Is oppositional defiant disorder a meaningful diagnosis in adults? Results from a large sample of adults with ADHD.
ABSTRACT We examined the prevalence and clinical characteristics of oppositional defiant disorder (ODD) in a sample of clinically referred adults with attention deficit hyperactivity disorder (ADHD). Subjects were consecutively referred adults with a DSM-III R/IV diagnosis of ADHD with or without ODD. Nearly half of subjects (43%) had a history of ODD. Subjects with a childhood history of ODD had increased risk for bipolar disorder, multiple anxiety disorders, and substance use disorders relative to the ADHD subjects without ODD. We concluded, as in children with ODD, adults with a childhood history of ODD have high rates of psychiatric comorbidity and more impaired psychosocial functioning than those without this condition. A better understanding of the course, phenomenology, and clinical significance of ODD in adults is needed to better understand therapeutic approaches for this disorder.
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ABSTRACT: Abstract Objective: The purpose of this study was to assess the effect of guanfacine extended release (GXR) adjunctive to a psychostimulant on oppositional symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: A multicenter, double-blind, placebo-controlled dose-optimization study of GXR (1-4 mg/d) or placebo administered morning (a.m.) or evening (p.m.) adjunctive to psychostimulant was conducted in subjects ages 6-17 with suboptimal response to psychostimulant alone. Suboptimal response was defined as treatment with a stable dose of psychostimulant for ≥4 weeks with ADHD Rating Scale IV total score ≥24 and Clinical Global Impressions-Severity of Illness score ≥3, as well as investigator opinion. Primary efficacy and safety results have been reported previously. Secondary efficacy measures included the oppositional subscale of the Conners' Parent Rating Scale-Revised: Long Form (CPRS-R:L); these are reported herein. Results: Significant reductions from baseline to the final on-treatment assessment on the oppositional subscale of the CPRS-R:L were seen with GXR plus psychostimulant compared with placebo plus psychostimulant, both in the overall study population (placebo-adjusted least squares [LS] mean change from baseline to the final on-treatment assessment: GXR a.m.+psychostimulant, -2.4, p=0.001; GXR p.m.+psychostimulant, -2.2, p=0.003) as well as in the subgroup of subjects with significant baseline oppositional symptoms (GXR a.m.+psychostimulant, -3.6, p=0.001; GXR p.m.+psychostimulant, -2.7, p=0.013). Treatment-emergent adverse events were reported by 77.3%, 76.3%, and 63.4% of subjects in the GXR a.m., GXR p.m., and placebo groups, respectively, in the overall study population. Conclusions: GXR adjunctive to a psychostimulant significantly reduced oppositional symptoms compared with placebo plus a psychostimulant in subjects with ADHD and a suboptimal response to psychostimulant alone.Journal of Child and Adolescent Psychopharmacology 06/2014; 24(5):245-252. DOI:10.1089/cap.2013.0103 · 3.07 Impact Factor
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ABSTRACT: Spite is an understudied construct that has been virtually ignored within the personality, social, and clinical psychology literatures. This study introduces a self-report Spitefulness Scale to assess individual differences in spitefulness. The scale was initially tested on a large sample of 946 college students and cross-validated on a national sample of 297 adults. The scale was internally consistent in both samples. Factor analysis supported a 1-factor solution for the initial pool of 31 items. Item response theory analysis was used to identify the best performing of the original 31 items in the university sample and reduce the scale to 17 items. Tests of measurement invariance indicated that the items functioned similarly across both university and national samples, across both men and women, and across both ethnic majority and minority groups. Men reported higher levels of spitefulness than women, younger people were more spiteful than older people, and ethnic minority members reported higher levels of spitefulness than ethnic majority members. Across both samples, spitefulness was positively associated with aggression, psychopathy, Machiavellianism, narcissism, and guilt-free shame, and negatively correlated with self-esteem, guilt-proneness, agreeableness, and conscientiousness. Ideally, this Spitefulness Scale will be able to predict behavior in both laboratory settings (e.g., ultimatum games, aggression paradigms) and everyday life, contribute to the diagnosis of personality disorders and oppositional defiant disorder, and encourage further study of this neglected, often destructive, trait. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Psychological Assessment 02/2014; 26(2). DOI:10.1037/a0036039 · 2.99 Impact Factor
Psicologia Teoria e Pesquisa 03/2009; 25(1):93-102. DOI:10.1590/S0102-37722009000100011