Oppositional Defiant Disorder and Conduct Disorder: A Review of the Past 10 Years, Part II

Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 12/2002; 41(11):1275-93. DOI: 10.1097/00004583-200211000-00009
Source: PubMed


To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD).
Selected summaries of the literature over the past decade are presented.
Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains.
Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.

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    • "The initial challenge occurs when parents first learn about the child's diagnosis (Huang, Kellett, & St John, 2010). How parents overcome intense and difficult emotions and adapt to the novel situation affects parenting practices, approaches towards the child, and parents' general well-being (Burke et al., 2004). Emotional , social and physical health problems are frequently reported among parents of children with CP, including difficulties in maintaining social relationships , marital conflicts, disadvantage in employment, and insufficient support from services, among others (Brehaut et al., 2004; Davis et al., 2009). "
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    ABSTRACT: Development of children with cerebral palsy (CP) depends on the quality of parental care. The aim of the research was to compare parenting attitudes in mothers of children with CP to mothers of typically developing children, and to study the relationship between parenting attitudes and personality traits, stress, coping strategies and self-efficacy in mothers of children with CP. Twenty-seven mothers of children with cerebral palsy (MCCP) (mean age 35.50 years, SD = 4.83) and twentyeight mothers (mean age 35.60 years, SD = 4.27) of typically developing children (MTDC) participated in this study. Each parent had a child between the ages of two and seven years. A battery of tests was administered to both groups, which included the Parenting Attitudes Scale (SPR), the NEO Five-Factor Inventory (NEO-FFI), the Generalized Self-Efficacy Scale (GSES), and the COPE Inventory. Also, maternal stress and the amount of social support received were assessed. Although acceptance was the most common parental attitude among all participants, mothers of children with CP presented with a stronger tendency towards overprotective and demanding attitudes. MCCP obtained higher scores in neuroticism and lower in openness compared to MTDC. Furthermore, MCCP declared a higher level of distress than MTDC. There were no statistically significant differences between the two groups of mothers regarding self-efficacy, the level of social support or the most often used coping strategies. Neuroticism was found to be the best predictor of overprotective and demanding parental attitudes. The study emphasises the importance of parenting programmes for mothers with children with CP to promote the development of autonomy among children with developmental difficulties.
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    • "According to the diathesisstress model (Zuckerman 1999), effects of environmental stressors may primarily occur in vulnerable individuals. An important general vulnerability factor is parental psychiatric history, which is considered a strong predictor of increased genetic and environmentally-driven vulnerability for externalizing and internalizing psychopathology in offspring (Burke et al. 2002; Kim-Cohen et al. 2005). "
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    ABSTRACT: Large individual differences in adolescent mental health following chronic psychosocial stress suggest moderating factors. We examined two established moderators, basal cortisol and parental psychiatric history, simultaneously. We hypothesized that individuals with high basal cortisol, assumed to indicate high context sensitivity, would show relatively high problem levels following chronic stress, especially in the presence of parental psychiatric history. With Linear Mixed Models, we investigated the hypotheses in 1917 Dutch adolescents (53.2 % boys), assessed at ages 11, 13.5, and 16. Low basal cortisol combined with the absence of a parental psychiatric history increased the risk of externalizing but not internalizing problems following chronic stress. Conversely, low basal cortisol combined with a substantial parental psychiatric history increased the risk of internalizing but not externalizing problems following chronic stress. Thus, parental psychiatric history moderated stress- cortisol interactions in predicting psychopathology, but in a different direction than hypothesized. We conclude that the premise that basal cortisol indicates context sensitivity may be too crude. Context sensitivity may not be a general trait but may depend on the nature of the context (e.g., type or duration of stress exposure) and on the outcome of interest (e.g., internalizing vs. externalizing problems). Although consistent across informants, our findings need replication.
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    • "Empirically, adolescents who possess unconventional beliefs or attitudes have been shown to have high levels of delinquency, because they do not consider social norms to be valid (Longshore et al. 2005; Ngai and Cheung 2005). Furthermore, Loeber et al. (2000) showed that a substantial proportion of children and adolescents who possess ODD developed subsequent conduct problems. Combining the theoretical perspectives and empirical results, we can expect that adolescents' unhealthy sleep practices may exert effects on their deviance through defiant attitude. "
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    ABSTRACT: Although sleep has been linked to activities in various domains of life, one under-studied link is the relationship between unhealthy sleep practices and conduct problems among adolescents. The present study investigates the influence of adolescents' unhealthy sleep practices-short sleep (e.g., less than 6 h a day), inconsistent sleep schedule (e.g., social jetlag), and sleep problems-on conduct problems (e.g., substance use, fighting, and skipping class). In addition, this study examines unhealthy sleep practices in relationship to adolescent emotional well-being, defiant attitudes, and academic performance, as well as these three domains as possible mediators of the longitudinal association between sleep practices and conduct problems. Three waves of the Taiwan Youth Project (n = 2,472) were used in this study. At the first time-point examined in this study, youth (51 % male) were aged 13-17 (M = 13.3). The results indicated that all three measures of unhealthy sleep practices were related to conduct problems, such that short sleep, greater social jetlag, and more serious sleep problems were concurrently associated with greater conduct problems. In addition, short sleep and sleep problems predicted conduct problems one year later. Furthermore, these three unhealthy sleep practices were differently related to poor academic performance, low levels of emotional well-being, and defiant attitudes, and some significant indirect effects on later conduct problems through these three attributes were found. Cultural differences and suggestions for prevention are discussed.
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