Predictability of oppositional defiant disorder and symptom dimensions in children and adolescents with ADHD combined type

Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland.
Psychological Medicine (Impact Factor: 5.94). 04/2010; 40(12):2089-100. DOI: 10.1017/S0033291710000590
Source: PubMed


Oppositional defiant disorder (ODD) is frequently co-occurring with attention deficit hyperactivity disorder (ADHD) in children and adolescents. Because ODD is a precursor of later conduct disorder (CD) and affective disorders, early diagnostic identification is warranted. Furthermore, the predictability of three recently confirmed ODD dimensions (ODD-irritable, ODD-headstrong and ODD-hurtful) may assist clinical decision making.
Receiver-operating characteristic (ROC) analysis was used in order to test the diagnostic accuracy of the Conners' Parent Rating Scale revised (CPRS-R) and the parent version of the Strength and Difficulties Questionnaire (PSDQ) in the prediction of ODD in a transnational sample of 1093 subjects aged 5-17 years from the International Multicentre ADHD Genetics study. In a second step, the prediction of three ODD dimensions by the same parent rating scales was assessed by backward linear regression analyses.
ROC analyses showed adequate diagnostic accuracy of the CPRS-R and the PSDQ in predicting ODD in this ADHD sample. Furthermore, the three-dimensional structure of ODD was confirmed by confirmatory factor analysis and the CPRS-R emotional lability scale significantly predicted the ODD irritable dimension.
The PSDQ and the CPRS-R are both suitable screening instruments in the identification of ODD. The emotional lability scale of the CPRS-R is an adequate predictor of irritability in youth referred for ADHD.

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Available from: Marcel Aebi, Oct 04, 2015
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    • "By using bioinformatics analysis and literature mining, we found that top findings obtained from the GWAS fit into a neurite outgrowthregulating molecular landscape. Previous research has focused on various dimensions within oppositional defiant behaviors [Stringaris and Goodman, 2009b; Aebi et al., 2010]. Further studies have attempted to identify discrete classes of children and adolescents according to their oppositional behavior profiles. "
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    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.
    American Journal of Medical Genetics Part B Neuropsychiatric Genetics 07/2015; DOI:10.1002/ajmg.b.32346 · 3.42 Impact Factor
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    • "Emotional dysregulation is often hypothesized to involve some deficit in the ability to modify emotional responses as a result of underlying neurobiological dysfunctions and/or temperament traits [31]. In the present study, we use the term emotional dysregulation descriptively, and thus similarly to how emotional lability and the irritable dimension of ODD has been used in studies of older children [28, 29, 32]. "
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    ABSTRACT: Anxiety disorders and attention deficit/hyperactivity disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio (OR) = 1.41, CI = 1.15-1.73) and emotional dysregulation (OR = 1.33, CI = 1.15-1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30-1.76) and emotional dysregulation (OR = 1.31, CI = 1.13-1.51). Co-occurring anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13-1.84), ADHD (OR = 1.30, CI = 1.11-1.54), and emotional dysregulation (OR = 1.34, CI = 1.13-1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3½ years.
    European Child & Adolescent Psychiatry 04/2014; 23(9):743-752. DOI:10.1007/s00787-014-0538-7 · 3.34 Impact Factor
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    • "Theoretical considerations (Burke, Loeber, Lahey, & Rathouz, 2005; Wakschlag, Tolan, & Leventhal, 2010) underlie this hypothesis, as well as a host of recent evidence, that irritability shows stronger associations with emotional problems, rather than conduct problems or antisocial behaviors (Aebi et al., 2010; Rowe, Costello, Angold, Copeland, & Maughan, 2010; Stringaris, Cohen, Pine, & Leibenluft, 2009; Stringaris & Goodman , 2009a,b). The scales used for this previous research were generated ad hoc using items from existing instruments, rather than ones specifically designed, to measure irritability – these contained only a few items and had low internal consistency (Aebi et al., 2010; Stringaris & Goodman, 2009a,b). Here, we test the hypothesis that irritability will remain associated with emotional problems – but not with conduct problems – when controlling for other variables such as hyperactivity, peer problems, or prosocial behaviors. "
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    ABSTRACT: Background Irritable mood has recently become a matter of intense scientific interest. Here, we present data from two samples, one from the United States and the other from the United Kingdom, demonstrating the clinical and research utility of the parent- and self-report forms of the Affective Reactivity Index (ARI), a concise dimensional measure of irritability. Methods The US sample (n = 218) consisted of children and adolescents recruited at the National Institute of Mental Health meeting criteria for bipolar disorder (BD, n = 39), severe mood dysregulation (SMD, n = 67), children at family risk for BD (n = 35), or were healthy volunteers (n = 77). The UK sample (n = 88) was comprised of children from a generic mental health setting and healthy volunteers from primary and secondary schools. Results Parent- and self-report scales of the ARI showed excellent internal consistencies and formed a single factor in the two samples. In the US sample, the ARI showed a gradation with irritability significantly increasing from healthy volunteers through to SMD. Irritability was significantly higher in SMD than in BD by parent-report, but this did not reach significance by self-report. In the UK sample, parent-rated irritability was differentially related to emotional problems. Conclusions Irritability can be measured using a concise instrument both in a highly specialized US, as well as a general UK child mental health setting.
    Journal of Child Psychology and Psychiatry 05/2012; 53(11):1109-17. DOI:10.1111/j.1469-7610.2012.02561.x · 6.46 Impact Factor
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