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.

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Available from: Argyris Stringaris, Jun 03, 2014
    • "Both these interpretations necessitate future research. Second, a growing literature suggests that symptoms of ODD could be categorized into distinctive dimensions (Burke et al., 2010;Burke et al., 2005;Stringaris & Goodman, 2009), as reflected in the DSM-5 diagnostic criteria. The finding that emotional abuse was the only predictor of emotional problems and physical abuse was the only predictor of behavioral problems for ODD children supported the multiple dimensions of ODD symptoms. "
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    ABSTRACT: Maltreatment has negative effects on the parent–child relationship and the emotional and behavioral development of children. The current study aimed to examine the associations among maltreatment, parent–child relationship, and emotional and behavioral problems in Chinese children with or without oppositional defiant disorder (ODD). Participants in the study included 259 children with ODD and their 269 non-ODD counterparts from northern, eastern, and southwestern China. We also collected data from their teachers and fathers or mothers. The results showed that ODD children suffered more maltreatment and had more emotional and behavioral problems than their non-ODD peers. For all children (both ODD and non-ODD children), emotional abuse predicted emotional problems but not behavioral problems. Physical abuse predicted behavioral problems but not emotional problems. Parent–child relationship mediated the effects of emotional abuse and physical abuse on emotional problems among ODD children but not among non-ODD children. Implications for prevention of emotional and physical abuse and ODD in the Chinese cultural context are discussed.
    No preview · Article · Jan 2016 · Journal of Interpersonal Violence
    • "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.
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    • "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). One of the most troublesome aspects in the assessment of dysregulated children is the availability of cost-effective and reliable diagnostic measures. "
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