Longitudinal Outcome of Youth Oppositionality: Irritable, Headstrong, and Hurtful Behaviors Have Distinctive Predictions

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892-2670USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 05/2009; 48(4):404-12. DOI: 10.1097/CHI.0b013e3181984f30
Source: PubMed


Oppositional behavior in youths is one of the strongest predictors of a wide range of psychiatric disorders. We test the hypothesis that oppositionality encompasses an Irritable, a Headstrong, and a Hurtful dimension, each with distinct predictions.
Longitudinal design combining data from two British national surveys and their respective 3-year follow-ups (N = 7,912). The Developmental and Well-Being Assessment was used to generate DSM-IV diagnoses.
The Irritable dimension was the sole predictor of emotional disorders at follow-up and was particularly associated with distress disorders (depression and anxiety) rather than fear disorders (phobias, separation anxiety, and panic disorder), both before and after adjustment for baseline psychopathology. The Headstrong dimension was the only predictor of attention-deficit/hyperactivity disorder at follow-up. Both Headstrong and Hurtful predicted conduct disorder, although only the Headstrong dimension did so after adjustment for baseline psychopathology. The Hurtful dimension was the strongest predictor of aggressive conduct disorder symptoms.
Our data suggest a developmental model of mental disorder whereby oppositionality is an interim shared manifestation of different dimensions of psychopathology with distinct outcomes.


Available from: Argyris Stringaris, Jun 03, 2014
    • "All of the studies agreed on a distinction between an irritable dimension and a defiant and/or vindictive dimension, although they found minor differences regarding the item compositions of the dimensions. Most importantly, these studies demonstrated differential predictions of future psychopathology with the irritable dimension predicting depressive or anxiety disorders and the defiant or vindictive dimension predicting disruptive behaviour disorders and criminal behaviours (Aebi, Plattner, Winkler Metzke, Bessler, & Steinhausen, 2013; Burke, 2012; Burke et al., 2010; Rowe, Costello, Angold, Copeland, & Maughan, 2010; Stringaris & Goodman, 2009a; Whelan et al., 2013). More recent studies identified different subgroups of children and adolescents according to their ODD symptom profiles. "
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    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.
    Journal of Child Psychology and Psychiatry 10/2015; DOI:10.1111/jcpp.12473 · 6.46 Impact Factor
    • "The comorbidity between mood and disruptive behaviors is currently a core element of discussion in the literature, as evident in the debated role of irritability in the Disruptive Mood Dysregulation Disorder and its inclusion among the Depressive Disorders in the DSM 5 (APA, 2013). In a cross-sectional community study, mood lability, a concept closely related to emotional dysregulation, resulted strongly associated with comorbidity between internalizing and externalizing disorders, suggesting that it could be a shared risk factor for both disorders (Stringaris and Goodman, 2009). "
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    ABSTRACT: A Child Behavior Checklist (CBCL) profile defined as Dysregulation Profile (DP) (scores 2 standard deviations or more in anxiety/depression, aggression, attention subscales) has been correlated to poor emotional and behavioral self-regulation. The clinical meaning and the prognostic implications of CBCL-DP are still debated, although it seems associated with severe psychopathology and poor adjustment. In the present study, we used the CBCL-DP score to examine the adolescent outcomes (psychiatric diagnosis, substance use, psychiatric hospitalization) in 80 referred children with disruptive behavior disorders -DBD- (Oppositional Defiant Disorder or conduct disorder), aged 8-9 years, 72 males (90%) and 8 females (10%), followed-up until the age of 14-15 years. Children with higher score on the CBCL-DP profile were at increased risk for presenting ADHD and mood disorders in adolescence. While ADHD in adolescence was predicted also by an ADHD diagnosis during childhood, CBCL-DP score was the only significant predictor of a mood disorder at 14-15 years. On the contrary, CBCL-DP score was not associated with a higher risk of conduct disorder, substance use and hospitalizations in adolescence. A cost-effective and reliable diagnostic measure such as the CBCL may be a part of the diagnostic procedure aimed to capture these at-risk children, to monitor their natural history up to adolescence, and to prevent the risk of a full-blown mood disorder. The small sample size and a selection bias of severe patients with DBD limit the generalization of the findings. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:249-253. DOI:10.1016/j.jad.2015.05.069 · 3.38 Impact Factor
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    • "Partly due to the fact that Oppositional Defiant Disorder (ODD) predicts to such a wide range of adjustment difficulties in children, the DSM 5 (American Psychiatric Association, 2013) has suggested a distinction among irritable, headstrong, and hurtful ODD dimensions, as these dimensions appear to associate with distinct outcomes. Importantly , studies suggest that the ODD subdimension of irritability (i.e. has temper outbursts; touchy or easily annoyed; angry or resentful) predicts adolescent and young adult depressive symptoms (Leibenluft , Cohen, Gorrindo, Brook, & Pine, 2006; Leibenluft & Stoddard, 2013; Stringaris & Goodman, 2009a; Whelan, Stringaris, Maughan, & Barker, 2013). In addition, previous studies show predictive associations between adolescent depressive symptoms and other child characteristics such as anxiety/depressive symptoms (e.g. has many worries or often seems worried; often unhappy, depressed or tearful) and conduct problems (e.g. "
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    ABSTRACT: The authors tested three possible pathways linking prenatal maternal depressive symptoms to adolescent depressive symptoms. These pathways went through childhood Irritability Symptoms, Anxiety/Depressive Symptoms or Conduct Problems. Data were collected from 3,963 mother-child pairs participating in the Avon Longitudinal Study of Parents and Children. Measures include maternal depressive symptoms (pre- and postnatal); toddler temperament (2 years); childhood (7-13 years) irritability symptoms, anxiety/depressive symptoms, conduct problems, and adolescent depressive symptoms (16 years). Irritability Symptoms: This pathway linked sequentially - prenatal maternal depressive symptoms, toddler temperament (high perceived intensity and low perceived adaptability), childhood irritability symptoms, and adolescent depressive symptoms. Anxiety/Depressive symptoms: This pathway linked sequentially - prenatal maternal depressive symptoms, toddler temperament (negative perceived mood), childhood anxiety/depressive symptoms, and adolescent depressive symptoms. Childhood conduct problems were not associated with adolescent depressive symptoms, above and beyond irritability symptoms and anxiety/depressive symptoms. Results suggest evidence for two distinct developmental pathways to adolescent depressive symptoms that involve specific early and midchildhood features. © 2015 Association for Child and Adolescent Mental Health.
    Journal of Child Psychology and Psychiatry 02/2015; 56(10). DOI:10.1111/jcpp.12395 · 6.46 Impact Factor
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