Levy
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sefi Kronenberg
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Russell James Schachar
- Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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24
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Ezpeleta L, Penelo E, de la Osa N, Navarro JB, Trepat E. How the Affective Reactivity Index (ARI) works for teachers as informants. J Affect Disord 2020; 261:40-48. [PMID: 31600586 DOI: 10.1016/j.jad.2019.09.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/21/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Affective Reactivity Index (ARI) is a brief instrument originally designed as a self- and parent report. However, the view of teachers, who can observe social situations that may give rise to irritability, is relevant. The goal is to provide the measurement qualities of the ARI score as reported by teachers. METHOD Children formed part of a longitudinal study on behavior problems in Barcelona (Spain) and they were assessed when they were 7 (N = 471) and 11 years old (N = 454) with questionnaires about psychopathology, anger and aggressive behavior, and a diagnostic interview answered by the parents, youths and teachers. Confirmatory factor analysis, measurement invariance, reliability and validity were studied for the ARI answered by teachers. RESULTS The 6-item, 1-factor model fitted well. Almost full metric invariance and partial scalar invariance was obtained across sex and over age. The ARI scores largely converged with other teacher-reported measures of anger and irritability, and with other measures of psychopathology, aggressive behavior, and callous-unemotional traits at a medium level. The associations with parent's measures were medium to low, and very low for child self-reported measures. The ARI scores significantly differentiated children with and without psychopathology and functional impairment, both cross-sectionally and longitudinally. LIMITATIONS Only one child self-report measure of irritability included. Limited internal consistency of some scale scores. Findings are mostly generalizable to Spanish children. CONCLUSIONS ARI could be a suitable instrument for measuring irritability as reported by teachers. The teacher's view can be useful when planning treatment by helping to identify treatment targets.
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Affiliation(s)
- Lourdes Ezpeleta
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, 2017 SGR 33, Generalitat de Catalunya, Spain; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Eva Penelo
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, 2017 SGR 33, Generalitat de Catalunya, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Núria de la Osa
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, 2017 SGR 33, Generalitat de Catalunya, Spain; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Blas Navarro
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, 2017 SGR 33, Generalitat de Catalunya, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Esther Trepat
- Unitat d'Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, 2017 SGR 33, Generalitat de Catalunya, Spain; Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Maire J, Galera C, Bioulac S, Bouvard M, Michel G. Emotional lability and irritability have specific associations with symptomatology in children with attention deficit hyperactivity disorder. Psychiatry Res 2020; 285:112789. [PMID: 32014627 DOI: 10.1016/j.psychres.2020.112789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022]
Abstract
Irritability and emotional lability have been shown to be severity and impairment factors in community and clinical sample studies and are frequent comorbid features of Attention Deficit Hyperactivity Disorder (ADHD). However, while irritability and emotional lability seem to be closely linked, the differential effect of these two features has received little attention. This study assessed the distinct associations of irritability and emotional lability on symptomatology in children with ADHD. One hundred and eight children diagnosed with ADHD participated in the study. Children were rated by parents on ADHD and comorbid symptomatology with the Conners Rating Scale - Revised. Irritability was the most significant predictive factor of the severity of anxiety and oppositional symptoms. Regarding emotional lability, it was significantly predictive of the severity of hyperactivity symptoms. While emotional lability shares common theoretical characteristics with irritability, each seems to be associated with specific areas. Irritability is a symptom of Oppositional Defiant Disorder, a frequent ADHD comorbidity, and also seems to be related to internalizing disorder (e.g. anxiety). Emotional lability seems to be related to ADHD severity symptoms per se. Both could be clinically informative in the diagnosis of ADHD and its comorbidities.
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Affiliation(s)
| | - Cédric Galera
- Department "Health and achievement in the young", INSERM U1219, University of Bordeaux, France; Child and Adolescent Psychiatry Department, Charles Perrens Hospital, Bordeaux, France
| | | | - Manuel Bouvard
- Child and Adolescent Psychiatry Department, Charles Perrens Hospital, Bordeaux, France
| | - Grégory Michel
- Institut de Sciences Criminelles et de la Justice (ISCJ), University of Bordeaux, Bordeaux, France
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Gomez R, Stavropoulos V. Oppositional Defiant Disorder Dimensions: Associations with Traits of the Multidimensional Personality Model among Adults. Psychiatr Q 2019; 90:777-792. [PMID: 31407123 DOI: 10.1007/s11126-019-09663-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The occurrence of Oppositional Defiant Disorder (ODD) behaviours among adults has been supported by a proportion of scholars. The current work examines potential ODD dimensions and their associations with the primary personality traits of Tellegen's [57] multi-dimensional conceptualization during adulthood. Two independent, general community, adult groups [Group 1: N = 214; mean age (SD) = 35.74 (16.60); Group 2: N = 205; mean age (SD) = 29.00 (12.42)] completed the Current Symptom Scale involving the eight ODD criteria. Group 2 additionally addressed the Multidimensional Personality Questionnaire -Brief Form (MPQ-BF). A series of Confirmatory Factor Analyses (CFA) were implemented. The three-dimensional ODD conceptualization of Burke and colleagues [14] referring to "Negative Affect", "Oppositional Behavior", and "Antagonistic Behavior" was confirmed. Considering personality traits, valuable associations were revealed between Oppositional Behavior and Aggression, Antagonistic Behavior and Social Potency as well as Harm Avoidance, and finally, Negative Affect and Stress Reaction, as well as Aggression. The dimensionality of ODD behaviours in adulthood and its correspondence with particular personality traits is approached in the context of psychological practice.
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Affiliation(s)
- Rapson Gomez
- Federation University, Mount Helen Campus, Ballarat, Victoria, Australia
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Young AS, Youngstrom EA, Findling RL, Van Eck K, Kaplin D, Youngstrom JK, Calabrese J, Stepanova E, The Lams Consortium. Developing and Validating a Definition of Impulsive/Reactive Aggression in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:787-803. [PMID: 31343896 DOI: 10.1080/15374416.2019.1622121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The goal of this study is to develop a rational data-driven definition of impulsive/reactive aggression and establish distinctions between impulsive/reactive aggression and other common childhood problems. This is a secondary analysis of data from Assessing Bipolar: A Community Academic Blend (ABACAB; N = 636, ages 5-18), Stanley Medical Research Institute N = 392, ages 5-17), and the Longitudinal Assessment of Manic Symptoms (LAMS; N = 679, ages 6-12) studies, which recruited youths seeking outpatient mental health services in academic medical centers and community clinics. Following Jensen et al.'s (2007) procedure, 3 judges independently rated items from several widely used scales in terms of assessing impulsive/reactive aggression. Principal components analyses (PCA) modeled structure of the selected items supplemented by items related to mood symptoms, rule-breaking behavior, and hyperactivity/impulsivity to better define the boundaries between impulsive/reactive aggression and other common childhood symptoms. In the rational item selection process, there was good agreement among the 3 experts who rated items as characterizing impulsive/reactive aggression or not. PCA favored 5 dimension solutions in all 3 samples. Across all samples, PCA resulted in rule-breaking behavior, aggression-impulsive/reactive (AIR), mania, and depression dimensions; there was an additional hyperactive/impulsive dimension in the LAMS sample and a self-harm dimension in ABACAB and Stanley samples. The dimensions demonstrated good internal consistency; criterion validity coefficients also showed consistency across samples. This study is a step toward developing an empirically derived nosology of impulsive aggression/AIR. Findings support the validity of the AIR construct, which can be distinguished from manic and depressive symptoms as well as rule-breaking behavior.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Kathryn Van Eck
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Dana Kaplin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | - Jennifer K Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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Evans SC, Bonadio FT, Bearman SK, Ugueto AM, Chorpita BF, Weisz JR. Assessing the Irritable and Defiant Dimensions of Youth Oppositional Behavior Using CBCL and YSR Items. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:804-819. [PMID: 31276433 DOI: 10.1080/15374416.2019.1622119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Research suggests that irritability and defiance are distinct dimensions of youth oppositionality that are differentially associated with internalizing and conduct problems, respectively. Because much of this evidence has emerged with limited psychometric evaluation, we conducted the first multi-informant examination of selected Child Behavior Checklist (CBCL) and Youth Self Report (YSR) items for measuring irritability and defiance in a large clinical sample. Clinically referred youths (N = 1,030; ages 6-15; 43% female, 42% ethnic minority) were assessed prior to treatment using multi-informant rating scales and diagnostic interviews. Analyses examined factor structure, invariance, internal consistency, multi-informant patterns, and convergent, discriminant, and criterion validity with internalizing and externalizing problems/disorders. A correlated 2-factor model of irritability (stubborn/sullen/irritable, mood, temper) and defiance (argues, disobeys-home, disobeys-school) fit well for both informants. Adequate measurement invariance and scale consistency was consistently found for parent-report but not youth-report. With both informants, all hypothesized convergent and discriminant validity associations were supported: irritability and defiance with internalizing and conduct scales, respectively. However, hypothesized criterion validity associations were largely found only by parent-report: irritability with anxiety and depressive disorders, defiance with conduct disorder, and both with oppositional defiant disorder. Results consistently supported the reliability and validity of the CBCL irritability and defiance scales, with somewhat less consistent support for the YSR scales. Thus, CBCL items may provide psychometrically sound assessment of irritability and defiance, whereas further research is needed to advance youth-report and multi-informant strategies. Results also provide further support for a two subdimension model of oppositional defiant disorder symptoms that includes irritability and defiance.
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Affiliation(s)
| | - F Tony Bonadio
- Department of Psychology, Harvard University.,Institute for Innovation and Implementation, School of Social Work , University of Maryland, Baltimore
| | | | - Ana M Ugueto
- Department of Psychiatry, McGovern Medical School, UT Health Science Center at Houston
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Pan PY, Yeh CB. Irritability and Maladaptation Among Children: The Utility of Chinese Versions of the Affective Reactivity Index and Aberrant Behavior Checklist-Irritability Subscale. J Child Adolesc Psychopharmacol 2019; 29:213-219. [PMID: 30388031 DOI: 10.1089/cap.2018.0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Irritability is among the most bothersome emotional symptoms in children. It often leads to mental health services referral, significant impairment, and distress to their families. Although there is increasing scientific evidence supporting the existence of extreme irritability in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) diagnosis of disruptive mood dysregulation disorder, few studies have investigated the measurement of irritability in children. This pilot study aimed to examine the psychometric properties of the Chinese version of the Affective Reactivity Index (ARI) and the Aberrant Behavior Checklist (ABC)-irritability subscale. In addition, we investigated adaptive difficulties among children with irritability. METHODS A total of 97 children and adolescents 6 to 17 years of age (M = 10.20, SD = 2.70) were recruited from the psychiatric outpatient department of a university hospital in Taipei. The participants completed the Chinese version of the ARI self-report form and the Social Adjustment Inventory for Children and Adolescents (SAICA). Their parents completed the ARI parent report form, the Chinese version of the ABC-irritability subscale, and the Child Behavior Checklist. Diagnostic interviews were administered based on diagnostic criteria of DSM-5 to confirm the participants' psychiatric diagnoses. RESULTS The Chinese ABC-irritability subscale and the parent and self-report scales of the Chinese ARI showed good test-retest reliability, internal consistency, and concurrent validity. Scores from the ABC-irritability subscale and two forms of the ARI were all significantly correlated with aggressive behaviors, anxious/depressed symptoms, and social problems. In addition, irritability among children was significantly associated with maladjustment in school, with peer problems, and with problems at home. CONCLUSIONS Our findings suggest that irritability may be associated with impaired social adaptive functioning among children and adolescents. The Chinese version of the ARI and the ABC-irritability subscale are useful for measuring irritability in both clinical and research settings in the Chinese population.
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Affiliation(s)
- Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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30
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Lin Y, Huang L, Xu J, Specht AJ, Yan C, Geng H, Shen X, Nie LH, Hu H. Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like behavior. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 659:161-167. [PMID: 30597466 PMCID: PMC7781015 DOI: 10.1016/j.scitotenv.2018.12.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Mounting evidence showed that lead exposure increased the risk of child attention-deficit-hyperactivity disorder (ADHD). Epidemiologic studies have typically used the blood-lead as a biomarker of lead exposure; blood-lead levels mostly reflect recent lead exposure. However, few studies have examined the relationship between bone-lead, a biomarker of cumulative exposure, and ADHD. Therefore, we aimed to compare the associations of bone-lead vs blood-lead levels with child ADHD symptoms and comorbidities. METHODS A total of 164 children aged 3-15 years were enrolled during 2014-2015. The Vanderbilt-ADHD-Diagnostic-Parent-Rating Scale (VADPRS) was used to evaluate the children's ADHD symptoms and comorbidities. Children's blood and bone lead concentrations were assessed, the latter using a non-invasive K-X-ray-fluorescence technique. According to blood-lead levels, children were classified into high (blood-lead ≥ 10.0 μg/dL) and low (blood-lead < 10.0 μg/dL) blood-lead groups. According to bone-lead levels, children were classified into high (bone-lead ≥ 2.66 μg/g) and low (bone-lead < 2.66 μg/g) bone-lead groups. We associated blood/bone lead with VADPRS data using multi-variable binary logistic regression models. RESULTS Children in the high blood-lead group had higher hyperactivity/impulsivity (P = 0.02) scores than the corresponding low blood-lead group. Children in the high bone-lead group had higher hyperactivity/impulsivity (P = 0.02) and oppositional-defiant-disorder (ODD) (P = 0.03) scores than the corresponding low bone-lead group. After adjusting for relevant confounders, children in the high bone-lead group were more likely to have ODD-behavior than the low group (OR = 6.7, 95%CI: 1.2-36.5). However, no adjusted association was observed between blood-lead and any ADHD-domain score. CONCLUSION High levels of cumulative lead exposure in children may be an independent risk factor of ODD-behavior.
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Affiliation(s)
- Yanfen Lin
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Huang
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Xu
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Aaron J Specht
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Chonghuai Yan
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongquan Geng
- Department of Pediatric Surgery, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine
| | - Xiaoming Shen
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linda H Nie
- School of Health Sciences, Purdue University, West Lafayette, IN, USA.
| | - Howard Hu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; School of Public Health, University of Washington, Seattle, WA, USA
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31
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Dimensions and subtypes of oppositionality and their relation to comorbidity and psychosocial characteristics. Eur Child Adolesc Psychiatry 2019; 28:351-365. [PMID: 30003396 DOI: 10.1007/s00787-018-1199-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/07/2018] [Indexed: 12/17/2022]
Abstract
The symptoms of oppositional defiant disorder (ODD), or oppositionality, seem to constitute a three-dimensional structure of angry/irritable, vindictiveness and argumentative behavior dimensions. Also, subjects with oppositionality are characterized by different comorbidity and longitudinal trajectories, suggesting that they could be divided into subtypes. This study is the first to examine the dimensions and subtypes of oppositionality in Nordic children. Study participants included 3435 children aged 7-10 years from the Danish National Birth Cohort. Information was collected using the Development and Well-Being Assessment (DAWBA) online version. A three-factor ODD model was identified. The angry/irritable dimension was associated with emotional problems and disorders, fewer social skills and fewer personal positive attributes. The argumentative behavior dimension was associated with hyperactivity/conduct problems, reduced social skills and positive attributes. The vindictiveness dimension was associated with externalizing, internalizing and prosocial problems. Four ODD subtypes were identified. The subtypes with many or mainly angry/irritable symptoms were characterized by comorbid psychopathology, increased functional impairment and psychosocial problems. Children with ODD had fewer positive attributes, more friendship/school problems and higher functional impairment than children with emotional disorders and control group children. Oppositionality consists of three dimensions differently associated with comorbidity and psychosocial characteristics, and the same pattern is seen for the four ODD subtypes identified in this study. Children with ODD experience more adversities and functional impairment than children with emotional disorders. Our results indicate that treatment of children with ODD would improve from extended knowledge on individual ODD dimensions and subtypes and the related child psychosocial characteristics.
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Bolhuis K, Muetzel RL, Stringaris A, Hudziak JJ, Jaddoe VWV, Hillegers MHJ, White T, Kushner SA, Tiemeier H. Structural Brain Connectivity in Childhood Disruptive Behavior Problems: A Multidimensional Approach. Biol Psychiatry 2019; 85:336-344. [PMID: 30119874 DOI: 10.1016/j.biopsych.2018.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Studies of white matter connectivity in children with disruptive behavior have yielded inconsistent results, possibly owing to the trait's heterogeneity, which comprises diverse symptoms like physical aggression, irritability, and delinquency. This study examined associations of global and specific white matter connectivity with childhood disruptive behavior problems, while accounting for their complex multidimensionality. METHODS In a large cross-sectional population-based study of 10-year-old preadolescents (n = 2567), we assessed four previously described empirically derived dimensions of disruptive behavior problems using the Child Behavior Checklist: physical aggression, irritability, disobedient behavior, and delinquent behavior. Global and specific white matter microstructure was assessed by diffusion tensor imaging. RESULTS Global fractional anisotropy and mean diffusivity were not associated with broad measures of disruptive behavior, e.g., Child Behavior Checklist externalizing problems scale. Global fractional anisotropy was negatively associated with delinquent behavior (β = -.123, pfalse discovery rate adjusted = .028) and global mean diffusivity was positively associated with delinquent behavior (β = .205, pfalse discovery rate adjusted < 0.001), suggesting reduced white matter microstructure in preadolescents with higher levels of delinquent behavior. Lower white matter microstructure in the inferior longitudinal fasciculus, superior longitudinal fasciculus, cingulum, and uncinate underlie these associations. Global white matter microstructure was not associated with physical aggression, irritability, or disobedient behavior. CONCLUSIONS Delinquent behavior, a severe manifestation of childhood disruptive behavior, was associated with lower white matter microstructure in tracts connecting frontal and temporal lobes. These brain regions are involved in decision making, reward processing, and emotion regulation. This study demonstrated that incorporating the multidimensional nature of childhood disruptive behavior traits shows promise in advancing the search for elucidating neurobiological correlates of disruptive behavior.
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Affiliation(s)
- Koen Bolhuis
- Department of Child and Adolescent Psychiatry; Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ryan L Muetzel
- Department of Child and Adolescent Psychiatry; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Argyris Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - James J Hudziak
- Department of Psychiatry, Vermont Center for Children, Youth and Families, University of Vermont, Burlington, Vermont
| | - Vincent W V Jaddoe
- Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry; Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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Oppositional behavior and longitudinal predictions of early adulthood mental health problems in chronic tic disorders. Psychiatry Res 2018; 266:301-308. [PMID: 29576412 DOI: 10.1016/j.psychres.2018.03.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/24/2018] [Accepted: 03/13/2018] [Indexed: 11/23/2022]
Abstract
Chronic tic disorders (TD) are associated with a number of psychological problems such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) as well as anxious and depressive symptoms. ODD is often considered a risk factor for many psychological symptoms and recent work suggests that different ODD dimensions show independent predictions of later psychological problems. This study examined the longitudinal predictions between ODD dimensions of Irritability and Defiance and the most frequent comorbidities in TD from childhood to early adulthood. From an initial sample of 135, parent reports were obtained on 58 participants with TD using standard clinical questionnaires and semi-structured interviews. Defiance symptoms decreased from baseline to follow-up whereas Irritability symptoms were more stable over time. In multiple regressions, Irritability in childhood predicted anxiety and OCB in early adulthood while Defiance in childhood predicted ADHD and conduct disorder symptoms in early adulthood. No developmental link was found for depressive symptoms. Results indicate that ODD dimensions are developmentally linked to both internalizing and externalizing adult mental health symptoms in TD.
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Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E. Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 2018; 59:721-739. [PMID: 29083031 DOI: 10.1111/jcpp.12823] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
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Affiliation(s)
- Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Pablo Vidal-Ribas
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.,Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Hukkelberg SS, Ogden T. Dimensionality of oppositional defiant disorder. Child Adolesc Ment Health 2018; 23:121-129. [PMID: 32677339 DOI: 10.1111/camh.12248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study examined dimensionality of oppositional defiant disorder (ODD) using 10 alternative items using network analysis and confirmatory factor analysis. METHODS The sample constituted 551 Norwegian children aged 2-12 and their parents. We used network analysis to investigate the connections between different symptoms. Next, we analysed data using traditional confirmatory factor methods, including the more recently proposed bifactor approach. RESULTS The bifactor model, with a strong general factor and three specific factors, provided the best model fit. Omega values did, however, reveal that only the general and the specific hurtful factor had satisfactory reliability. Network analysis showed that symptoms in general were positively connected within the ODD network. Strong connections between several symptoms within the irritable and hurtful cluster emerged, whereas some symptoms of the headstrong cluster seem to function as bridge nodes between the irritable and hurtful symptom clusters. CONCLUSIONS The findings support a bifactor model of ODD indicators, but omegas only gave support to the use of a general latent factor, and one specific factor. Network analysis did, however, provide some additional and interesting findings, revealing clusters of strongly connected symptoms and central bridge node symptoms. Implications of the results are discussed.
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Affiliation(s)
- Silje S Hukkelberg
- The Norwegian Center for Child Behavioral Development (NUBU) , Oslo, Norway
| | - Terje Ogden
- The Norwegian Center for Child Behavioral Development (NUBU) , Oslo, Norway
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Maternal ratings of ODD symptoms: Subtypes versus severity in a general community sample of children. Compr Psychiatry 2018; 81:81-90. [PMID: 29306067 DOI: 10.1016/j.comppsych.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIMS Oppositional Defiant Disorder (ODD) is a common childhood disorder (American Psychiatric Association [APA], 2000; APA, 2013). The aim of the present study was to ascertain the optimal structure for the ODD symptoms by identifying whether ODD is a qualitatively distinct entity (categorical) or is a continuum, with high levels on this continuum reflecting ODD (quantitative or dimensional view). METHODS Mothers' ratings of the ODD symptoms of 457 children, aged 3 to 15years, as presented in the disruptive behavior rating scale were obtained. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling (FMM) were applied to determine the best model for oppositional defiant disorder (ODD) symptoms in children. RESULTS The findings provided most support for a FMM with 3 classes (unaffected odd class, at risk class, and affected class) and 3 factors (oppositional, antagonistic, and negative affect). CONCLUSION The findings are discussed in relation to dimensional, categorical, and hybrid (categorical/dimensional) models of ODD symptoms.
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The generalizability of the structure of substance abuse and antisocial behavioral syndromes: A systematic review. Psychiatry Res 2018; 259:412-421. [PMID: 29120851 DOI: 10.1016/j.psychres.2017.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/29/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies. PURPOSE The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence. METHOD We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis". RESULTS Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused. CONCLUSIONS Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model.
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Kaya C, Tansey TN, Melekoglu M, Cakiroglu O, Chan F. Psychometric evaluation of Turkish version of the Perceived Stress Scale with Turkish college students. J Ment Health 2017; 28:161-167. [PMID: 29260926 DOI: 10.1080/09638237.2017.1417566] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Turkish version of the Perceived Stress Scale (T-PSS-10) measures the extent to which situations in one's life are appraised as stressful. AIMS The purpose of this study was to evaluate the measurement structure of T-PSS-10. METHOD Two-hundred and thirty-five Turkish university students (93 men and 142 women) completed the T-PSS-10, the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder 7-Item Scale (GAD-7), and the Inventory of Common Problems (ICP). RESULTS Confirmatory factor analysis results indicated that a one-factor model did not fit the data, whereas a two-factor correlated model (stress related self-efficacy beliefs, stress related feelings of helplessness) provided a better fit between the model and the data. Significant moderate correlations were found for the stress-related self-efficacy beliefs and stress-related feelings of helplessness factors with depression, anxiety, academic difficulty, relationship problems and health problems. The internal consistency reliability coefficients for the stress-related self-efficacy beliefs and stress-related feelings of helplessness factors were 0.68 and 0.85, respectively. CONCLUSIONS This study provided support for the reliability and validity of T-PSS-10 suggesting that it can be used as a screening instrument by health professionals working with Turkish college students.
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Affiliation(s)
- Cahit Kaya
- a Southern University-Baton Rouge , Baton Rouge , LA , USA
| | - Timothy N Tansey
- b Department of Rehabilitation Psychology and Special Education , University of Wisconsin-Madison , Madison , WI , USA
| | - Macid Melekoglu
- c Department of Special Education , Eskisehir Osmangazi University , Eskisehir , Turkey , and
| | - Orhan Cakiroglu
- d Department of Special Education , Karadeniz Teknik University , Trabzon , Turkey
| | - Fong Chan
- b Department of Rehabilitation Psychology and Special Education , University of Wisconsin-Madison , Madison , WI , USA
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Abstract
Oppositional defiant disorder (ODD) is diagnosed broadly on the basis of frequent and persistent angry or irritable mood, argumentativeness/defiance, and vindictiveness. Since its inception in the third Diagnostic and Statistical Manual of Mental Disorders, epidemiological and longitudinal studies have strongly suggested a distinct existence of ODD that is different from other closely related externalizing disorders, with different course and outcome and possibly discrete subtypes. However, several issues, such as symptom threshold, dimensional versus categorical conceptualization, and sex-specific symptoms, are yet to be addressed. Although ODD was found to be highly heritable, no genetic polymorphism has been identified with confidence. There has been a definite genetic overlap with other externalizing disorders. Studies have begun to explore its epigenetics and gene–environment interaction. Neuroimaging findings converge to implicate various parts of the prefrontal cortex, amygdala, and insula. Alteration in cortisol levels has also been demonstrated consistently. Although a range of environmental factors, both familial and extrafamilial, have been studied in the past, current research has combined these with other biological parameters. Psychosocial treatment continues to be time-tested and effective. These include parental management training, school-based training, functional family therapy/brief strategic family therapy, and cognitive behavior therapy. Management of severe aggression and treatment of co-morbid disorders are indications for pharmacotherapy. In line with previous conceptualization of chronic irritability as a bipolar spectrum abnormality, most studies have explored antipsychotics and mood stabilizers in the management of aggression, with limited effects.
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Affiliation(s)
- Abhishek Ghosh
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
| | - Anirban Ray
- Department of Psychiatry, Institute of Psychiatry, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Aniruddha Basu
- Drug De-addiction and Treatment Centre, Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh
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Mikolajewski AJ, Taylor J, Iacono WG. Oppositional defiant disorder dimensions: genetic influences and risk for later psychopathology. J Child Psychol Psychiatry 2017; 58:702-710. [PMID: 28059443 PMCID: PMC5438275 DOI: 10.1111/jcpp.12683] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was undertaken to determine how well two oppositional defiant disorder (ODD) dimensions (irritable and headstrong/hurtful) assessed in childhood predict late adolescent psychopathology and the degree to which these outcomes can be attributed to genetic influences shared with ODD dimensions. METHODS Psychopathology was assessed via diagnostic interviews of 1,225 twin pairs at ages 11 and 17. RESULTS Consistent with hypotheses, the irritable dimension uniquely predicted overall internalizing problems, whereas the headstrong/hurtful dimension uniquely predicted substance use disorder symptoms. Both dimensions were predictive of antisocial behavior and overall externalizing problems. The expected relationships between the irritable dimension and specific internalizing disorders were not found. Twin modeling showed that the irritable and headstrong/hurtful dimensions were related to late adolescent psychopathology symptoms through common genetic influences. CONCLUSIONS Symptoms of ODD in childhood pose a significant risk for various mental health outcomes in late adolescence. Further, common genetic influences underlie the covariance between irritable symptoms in childhood and overall internalizing problems in late adolescence, whereas headstrong/hurtful symptoms share genetic influences with substance use disorder symptoms. Antisocial behavior and overall externalizing share common genetic influences with both the irritable and headstrong/hurtful dimensions.
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Affiliation(s)
- Amy J. Mikolajewski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Tulane University, New Orleans, LA,Department of Psychology, Florida State University, Tallahassee, FL
| | - Jeanette Taylor
- Department of Psychology, Florida State University, Tallahassee, FL
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Aebi M, Kuhn C, Banaschewski T, Grimmer Y, Poustka L, Steinhausen HC, Goodman R. The contribution of parent and youth information to identify mental health disorders or problems in adolescents. Child Adolesc Psychiatry Ment Health 2017; 11:23. [PMID: 28465720 PMCID: PMC5408828 DOI: 10.1186/s13034-017-0160-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Discrepancies between multiple informants often create considerable uncertainties in delivering services to youth. The present study assessed the ability of the parent and youth scales of the Strength and Difficulties Questionnaire (SDQ) to predict mental health problems/disorders across several mental health domains as validated against two contrasting indices of validity for psychopathology derived from the Development and Well Being Assessment (DAWBA): (1) an empirically derived computer algorithm and (2) expert based ICD-10 diagnoses. METHODS Ordinal and logistic regressions were used to predict any problems/disorders, emotional problems/disorders and behavioural problems/disorders in a community sample (n = 252) and in a clinic sample (n = 95). RESULTS The findings were strikingly similar in both samples. Parent and youth SDQ scales were related to any problem/disorder. Youth SDQ symptom and impact had the strongest association with emotional problems/disorder and parent SDQ symptom score were most strongly related to behavioural problems/disorders. Both the SDQ total and the impact scores significantly predicted emotional problems/disorders in males whereas this was the case only for the total SDQ score in females. CONCLUSION The present study confirms and expands previous findings on parent and youth informant validity. Clinicians should include both parent and youth for identifying any mental health problems/disorders, youth information for detecting emotional problems/disorders, and parent information to detect behavioural problems/disorders. Not only symptom scores but also impact measures may be useful to detect emotional problems/disorders, particularly in male youth.
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Affiliation(s)
- Marcel Aebi
- 0000 0004 0478 9977grid.412004.3Department of Child and Adolescent Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland ,0000 0004 0478 9977grid.412004.3Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Neptunstrasse 60, 8032 Zurich, Switzerland ,0000 0004 1937 0650grid.7400.3Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, University of Zurich, Zurich, Switzerland
| | - Christine Kuhn
- 0000 0004 0478 9977grid.412004.3Department of Child and Adolescent Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Tobias Banaschewski
- 0000 0001 2190 4373grid.7700.0Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Yvonne Grimmer
- 0000 0001 2190 4373grid.7700.0Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Luise Poustka
- 0000 0001 2364 4210grid.7450.6Department of Child and Adolescent Psychiatry/Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Hans-Christoph Steinhausen
- 0000 0004 0478 9977grid.412004.3Department of Child and Adolescent Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland ,Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark ,0000 0004 1937 0642grid.6612.3Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Robert Goodman
- 0000 0001 2322 6764grid.13097.3cDepartment of Child and Adolescent Psychiatry, King’s College London Institute of Psychology, Psychiatry & Neuroscience, London, UK
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Tseng WL, Moroney E, Machlin L, Roberson-Nay R, Hettema JM, Carney D, Stoddard J, Towbin KA, Pine DS, Leibenluft E, Brotman MA. Test-retest reliability and validity of a frustration paradigm and irritability measures. J Affect Disord 2017; 212:38-45. [PMID: 28135689 PMCID: PMC8049456 DOI: 10.1016/j.jad.2017.01.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data on the reliability and validity of assessments for irritability, particularly behavioral paradigms, are limited. This study examined the test-retest reliability and validity of a frustration paradigm (the Affective Posner 2 task) and two irritability measures [the Affective Reactivity Index (ARI) and Child Behavior Checklist (CBCL) irritability]. METHODS Participants were 109 youth from a general population sample of twins (aged 9-14 years). Participants completed two visits that were 2-4 weeks apart. At both visits, participants completed the Affective Posner 2 task and self-reported their irritability using the ARI. Parents reported their child's irritability using the ARI and completed the CBCL. RESULTS The Affective Posner 2 task demonstrated good test-retest reliability, with intraclass correlations (ICCs) ranging from .44 to .78. The task effectively evoked negative affect (frustration and unhappiness) at both test and retest, demonstrating its construct validity. Moreover, self-rated frustration and unhappiness during the frustration components of the task correlated positively with self-reported but not parent-reported irritability, providing modest support for convergent validity. Parent- and child-reports of the ARI and parent-reports of the CBCL irritability measure showed excellent test-retest reliability, with ICCs ranging from .88 to .90. LIMITATIONS The sample consists of mostly twins aged 9-14 years from the communities. Thus, results may not generalize to non-twin samples or clinical samples outside of this age range. CONCLUSIONS The Affective Posner 2 paradigm and the ARI and CBCL irritability scales may be useful tools for longitudinal or treatment research on irritability.
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Affiliation(s)
- Wan-Ling Tseng
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Elizabeth Moroney
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Laura Machlin
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Roxann Roberson-Nay
- Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - John M. Hettema
- Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Dever Carney
- Department of Psychiatry and the Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Joel Stoddard
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Kenneth A. Towbin
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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43
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Gomez R. Factor structure of parent and teacher ratings of the ODD symptoms for Malaysian primary school children. Asian J Psychiatr 2017; 25:22-26. [PMID: 28262156 DOI: 10.1016/j.ajp.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/01/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022]
Abstract
This present study used confirmatory factor analysis (CFA) to examine the applicability of one-, two- three- and second order Oppositional Defiant Disorder (ODD) factor models, proposed in previous studies, in a group of Malaysian primary school children. These models were primarily based on parent reports. In the current study, parent and teacher ratings of the ODD symptoms were obtained for 934 children. For both groups of respondents, the findings showing some support for all models examined, with most support for a second order model with Burke et al. (2010) three factors (oppositional, antagonistic, and negative affect) as the primary factors. The diagnostic implications of the findings are discussed.
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Irritability in child and adolescent psychopathology: An integrative review for ICD-11. Clin Psychol Rev 2017; 53:29-45. [PMID: 28192774 DOI: 10.1016/j.cpr.2017.01.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022]
Abstract
In preparation for the World Health Organization's development of the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11) chapter on Mental and Behavioral Disorders, this article reviews the literature pertaining to severe irritability in child and adolescent psychopathology. First, research on severe mood dysregulation suggests that youth with irritability and temper outbursts, among other features of hyperactivity and arousal, demonstrate cross-sectional correlates and developmental outcomes that distinguish them from youth with bipolar disorder. Second, other evidence points to an irritable dimension of Oppositional Defiant Disorder symptomatology, which is uniquely associated with concurrent and subsequent internalizing problems. In contrast to the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Disruptive Mood Dysregulation Disorder, our review of the literature supports a different solution: a subtype, Oppositional Defiant Disorder with chronic irritability/anger (proposal included in Appendix). This solution is more consistent with the available evidence and is a better fit with global public health considerations such as harm/benefit potential, clinical utility, and cross-cultural applicability. Implications for assessment, treatment, and research are discussed.
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Griffith SF, Arnold DH, Rolon-Arroyo B, Harvey EA. Neuropsychological Predictors of ODD Symptom Dimensions in Young Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 48:80-92. [PMID: 28080145 DOI: 10.1080/15374416.2016.1266643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Oppositional defiant disorder (ODD) is a commonly diagnosed childhood behavior disorder, yet knowledge of relations between ODD and early neuropsychological functions, particularly independent of attention deficit/hyperactivity disorder (ADHD), is still limited. In addition, studies have not examined neuropsy chological functioning as it relates to the different ODD symptom dimensions. Structural equation modeling was used to investigate how preschool neuropsychological functioning predicted negative affect, oppositional behavior, and antagonistic behavior symptom dimensions of ODD in 224 six-year-old children, oversampled for early behavior problems. Working memory, inhibition, and sustained attention predicted negative affect symptoms of ODD, controlling for ADHD, whereas delay aversion uniquely predicted oppositional behavior, controlling for ADHD. Delay aversion also marginally predicted antagonistic behavior, controlling for ADHD. Results demonstrate that different ODD symptom dimensions may be differentially predicted by different neuropsychological functions. The findings further underscore the importance of future research on ODD to take into account the possible heterogeneity of both symptoms and underlying neuropsychological functioning.
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Affiliation(s)
- Shayl F Griffith
- a Psychological and Brain Sciences , University of Massachusetts Amherst
| | - David H Arnold
- a Psychological and Brain Sciences , University of Massachusetts Amherst
| | | | - Elizabeth A Harvey
- a Psychological and Brain Sciences , University of Massachusetts Amherst
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46
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Vidal-Ribas P, Brotman MA, Valdivieso I, Leibenluft E, Stringaris A. The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review. J Am Acad Child Adolesc Psychiatry 2016; 55:556-70. [PMID: 27343883 PMCID: PMC4927461 DOI: 10.1016/j.jaac.2016.04.014] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Research and clinical interest in irritability have been on the rise in recent years. Yet several questions remain about the status of irritability in psychiatry, including whether irritability can be differentiated from other symptoms, whether it forms a distinct disorder, and whether it is a meaningful predictor of clinical outcomes. In this article, we try to answer these questions by reviewing the evidence on how reliably irritability can be measured and its validity. METHOD We combine a narrative and systematic review and meta-analysis of studies. For the systematic review and meta-analysis, we searched studies in PubMed and Web of Science based on preselected criteria. A total of 163 articles were reviewed, and 24 were included. RESULTS We found that irritability forms a distinct dimension with substantial stability across time, and that it is specifically associated with depression and anxiety in longitudinal studies. Evidence from genetic studies reveals that irritability is moderately heritable, and its overlap with depression is explained mainly by genetic factors. Behavioral and neuroimaging studies show that youth with persistent irritability exhibit altered activations in the amygdala, striatum, and frontal regions compared with age-matched healthy volunteers. Most knowledge about the treatment of irritability is based on effects of treatment on related conditions or post hoc analyses of trial data. CONCLUSION We identify a number of research priorities including innovative experimental designs and priorities for treatment studies, and conclude with recommendations for the assessment of irritability for researchers and clinicians.
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Affiliation(s)
- Pablo Vidal-Ribas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Melissa A Brotman
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Isabel Valdivieso
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Argyris Stringaris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Brevik EJ, van Donkelaar MMJ, Weber H, Sánchez‐Mora C, Jacob C, Rivero O, Kittel‐Schneider S, Garcia‐Martínez I, Aebi M, van Hulzen K, Cormand B, Ramos‐Quiroga JA, Lesch K, Reif A, Ribasés M, Franke B, Posserud M, Johansson S, Lundervold AJ, Haavik J, Zayats T. Genome-wide analyses of aggressiveness in attention-deficit hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 2016; 171:733-47. [PMID: 27021288 PMCID: PMC5071721 DOI: 10.1002/ajmg.b.32434] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/09/2016] [Indexed: 12/03/2022]
Abstract
Aggressiveness is a behavioral trait that has the potential to be harmful to individuals and society. With an estimated heritability of about 40%, genetics is important in its development. We performed an exploratory genome-wide association (GWA) analysis of childhood aggressiveness in attention deficit hyperactivity disorder (ADHD) to gain insight into the underlying biological processes associated with this trait. Our primary sample consisted of 1,060 adult ADHD patients (aADHD). To further explore the genetic architecture of childhood aggressiveness, we performed enrichment analyses of suggestive genome-wide associations observed in aADHD among GWA signals of dimensions of oppositionality (defiant/vindictive and irritable dimensions) in childhood ADHD (cADHD). No single polymorphism reached genome-wide significance (P < 5.00E-08). The strongest signal in aADHD was observed at rs10826548, within a long noncoding RNA gene (beta = -1.66, standard error (SE) = 0.34, P = 1.07E-06), closely followed by rs35974940 in the neurotrimin gene (beta = 3.23, SE = 0.67, P = 1.26E-06). The top GWA SNPs observed in aADHD showed significant enrichment of signals from both the defiant/vindictive dimension (Fisher's P-value = 2.28E-06) and the irritable dimension in cADHD (Fisher's P-value = 0.0061). In sum, our results identify a number of biologically interesting markers possibly underlying childhood aggressiveness and provide targets for further genetic exploration of aggressiveness across psychiatric disorders. © 2016 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Erlend J. Brevik
- Division of PsychiatryHaukeland University HospitalBergenNorway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of BiomedicineUniversity of BergenBergenNorway
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway
| | - Marjolein M. J. van Donkelaar
- Department of Human GeneticsDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Heike Weber
- Department of Psychiatry, Psychosomatics and PsychotherapyUniversity of FrankfurtFrankfurtGermany
| | - Cristina Sánchez‐Mora
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of PsychiatryHospital Universitari Vall d'HebronBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
| | - Christian Jacob
- Department of Psychiatry and PsychotherapyKlinik NürtingenNürtingenGermany
| | - Olga Rivero
- Division of Molecular PsychiatryCenter of Mental Health, University of WürzburgWürzburgGermany
| | - Sarah Kittel‐Schneider
- Division of Molecular PsychiatryCenter of Mental Health, University of WürzburgWürzburgGermany
| | - Iris Garcia‐Martínez
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of PsychiatryHospital Universitari Vall d'HebronBarcelonaSpain
| | - Marcel Aebi
- Department of Forensic PsychiatryChild and Youth Forensic Service, University Hospital of PsychiatryZurichSwitzerland
- Department of Child and Adolescent PsychiatryUniversity of ZurichZurichSwitzerland
| | - Kimm van Hulzen
- Department of Human GeneticsDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Bru Cormand
- Facultat de Biologia, Departament de GenèticaUniversitat de BarcelonaCataloniaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)BarcelonaSpain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB)CataloniaSpain
| | - Josep A. Ramos‐Quiroga
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of PsychiatryHospital Universitari Vall d'HebronBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
- Department of Psychiatry and Legal MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Klaus‐Peter Lesch
- Department of Psychiatry and PsychotherapyKlinik NürtingenNürtingenGermany
- Department of Translational NeuroscienceSchool for Mental Health and Neuroscience (MHeNS), Maastricht UniversityMaastrichtThe Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatics and PsychotherapyUniversity of FrankfurtFrankfurtGermany
| | - Marta Ribasés
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
- Department of PsychiatryHospital Universitari Vall d'HebronBarcelonaSpain
- Biomedical Network Research Centre on Mental Health (CIBERSAM)BarcelonaSpain
| | - Barbara Franke
- Department of Human GeneticsDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
- Department of PsychiatryDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Maj‐Britt Posserud
- Division of PsychiatryHaukeland University HospitalBergenNorway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of BiomedicineUniversity of BergenBergenNorway
| | - Stefan Johansson
- Center for Medical Genetics and Molecular MedicineHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Astri J. Lundervold
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of BiomedicineUniversity of BergenBergenNorway
- Department of Biological and Medical PsychologyUniversity of BergenBergenNorway
| | - Jan Haavik
- Division of PsychiatryHaukeland University HospitalBergenNorway
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of BiomedicineUniversity of BergenBergenNorway
| | - Tetyana Zayats
- K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Department of BiomedicineUniversity of BergenBergenNorway
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Aebi M, van Donkelaar MMJ, Poelmans G, Buitelaar JK, Sonuga‐Barke EJS, Stringaris A, consortium IMAGE, Faraone SV, Franke B, Steinhausen H, van Hulzen KJE. Gene-set and multivariate genome-wide association analysis of oppositional defiant behavior subtypes in attention-deficit/hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 2016; 171:573-88. [PMID: 26184070 PMCID: PMC4715802 DOI: 10.1002/ajmg.b.32346] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/29/2015] [Indexed: 12/02/2022]
Abstract
Oppositional defiant disorder (ODD) is a frequent psychiatric disorder seen in children and adolescents with attention-deficit-hyperactivity disorder (ADHD). ODD is also a common antecedent to both affective disorders and aggressive behaviors. Although the heritability of ODD has been estimated to be around 0.60, there has been little research into the molecular genetics of ODD. The present study examined the association of irritable and defiant/vindictive dimensions and categorical subtypes of ODD (based on latent class analyses) with previously described specific polymorphisms (DRD4 exon3 VNTR, 5-HTTLPR, and seven OXTR SNPs) as well as with dopamine, serotonin, and oxytocin genes and pathways in a clinical sample of children and adolescents with ADHD. In addition, we performed a multivariate genome-wide association study (GWAS) of the aforementioned ODD dimensions and subtypes. Apart from adjusting the analyses for age and sex, we controlled for "parental ability to cope with disruptive behavior." None of the hypothesis-driven analyses revealed a significant association with ODD dimensions and subtypes. Inadequate parenting behavior was significantly associated with all ODD dimensions and subtypes, most strongly with defiant/vindictive behaviors. In addition, the GWAS did not result in genome-wide significant findings but bioinformatics and literature analyses revealed that the proteins encoded by 28 of the 53 top-ranked genes functionally interact in a molecular landscape centered around Beta-catenin signaling and involved in the regulation of neurite outgrowth. Our findings provide new insights into the molecular basis of ODD and inform future genetic studies of oppositional behavior. © 2015 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Marcel Aebi
- Department of Forensic Psychiatry, Child and Youth Forensic ServiceUniversity Hospital of PsychiatryZurichSwitzerland
- Department of Child and Adolescent PsychiatryUniversity of ZurichZurichSwitzerland
| | - Marjolein M. J. van Donkelaar
- Department of Human GeneticsRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Geert Poelmans
- Department of Human GeneticsRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
- Department of Molecular Animal PhysiologyDonders Institute for Brain, Cognition and Behavior, Radboud Institute for Molecular Life Sciences, Radboud UniversityNijmegenThe Netherlands
| | - Jan K. Buitelaar
- Department of Cognitive NeuroscienceDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Edmund J. S. Sonuga‐Barke
- Developmental Brain‐Behaviour LaboratoryDepartment of PsychologyUniversity of SouthamptonSouthamptonUK
- Department of Experimental Clinical and Health PsychologyGhent UniversityGhentBelgium
| | | | - IMAGE consortium
- Department of Forensic Psychiatry, Child and Youth Forensic ServiceUniversity Hospital of PsychiatryZurichSwitzerland
| | - Stephen V. Faraone
- Department of PsychiatrySUNY Upstate Medical UniversitySyracuseNew York
- Departmentof Neuroscience and PhysiologySUNY Upstate Medical UniversitySyracuseNew York
- Department of BiomedicineK.G. Jebsen Centre for Psychiatric DisordersUniversity of BergenBergenNorway
| | - Barbara Franke
- Department of Human GeneticsRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- Department of PsychiatryDonders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Hans‐Christoph Steinhausen
- Department of Child and Adolescent PsychiatryUniversity of ZurichZurichSwitzerland
- Department of Psychology, Clinical Psychology and EpidemiologyUniversity of BaselBaselSwitzerland
- Research Unit for Child and Adolescent Psychiatry, Psychiatric HospitalAalborg University HospitalAalborgDenmark
| | - Kimm J. E. van Hulzen
- Department of Human GeneticsRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
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Aebi M, Barra S, Bessler C, Steinhausen HC, Walitza S, Plattner B. Oppositional defiant disorder dimensions and subtypes among detained male adolescent offenders. J Child Psychol Psychiatry 2016; 57:729-36. [PMID: 26493948 DOI: 10.1111/jcpp.12473] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND In adolescent offenders, oppositional defiant disorder (ODD) and its dimensions/subtypes have been frequently ignored due to the stronger focus on criminal behaviours. The revised criteria of the DSM-5 now allow diagnosing ODD in older youths independent of conduct disorder (CD). This study aimed at analysing ODD dimensions/subtypes and their relation to suicidality, comorbid psychiatric disorders, and criminal behaviours after release from detention in a sample of detained male adolescents. METHODS Suicidality and psychiatric disorders (including ODD symptoms) were assessed in a consecutive sample of 158 male adolescents (Mage = 16.89 years) from the Zurich Juvenile Detention Centre. Based on previous research findings, an irritable ODD dimension and a defiant/vindictive ODD dimension based on ODD symptoms were defined. Latent Class Analysis (LCA) was used to identify distinct subtypes of adolescent offenders according to their ODD symptom profiles. Logistic regression and Cox regression were used to analyse the relations of ODD dimensions/ODD subtypes to comorbid psychopathology and criminal reoffenses from official data. RESULTS The ODD-irritable dimension, but not the ODD defiant/vindictive dimension predicted comorbid anxiety, suicidality and violent reoffending. LCA identified four subtypes, namely, a no-ODD subtype, a severe ODD subtype and two moderate ODD subtypes with either defiant or irritable symptoms. The irritable ODD subtype and the severe ODD subtype were related to suicidality and comorbid affective/anxiety disorders. The irritable ODD subtype was the strongest predictor of criminal (violent) reoffending even when controlling for CD. CONCLUSIONS The present findings confirm the presence of ODD dimensions/subtypes in a highly disturbed adolescent offender sample. Irritable youths were at risk of suicide and persistent criminal behaviours. Due to the severe consequences of irritability, a standardized assessment approach and a specific treatment is needed in prison to prevent suicide among the detainees and further harm to the society. As defined in the DSM-5, the present findings confirm the validity of ODD and ODD dimensions/subtypes as a diagnostic category among older youths.
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Affiliation(s)
- Marcel Aebi
- Department of Forensic Psychiatry, Child and Youth Forensic Service, University Hospital of Psychiatry, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Steffen Barra
- Department of Forensic Psychiatry, Child and Youth Forensic Service, University Hospital of Psychiatry, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Cornelia Bessler
- Department of Forensic Psychiatry, Child and Youth Forensic Service, University Hospital of Psychiatry, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland.,Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Belinda Plattner
- Department of Child and Adolescent Psychiatry, Paracelsus Medical University, Salzburg, Austria
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Herzhoff K, Smack AJ, Reardon KW, Martel MM, Tackett JL. Child Personality Accounts for Oppositional Defiant Disorder Comorbidity Patterns. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 45:327-335. [PMID: 27233508 DOI: 10.1007/s10802-016-0162-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kathrin Herzhoff
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL, 60208, USA.
| | - Avanté J Smack
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL, 60208, USA
| | - Kathleen W Reardon
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL, 60208, USA
| | - Michelle M Martel
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jennifer L Tackett
- Department of Psychology, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL, 60208, USA.
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