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: 5.43). 04/2010; 40(12):2089-100. DOI: 10.1017/S0033291710000590
Source: PubMed

ABSTRACT 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, Aug 22, 2015
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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.
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