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Chen M, Jiang X. The impact of modified Cognitive-Behavioral Group Therapy in social adjustment functions of children with attention deficit hyperactivity disorder and their parents' stress levels: A nonrandomized clinical trial. J Clin Psychol 2024; 80:1969-1980. [PMID: 38747969 DOI: 10.1002/jclp.23704] [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] [Received: 10/30/2023] [Revised: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 08/04/2024]
Abstract
This study aims to investigate the potential of a modified Cognitive-Behavioral Group Therapy (CBGT) intervention in promoting social adjustment and reducing their parental stress among children exhibiting symptoms of attention deficit hyperactivity disorder (ADHD). The research also highlights the mechanisms and advantages of employing modified CBGT to address negative symptoms associated with ADHD in children. The study was conducted at Fuzhou Children's Hospital of Fujian Province, with a total of 20 pairs of parents and children with ADHD participating. The assessment utilized measures including SNAP, Barratt Impulsivity, and Conners to evaluate changes in the children's social adjustment abilities and core/associated ADHD symptoms before and after CBGT intervention. Additionally, the Parental Stress Index was employed to gauge the level of stress experienced by the parents. Consequently, CBGT interventions have shown substantial improvements in children's social adjustment abilities and have proven to be a significant source of stress relief for parents.
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Affiliation(s)
- Minrong Chen
- Department of Psychiatry, Fuzhou Children's Hospital of Fujian Province, Fuzhou, China
| | - Xiangyu Jiang
- Counselor Education Program, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Zhang W, He T, Hinshaw S, Chi P, Lin X. Longitudinal relationship between oppositional defiant disorder symptoms and attention-deficit/hyperactivity disorder symptoms in Chinese children: insights from cross-lagged panel network analyses. Eur Child Adolesc Psychiatry 2024; 33:2557-2570. [PMID: 38151686 DOI: 10.1007/s00787-023-02347-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common childhood mental disorders, and they have substantial comorbidity. The developmental precursor model has long been widely used to explain the mechanisms of comorbidity between ODD and ADHD, however whether it is equally effective at the symptomatic level is unclear. Therefore, this study aimed to (a) examine the stability of the ODD and ADHD comorbidity network in a longitudinal sample of high-risk children in China; and (b) examine the longitudinal relationship between the ODD and ADHD symptom networks based on a developmental precursor model. Two hundred sixty-three Chinese children aged 6 to 13 years with ODD and/or ADHD were assessed for symptoms of ODD and ADHD in two surveys conducted 1 year apart. We used data from these two time points to construct two cross-sectional networks and a cross-lagged panel network (CLPN) to explore the symptom network for comorbidity of ODD and ADHD. The analysis shows that: (1) the two cross-sectional networks are highly similar in terms of structure, existence of edges, centrality estimates, and the invariance test shows that there is no significant difference between them. The symptoms "follow through", "interrupts/intrudes", "difficulty playing quietly" and "concentration" had the highest expected influence centrality at both time points. (2) Combined with the results of the cross-sectional and cross-lagged networks, we found that "annoy" and "blame" are potential bridge symptoms between the ODD and ADHD symptom networks. The symptom "annoy" forms a reciprocal predictive relationship with "interrupts/intrudes", while "blame" unidirectionally predicts "close attention". In addition, we found that "vindictive" predicted numerous ADHD symptoms, whereas "angry" was predicted by numerous ADHD symptoms. The findings emphasize the broad predictive relationship between ODD and ADHD symptoms with each other, and that ODD symptoms may lead to activation of the ADHD symptom network and vice versa. These findings suggest that the developmental precursor model at the symptom level may partially explain the comorbidity mechanisms of ODD and ADHD, and future studies should further investigate the underlying multiple mechanisms.
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Affiliation(s)
- Wenrui Zhang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Ting He
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Peilian Chi
- Department of Psychology, University of Macau, Macau, China
| | - Xiuyun Lin
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China.
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China.
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Zhang W, Tang Y, Wu Q, Zhou N, Lin X. Oppositional Defiant Disorder Symptoms and Multi-level Family Factors in Chinese Migrant Children: A Network Perspective. Res Child Adolesc Psychopathol 2023:10.1007/s10802-023-01074-9. [PMID: 37162687 DOI: 10.1007/s10802-023-01074-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
Based on the network theory of mental disorders, this study used network analysis to examine the network of ODD symptoms and multilevel family factors and identify the most crucial family factors influencing ODD symptoms in children. A total of 718 Chinese migrant children aged 7-14 years participated in this study. This study measured ODD symptoms, family system-level variables (3 factors), family dyadic-level variables (6 factors), and family individual-level variables (6 factors) with factors selected based on the multilevel family factors theory of ODD symptoms. The results indicated that (1) "annoy" was the center symptom of ODD, (2) "annoy" and "vindictive" was the main bridge connecting the multilevel family factors, and (3) family cohesion at the family system level, parent-child conflict at the family dyadic level, and parental depression at the family individual level were critical central and bridging influencing factors. The findings of this study highlight the critical role of "annoy" and "vindictive" symptoms in the activation of ODD symptom networks in children and provide a basis for future improvements in diagnostic criteria. These potential core and bridge factors might become key intervention targets for childhood ODD.
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Affiliation(s)
- Wenrui Zhang
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Yingying Tang
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, 78705, United States
| | - Qinglu Wu
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Nan Zhou
- Faculty of Education, University of Macau, Macau, China
| | - Xiuyun Lin
- Institute of Developmental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China.
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, 100875, China.
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Lawrence-Sidebottom D, Huffman LG, Huberty J, Beatty C, Roots M, Roots K, Parikh A, Guerra R, Weiser J. Using digital measurement-based care to address symptoms of inattention, hyperactivity, and opposition in youth: A retrospective analysis of Bend Health (Preprint). JMIR Form Res 2023; 7:e46578. [PMID: 37099379 PMCID: PMC10173032 DOI: 10.2196/46578] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. OBJECTIVE The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. METHODS Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). RESULTS Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. CONCLUSIONS This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.
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Affiliation(s)
| | | | - Jennifer Huberty
- Bend Health, Inc., Madison, WI, United States
- FitMinded, Inc. LLC, Phoenix, AZ, United States
| | | | | | - Kurt Roots
- Bend Health, Inc., Madison, WI, United States
| | - Amit Parikh
- Bend Health, Inc., Madison, WI, United States
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Yu RA, Goulter N, McMahon RJ. Longitudinal Associations between Parental Warmth, Harsh Discipline, Child Emotion Regulation, and ODD Dimensions. Child Psychiatry Hum Dev 2022; 53:1266-1280. [PMID: 34148149 PMCID: PMC8684556 DOI: 10.1007/s10578-021-01205-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
Research has yet to investigate the mediating role of emotion regulation in the relation between parental warmth and harsh discipline with oppositional defiant disorder (ODD). Further, few studies have investigated ODD as both a unitary construct and as three distinct dimensions (anger, defiance, spitefulness). Thus, the present study aimed to investigate child emotion regulation (grade 2) as a mediator of the relation between parental warmth and harsh discipline (kindergarten, grade 1, grade 2) and ODD and its dimensions (grade 3). Participants included the high-risk and normative samples from the Fast Track project (N = 753, male = 58 %, Black = 46 %). Constructs were assessed using observation and parent and teacher reports. Although results demonstrated an absence of indirect effects, emotion regulation was negatively associated with overall ODD and anger and defiance, but not spitefulness. Findings illustrate how increased attention toward the study of ODD as distinct dimensions contributes to our ability to parse out heterogeneity among children with the disorder.
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Affiliation(s)
- Rachelle A Yu
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Natalie Goulter
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Robert J McMahon
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
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6
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Crianças com TDAH e professoras. PSICO 2022. [DOI: 10.15448/1980-8623.2022.1.39098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) constitui risco no desenvolvimento infantil, impactando nas relações interpessoais e desempenho acadêmico. O presente estudo objetivou caracterizar recursos e dificuldades, relatados por professoras e crianças com TDAH, no contexto escolar. Participaram 43 estudantes (M=9,6 anos) e 36 professoras (M=43 anos) do ensino público de uma cidade do interior paulista. Os instrumentos utilizados foram entrevistas (crianças) e questionários (professoras). Foi realizada análise temática com auxílio do software Iramuteq. Os resultados apontaram dificuldades: nas crianças quanto ao autoconceito negativo, aos prejuízos acadêmicos e à exclusão por pares e, nas professoras, quanto à falta de conhecimento sobre o TDAH e à ausência de estratégias pedagógicas diferenciadas. Em relação aos recursos, o auxílio familiar em questões acadêmicas foi destacado pelas crianças e professoras. Os achados contribuem para a discussão de políticas educacionais, como formação continuada de professores e intervenções multidisciplinares.
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Lin X, He T, Heath M, Chi P, Hinshaw S. A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10866. [PMID: 36078582 PMCID: PMC9517877 DOI: 10.3390/ijerph191710866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 05/25/2023]
Abstract
Oppositional Defiant Disorder (ODD) is characterized by a recurrent pattern of angry/irritable emotional lability, argumentative/defiant behavior, and vindictiveness. Previous studies indicated that ODD typically might originate within a maladaptive family environment, or was at least maintained within such an environment. As such, the present review summarized pertinent research from the last 20 years that focused on the pathways connecting family risk factors to the development of child ODD symptoms. A systematic search of electronic databases was completed in August 2020, resulting in the inclusion of 62 studies in the review. The review established a multi-level framework to describe the mechanisms underlying the pathway from familial factors to ODD psychopathological symptoms: (a) the system level that is affected by the family's socioeconomic status and family dysfunction; (b) the dyadic level that is affected by conflict within the marital dyad and parent-child interactions; and (c) the individual level that is affected by parent and child factors. Additionally, from the perspective of family systems theory, we pay special attention to the interactions among and between the various levels of the pathway (moderation and mediation) that might be associated with the occurrence and severity of ODD symptoms. Considering future prevention and intervention efforts, this three-level model emphasizes the necessity of focusing on familial risk factors at multiple levels and the mechanisms underlying the proposed pathways.
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Affiliation(s)
- Xiuyun Lin
- School of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Ting He
- School of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing 100875, China
| | - Melissa Heath
- McKay School of Education, Brigham Young University, Provo, UT 84602, USA
| | - Peilian Chi
- Department of Psychology, University of Macau, Macau 999078, China
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley, CA 94720, USA
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Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12:787-800. [PMID: 35978969 PMCID: PMC9258275 DOI: 10.5498/wjp.v12.i6.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.
AIM To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.
METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.
RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].
CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
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Affiliation(s)
- Ruu-Fen Tzang
- Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan
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Prout TA, Rice T, Chung H, Gorokhovsky Y, Murphy S, Hoffman L. Randomized controlled trial of Regulation Focused Psychotherapy for children: A manualized psychodynamic treatment for externalizing behaviors. Psychother Res 2021; 32:555-570. [PMID: 34583626 DOI: 10.1080/10503307.2021.1980626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This article examines outcomes of the first randomized controlled trial of Regulation Focused Psychotherapy for Children (RFP-C), a manualized, short-term, psychodynamic intervention for decreasing symptoms of the oppositional defiant disorder (ODD) in school-aged children. METHOD Participants (n = 43) were school-aged children who were randomly assigned to RFP-C or a waitlist control group. Symptoms of ODD and explicit emotion regulation capacities were assessed at baseline, end of waitlist, and end of treatment. Multilevel modeling was used to account for patient and therapist factors in outcomes. RESULTS At the end of treatment, parents reported significant reductions in children's ODD symptoms on the primary outcome measure. There were no observed changes in explicit emotion regulation. Reliable change index scores indicated that 79.4% of children were recovered or improved after 10 weeks of treatment. There were no identifiable patient or therapist effects. Treatment adherence and completion was high. CONCLUSION This study is the first randomized controlled trial of a manualized psychodynamic intervention for children with ODD. Participants demonstrated significant reductions in symptoms of ODD after 10 weeks of treatment. Further investigation is needed to compare RFP-C relative to active treatment, assess changes in implicit emotion, and to determine long-term maintenance of symptom improvement.Clinical trial registration information: Evaluation of Regulation Focused Psychotherapy for Children (RFP-C); https://clinicaltrials.gov/ct2/show/NCT03594253.
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Affiliation(s)
- Tracy A Prout
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Timothy Rice
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hyewon Chung
- Department of Education, Chungnam National University, Daejeon, South Korea
| | - Yulia Gorokhovsky
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Sean Murphy
- New York Psychoanalytic Society & Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leon Hoffman
- New York Psychoanalytic Society & Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Structural Equation Modeling (SEM): Childhood Aggression and Irritable ADHD Associated with Parental Psychiatric Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910068. [PMID: 34639370 PMCID: PMC8507797 DOI: 10.3390/ijerph181910068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Children with attention deficit hyperactivity disorder (ADHD) co-occurring with Oppositional Defiant Disorder (ODD) further present aggressive behavior and may have a depressive parent. A child with co-occurring ADHD and ODD has differentially higher levels of behavioral and emotional difficulties. Little is known about how the irritable subtype of ADHD in children mediates the development of parental symptomatology. This study aims to elucidate the direct or indirect influence of childhood disruptive ADHD with aggressive behavior on their parental symptom using Structural Equation Modeling (SEM). Methods: A total of 231 ADHD children and their parents completed the Swanson, Nolan, and Pelham Version IV questionnaire for symptoms of ADHD, Oppositional Defiant Disorder (ODD) scale for irritable symptoms, Child Behavior Check List (CBCL) for aggression, and Symptom Checklist (SCL) for parental symptom. Results: The three-factor confirmatory factor analysis (CFA) model found symptoms of inattention, hyperactivity/impulsivity, irritable ODD, and aggression were inter-related. Mediational analyses demonstrated ODD mediates symptoms directly predicting the risk of increasing ADHD severity. Disruptive child symptoms (ADHD + ODD + aggression) may increase the risk of depression-related symptoms in the parent. When the child’s aggression increases by one standard deviation (SD), parental psychiatric symptoms increase by 0.235 SD (p < 0.001). Conclusions: By this SEM pathway analysis, there is the correlation between the disruptive, more aggressive subtype of ADHD in children/adolescents and the existence of psychopathological symptomatology of their parents. ADHD + ODD + aggression in children should be classified as an irritable subtype of ADHD, warranting early diagnosis and intensive treatment.
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Na KS, Geem ZW, Cho SE. Machine learning-based prediction of persistent oppositional defiant behavior for 5 years. Nord J Psychiatry 2020; 74:505-510. [PMID: 32689863 DOI: 10.1080/08039488.2020.1748711] [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: 10/23/2022]
Abstract
BACKGROUND Early detection of oppositional defiant behavior is warranted for timely intervention in children at risk. This study aimed to build a predictive model of persistent oppositional defiant behavior based on a machine learning algorithm. METHODS With nationwide cohort data collected from 2012 to 2017, a tree-based ensemble model, random forest, was exploited to build a predictive model for persistent oppositional defiant behavior. The persistent oppositional defiant behavior was defined by the presence of oppositional defiant behavior for all the five years. The area under the receiver operating characteristic curve (AUC), overall accuracy, sensitivity, specificity, and Matthew's correlation coefficients (MCC) were measured. RESULTS Data of 1,323 children were used for building the machine learning-based predictive model. The baseline mean ± standard deviation month-age of the participants was 51.0 ± 1.2 months. The proportion of persistent oppositional defiant behavior was 0.98% (13/1323). In the hold-out test set, the overall accuracy, AUC, sensitivity, specificity, and MCC were 0.955, 0.982, 1.000, 0.954, and 0.417, respectively. CONCLUSION Our study demonstrated that the machine learning-based approach is useful for predicting persistent oppositional defiant behavior in preschool-aged children.
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Affiliation(s)
- Kyoung-Sae Na
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
| | - Zong Woo Geem
- Department of Energy and Information Technology, Gachon University, Seongnam, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea
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12
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Eskander N. The Psychosocial Outcome of Conduct and Oppositional Defiant Disorder in Children With Attention Deficit Hyperactivity Disorder. Cureus 2020; 12:e9521. [PMID: 32905151 PMCID: PMC7465825 DOI: 10.7759/cureus.9521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders diagnosed in children below the age of 12 years. It is characterized by hyperactivity, inattention, and impulsive behavior. ADHD affects the social, academic, and psychological aspects of children and adolescents. Children with ADHD struggle with school tasks and performance. They have lower grades than their peers and have difficulties interacting with their friends. Oppositional defiant disorder (ODD) is a mental disorder characterized by disruptive behavior, a pattern of angry and irritable mood, argumentative, and vindictive behavior. Children with ODD struggle with forming friendships and have problems at school. Conduct disorder (CD) is divided into the childhood onset and the adolescent onset types. The childhood onset is associated with poor outcomes in adulthood, an increase in criminal behavior, violence, and progression to antisocial behavior. Children with CD are at increased risk for substance use disorders (SUD) and antisocial personality disorder. The current literature review is aiming to provide an overview of the psychosocial impact of comorbid ODD and CD in children with ADHD. The results of this study review showed the comorbidity of ODD and CD is very strong. ODD is a strong predictor of CD in boys. The presence of comorbid ODD and ADHD in children is a significant predictor of adolescent onset CD. The comorbidity of ADHD with ODD and CD worsens symptom severity and is associated with high psychosocial dysfunction. Children with ADHD and comorbid ODD and CD have difficulties with school, friends, and trouble with the police.
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Affiliation(s)
- Noha Eskander
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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13
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Kelleher KJ, Rubin D, Hoagwood K. Policy and Practice Innovations to Improve Prescribing of Psychoactive Medications for Children. Psychiatr Serv 2020; 71:706-712. [PMID: 32188362 DOI: 10.1176/appi.ps.201900417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychoactive medications are the most expensive and fastest-growing class of pharmaceutical agents for children. The cost, side effects, and unprecedented growth rate at which these drugs are prescribed have raised alarms from health care clinicians, patient advocates, and agencies about the appropriateness of how these drugs are distributed to parents and their children. This article examines current prescribing of three classes of psychoactive drugs-stimulants, antidepressants, and antipsychotics-and efforts to improve pediatric prescribing of these agents. Federal policy efforts to curb questionable prescribing of psychoactive medications to children have focused particularly on oversight of antipsychotic use among foster care children. The article reviews system-level interventions, including delivery system enhancements, which increase availability of alternatives to medication treatments, employ electronic medical record reminders, and increase cross-sector care coordination; clinician prescribing enhancements, which disseminate best-practice guidelines, create quality and learning collaboratives, and offer "second opinion" psychiatric consultations; and prescriber monitoring programs, which include retrospective review and prospective monitoring of physicians' prescribing to identify patterns suggestive of inappropriate prescribing. Potential interventions to deter inappropriate pediatric prescribing are briefly described, such as transparency in drug prices and incentives among insurers, public agencies, and pharmacy benefit managers; value-based purchasing, specifically value-based payment for medications; and preventive interventions, such as parent training.
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Affiliation(s)
- Kelly J Kelleher
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
| | - David Rubin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
| | - Kimberly Hoagwood
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio (Kelleher); PolicyLab at Children's Hospital of Philadelphia, Philadelphia (Rubin); Department of Pediatrics, New York University Langone Health, New York (Hoagwood)
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