Criteria For Oppositional Defiant Disorder Research Articles

Understanding Attentional Functioning in Adult Attention Deficit Hyperactivity Disorder—Could This Improve Diagnostic Specificity?

The diagnostic criteria for attention deficit hyperactivity disorder (ADHD) reflect the behavioural and functional outcomes of cognitive processes. Historically they have been based on external observations and lack specificity: clinical cohorts of children meeting diagnostic criteria show that around 40% may also meet diagnostic criteria for oppositional defiant disorder (ODD). We have proposed a clinical model to explain this: the Mental Effort Reward Imbalances model of ADHD (MERIM). This model views the lower levels of task completion that underlie several of the diagnostic criteria for ADHD as being due to a summation of deficits in executive functioning and reward processing. The subjective experience of inadequate reward from task completion may explain the reduced motivation, negativity, and oppositional attitude associated with ODD. The hypothesis for this study is that descriptions of affected individuals' attentional characteristics could be more specific for the executive functioning deficits associated with ADHD than the current symptom-based approaches. To test whether this might be usable in practice, we conducted a workshop that aimed to characterise in depth the patterns of attention experienced by adults with ADHD and how they impact functioning. Three main patterns were described: (1) complete lapses in attention; (2) partial attention to a task; (3) attending to multiple tasks and distractions, either simultaneously or in rapid sequence. All of these resulted in reduced productivity. They also described strategies for managing their attention deficits. Some people used distractions positively, to stimulate the mind to remain active and engaged rather than losing focus. Multi-tasking could also achieve this by providing higher levels of stimulation, however, the stimulation could itself become a distraction. Interest or stress might maintain engagement; extremes could sometimes lead to hyperfocusing, which was typically infrequent but could be highly productive. Focusing on executive functions may improve diagnostic sensitivity, as the current criteria fail to identify people who function adequately due to their use of strategies that mitigate the effects of their attentional deficits. Such people may present with secondary depression or anxiety rather than clear, behavioural symptoms of ADHD. With further development, the approach described in this paper may provide a more simple and fundamental way of recognising ADHD within the community. In the longer term, focusing more specifically on executive functions may provide cohorts with a 'purer' form of ADHD for scientific study.

Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach

ABSTRACT Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7–18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.

The Feasibility, Acceptability, and Efficacy of Positive Search Training for Irritable Youth: A Single-Case Experimental Design

AbstractAlthough irritability is common in youth, research on treatment is in its infancy. Threat biases are more pronounced in irritable compared to low irritable youth, similar to evidence found in anxious youth. Therefore, interventions targeting these biases may be promising for reducing irritability. This study utilised a multiple baseline case series design to determine the feasibility, acceptability, and efficacy of positive search training (PST) for irritable children. Three children were included who met criteria for a principal diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), and a secondary diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) or Major Depressive Disorder (MDD). PST was feasible with two of the three participants; one child refused to continue after one session. For the two participants who completed PST, acceptability was stable with moderate-to-high ratings of engagement and enjoyment, and high and stable treatment-relevant verbalisations of the key strategies. Both cases showed declines in DMDD severity across treatment and no longer met criteria at post-treatment. Both participants met criteria for Oppositional Defiant Disorder (ODD) at post-treatment (considered less severe for irritability than DMDD). Declines in parent-reported irritability occurred for both cases, however some returns to baseline were observed. Overall, PST for irritable youth shows promise as an acceptable and feasible intervention. Further studies are needed combining PST with strategies for secondary diagnoses, given its high comorbidity with disruptive behaviour disorders.

The Parent–Child Relationship and Posttreatment Child Outcomes Across Two Treatments for Oppositional Defiant Disorder

This study examined the degree to which the parent–child relationship uniquely predicted clinical outcomes in externalizing problems and adaptive skills in children meeting diagnostic criteria for oppositional defiant disorder and whether facets of this relationship moderated the effects of two unique psychosocial treatments. We recruited 134 children and their parents (38.06% female; M age = 9.52 years, range = 7–14; 83.58% White). Families were randomly assigned to 1 of 2 treatments: Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). We formed principal components from pretreatment reports and behaviors of the parent–child relationship to predict within- and between-family outcomes in children’s externalizing problems and adaptive skills. Four principal components were supported (parental warmth, parental monitoring, family hostility, and family permissiveness). Parental monitoring predicted fewer externalizing problems, whereas family permissiveness predicted more externalizing problems. Parental warmth predicted greatest improvements in children’s adaptive skills among families receiving PMT. Family hostility predicted more externalizing problems and poorer adaptive skills for children; however, families receiving CPS were buffered from the negative effect of family hostility on adaptive skills. The parent–child relationship can uniquely inform posttreatment outcomes following treatment for oppositional defiant disorder. Certain treatment approaches may better fit unique relationships that emphasize warmth and/or hostility, allowing clinicians to anticipate and tailor treatments to families.

Assessment of Behavioral Problems in Children With Hearing Loss.

To compare the prevalence of disruptive behavior problems between preschool-aged children with hearing loss and normal hearing. Cross-sectional study. Tertiary academic center. Caregivers of children (2-5 yr old) with normal hearing (NH) (n = 39), hearing loss using hearing aid(s) (HA) (n = 29), or cochlear implant(s) (CI) (n = 21). Demographic information and a mental health history were obtained. Child behavior and language development were assessed. The Young Child-Diagnostic Interview Schedule for Children-IV and the MacArthur-Bates Communication Development Inventory III. Distributions of race, socioeconomic status, insurance status, and parental home situation (single versus two parent family) were similar across all groups. Parents of children with hearing loss were significantly more likely to report behavior problems (HA = 41%, CI = 38%) than parents of NH children (10%; p = 0.002). Children with hearing loss were significantly more likely to meet diagnostic criteria for oppositional defiant disorder (HA = 48%, CI = 48%) than NH children (23%; p = 0.02). More NH children (8%) than hearing impaired children (0%) had accessed mental health services (p = 0.08). NH children were found to have more advanced language development than hearing-impaired children (p < 0.01), but controlling for Communication Development Inventory III percentiles, the observed behavioral differences remained. Controlling for language development, children with hearing loss have higher prevalence of and impairment from disruptive behaviors than their NH peers. These children are less likely to receive appropriate behavioral interventions. Further research is warranted to investigate the impact of disruptive behaviors on speech and hearing rehabilitation. Methods to improve access to effective behavioral interventions in this population are needed.

Effectiveness of the Incredible Years Parenting Program for Families with Socioeconomically Disadvantaged and Ethnic Minority Backgrounds

Families with socioeconomically disadvantaged and ethnic minority backgrounds are often hard to reach for the prevention and treatment of disruptive child behavior problems. We examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority backgrounds in the Netherlands. One hundred fifty-four families from a wide range of socioeconomic and ethnic backgrounds were recruited in an outpatient clinic for child and adolescent psychiatry and in elementary schools serving deprived neighborhoods. Families were randomly assigned to the BASIC Incredible Years parenting intervention or a waiting list control condition. Children were 3–8 years old (M = 5.59, SD = 1.35; 62% boys, 66% ethnic minorities) and 65% of the children met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria for oppositional defiant disorder, conduct disorder, and/or attention-deficit hyperactivity disorder. Incredible Years reduced parent-reported disruptive child behavior and teacher-reported hyperactive and inattentive child behavior and increased parent-reported use of praise and incentives and reduced harsh and inconsistent discipline. Incredible Years did not affect parent-reported hyperactive and inattentive child behavior; teacher-reported child conduct problems; and parent-reported use of appropriate discipline techniques, clear expectations, physical punishment, and parenting stress. Of importance, the effectiveness of Incredible Years did not differ across families with different socioeconomic and ethnic backgrounds. Effects were maintained at 3-month follow-up. This study shows that socioeconomically disadvantaged and ethnic minority families in disadvantaged neighborhoods can be engaged in and benefit from parenting interventions to reduce disruptive child behavior.

Association of regional gray matter volumes in the brain with disruptive behavior disorders in male and female children.

Because the disruptive behavior disorders are highly impairing conditions, it is important to determine if structural variations in brain are associated early in life with these problems among children.Structural MRI data were acquired from 111 9–11 year olds (58 girls and 53 boys), 43 who met diagnostic criteria for oppositional defiant disorder and/or conduct disorder and 68 healthy controls. Voxel-based morphometry was used to examine associations of behavioral measures with gray matter volumes in whole-brain analyses.Unlike previous studies, variation in gray matter volume was not found to be associated with a disruptive behavior disorder diagnosis in any brain region at p < .05 with FWE correction. Nonetheless, an inverse nonlinear association of the number of conduct disorder (CD) symptoms with gray matter volume along the left superior temporal sulcus was significant in the full sample (p < .05 with FWE correction), with a trend in the right hemisphere (p < 0.001 uncorrected). There also was a trend toward a stronger association of the number of CD symptoms with gray matter volume along the left superior temporal sulcus in girls than boys.The present findings did not replicate previous findings of reduced gray matter volumes in the anterior insula, amygdala, and frontal cortex in youth with CD, but are consistent with previous findings of reduced gray matter volumes in temporal regions, particularly in girls.

Comorbidity of ADHD and Anxiety: From Basic to Applied Research

Population, 7 • Research Findings, 10 Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by a comorbid disorder. For example, approximately 50% of children with ADHD meet criteria for oppositional defiant disorder (ODD) or conduct disorder (CD; Newcorn, Halperin, & Miller, 2009). While comorbidity with these disorders is clearly very high, it is also important to note that internalizing disorders such as anxiety disorders are comorbid with ADHD in approximately 30%–40% of clinically referred children (Jarrett, Wolff, & Ollendick, 2007; MTA Cooperative Group, 1999; Tannock, 2009). While this comorbidity is common, only a limited number of studies have examined the characteristics of children with ADHD and comorbid anxiety disorders (see Jarrett & Ollendick, 2008, for a recent review), suggesting that greater research is needed in this area. The purpose of this current review is to discuss emerging research on the comorbidity of ADHD and anxiety in terms of both basic and applied research. Following an overview of basic research findings, we discuss an article that we recently published in the Journal of Attention Disorders that examined differences among diagnostic groups consisting of children with only ADHD (ADHD), ADHD plus anxiety disorders (ADHD + ANX), and anxiety disorders only (ANX). Following a review of this study and others, we will discuss important implications of this type of research for the assessment and treatment of children with ADHD and anxiety. We will also review some emerging treatment research for this subgroup and promising avenues for possible future treatment development.

NewDSMChapter to Focus on Disorders of Self-Control

Back to table of contents Previous article Next article Professional NewsFull AccessNew DSM Chapter to Focus on Disorders of Self-ControlMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Apr 2013https://doi.org/10.1176/appi.pn.2013.4a20AbstractThe chapter on disruptive disorders brings together diagnoses previously classified as disorders of childhood and adolescence with other disorders of self-control not limited by age.Refinements to oppositional defiant disorder (ODD), conduct disorder, and intermittent explosive disorder mark the prominent changes clinicians will see in a new chapter in DSM-5 on “Disruptive, Impulse-Control, and Conduct Disorders.”The chapter brings together disorders marked by problems with emotional and behavioral self-control that were previously included in the chapter in DSM-IV titled “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” (ODD, conduct disorder, and intermittent explosive disorder) and other disorders of self-control not confined to childhood, such as pyromania and kleptomania.Because of significant overlap with antisocial personality disorder, the latter appears in the disruptive disorders chapter as well as in the chapter on personality disorders. (Attention-deficit/hyperactivity disorder, whose symptoms also overlap with many of the disorders in this chapter, appears in the chapter on neurodevelopmental disorders; see Psychiatric News, January 18.)“All of these disorders have previously been identified as ‘externalizing’ as compared to ‘internalizing’ disorders,” explained Darrel Regier, M.D., M.P.H., APA director of research and vice chair of the DSM-5 Task Force. “Since we eliminated a section that included only disorders of childhood and adolescence in order to distribute these to disorder sections that would cover the entire lifespan, putting ODD and conduct disorder together with antisocial personality disorder, intermittent explosive disorder, pyromania, and kleptomania was appropriate.”Four refinements mark changes to criteria for oppositional defiant disorder. Symptoms are now grouped into three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness, reflecting that the disorder includes both emotional and behavioral symptoms. The exclusion criterion for conduct disorder has been removed. “You can have both conduct disorder and ODD,” Francisco Castellanos, M.D., a member of the Work Group on Disruptive Disorders, told Psychiatric News. “It’s not as simple as you graduate from one to the other.” Additionally, the criteria will indicate that symptoms must be present more than once a week to distinguish the diagnosis from symptoms common to normally developing children and adolescents. And a severity rating has been added to the criteria to reflect research showing that the degree of pervasiveness of symptoms across settings is an important indicator of severity. Castellanos explained that the work group considered whether children who showed only symptoms of ODD toward one particular member of the family, for instance, would still meet the criteria. “Turns out the predictive validity is the same,” he said. “But what does seem to matter is the severity of prognosis. If a child displays only this behavior toward mother, it turns out that is better prognostically than if the child displays the behavior pervasively. So it seems that the number of different settings in which the symptoms appear is a very reasonable indicator of severity.” The primary change in DSM-5 intermittent explosive disorder is the type of aggressive outbursts that should be considered: physical aggression was required in DSM-IV, whereas verbal aggression and nondestructive/noninjurious physical aggression also meet criteria in DSM-5. DSM-5 also provides more specific criteria defining frequency needed to meet criteria and specifies that the aggressive outbursts are impulsive and/or anger and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences. Because of the paucity of research on this disorder in young children and the potential difficulty of distinguishing these outbursts from normal temper tantrums in young children, a minimum age of 6 years (or equivalent developmental level) is now required.Work group chair David Shaffer, M.D., said changes to the criteria are based largely on the work of Emil Coccaro, M.D., chair of the Department of Psychiatry at the University of Chicago, and are designed to make the criteria considerably more specific than are DSM-IV criteria. He also said the changes are expected to decrease prevalence of the diagnosis. Criteria for conduct disorder are largely unchanged from DSM-IV, but a descriptive specifier has been added for children who are deficient in “pro social behaviors.” Castellanos said the designation replaces the phrase “callous and unemotional”—a term used by research psychologists that has been deemed stigmatizing. The new specifier is based on research showing that individuals with conduct disorder who are deficient in pro social behaviors may show a more severe form of the disorder and a different treatment response. “There is a compelling literature that this subtype of conduct disorder exists and is predictive of long-term outcome, and that identification of such children can help to target treatment,” Castellanos told Psychiatric News. ■A fact sheet and audio clips on conduct disorder can be accessed at http://www.psychiatry.org/dsm5. ISSUES NewArchived

Mind the gap: Assessing impairment among children affected by proposed revisions to the diagnostic criteria for oppositional defiant disorder.

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) workgroup for disruptive behavior disorders is considering adopting a frequency threshold for symptoms of oppositional defiant disorder (ODD). In the present study, the impact of substituting the term "often" with a specific age-based frequency on impairment and prognosis among preschool children was tested in a longitudinal design. Mutually exclusive groups were created to identify children who met criteria for ODD based on a symptom threshold of "often," as in Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-4), and those that met criteria for ODD based on a threshold of "1-2 times per day," which approximated the proposal for DSM-5. Comparisons of these groups to each other and to nondiagnosed peers determined the impact of changing the symptom threshold on impairment and prognosis. Close to one-third of children who met DSM-4 criteria for ODD did not meet criteria under the alternative diagnosis; African American children were overrepresented in this group. Preschoolers who met DSM-4, but not the alternative criteria, had higher rates of ODD, conduct disorder (CD), and were more impaired than their nondiagnosed peers at baseline and follow-up. Preschoolers meeting DSM-4 criteria were less impaired than children meeting the alternative ODD criteria at baseline according to parent, but not according to teacher report. No differences could be detected between those meeting DSM-4 and those meeting the alternative criteria in rate of ODD, CD, or impairment at follow-up. Among clinically referred preschool children, changing the symptom threshold for ODD could result in a sizable group of children who would no longer meet diagnostic criteria, despite demonstrating significant morbidity concurrently and prospectively.

Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder

Chronic tic disorders (TD) are consistently found to have high rates of comorbidity with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). The purpose of this study is to compare the severity of TD only to TD with comorbid OCD or ADHD based on severity of tics, measures of psychopathology and additional comorbid diagnoses. Baseline data from 158 youth with a chronic TD who participated in two longitudinal studies were examined. Fifty-three percent (N = 85) of the youth also met criteria for a diagnosis of OCD, 38.6 % (n = 61) met criteria for ADHD and 24.1 % (N = 38) met criteria for both. Measures of interest addressed severity of tics, symptoms of anxiety, depression, ADHD, psychosocial stress, global functioning and the presence of comorbid diagnoses. Youth with comorbid TD and OCD were characterized by more severe tics, increased levels of depressive and anxious symptoms, heightened psychosocial stress and poorer global functioning. Youth with comorbid TD and ADHD did not differ from those with TD alone on measures of tic severity, but experienced greater psychosocial stress and poorer global functioning. Subjects with comorbid TD and OCD had more internalizing disorders than those without OCD, while those with comorbid ADHD were more likely to meet criteria for oppositional defiant disorder. TD with OCD is a more severe subtype of TD than TD without OCD. TD with ADHD is associated with higher psychosocial stress and more externalizing behaviors. Further research is needed into the underlying relationships between these closely associated conditions.

HEADS UP

Cultures of blood and pleural fluid have a fairly low yield in pleural or parapneumonic empyema, whether or not the child received prior antibiotics, and this complicates choice of antibiotic therapy. A study from Utah used real time polymerase chain reaction (PCR) testing to detect the 5 most likely pathogens in pleural fluid collected over a one year period.1 A pathogen was cultured from pleural fluid or blood in 22 (35%) of 63 children, most commonly Streptococcus pneumoniae (15 cases). All positive cultures were confirmed by PCR. In addition, PCR increased the yield of positive identifications to 53 (84%), of which 45 (71%) were S. pneumoniae. Spanish collaborators were able to serotype the S. pneumoniae isolates by PCR; 7F was the commonest serotype detected (21 cases). Other organisms detected by culture or PCR were Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae and Mycoplasma pneumoniae. Molecular techniques can help direct antibiotic therapy for pleural empyema by greatly improved identification of pathogens. Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Gastro-oesophageal reflux disease (GORD) is diagnosed in 12.3% of North American infants and 1% of older children. In the last decade, prescriptions for proton-pump inhibitors (PPIs) for infants and children have increased enormously, despite scanty evidence on their efficacy and safety. Now a systematic review found only 12 randomised controlled trials or cross-over trials in children.1 Five studies involved infants: two studies of omeprazole found no advantage over placebo in reducing GORD symptoms, despite one trial showing that omeprazole reduced gastric acidity. One study found that lanoprazole reduced GORD symptoms compared with hydrolysed formula. PPIs caused mild-to-moderate adverse events. In older children, PPIs were as effective as alginates or ranitidine. The authors conclude that PPIs are not effective in reducing GORD symptoms in infants, while there are insufficient data in older children. The management of GORD in infants has been plagued by inappropriate medication without adequate evidence, resulting in unnecessary toxicity and expense. The treatment of GORD needs to be evidence-based. Link: http://pediatrics.aappublications.org/content/127/5/925.long Reviewers: Nick Wood, NicholW2@chw.edu.au; David Isaacs, david.isaacs@health.nsw.gov.au The monovalent influenza H1N1 pandemic (swine flu) vaccine was known to be immunogenic in children after a single dose, but its efficacy was unproven. Now a single dose of the vaccine has been shown to be highly effective in Beijing schoolchildren.1 Children were chosen to participate in a parade to celebrate China's National Day based solely on being the correct height to ride on a float, and participants were immunised with a single dose of swine flu vaccine. Only 9 of 25 037 vaccinated children developed proven swine flu over the next 9 weeks, compared with 687 of 244 091 unvaccinated children (vaccine efficacy 87.3%, 95% CI 75.4% to 93.4%). Adverse reactions were reported in 12% of a sub-sample of almost 100 000 vaccinated adults and children, mostly local reactions, dizziness and fatigue, but no Guillain-Barre syndrome. Link: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1006736 Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au The role of foods in ADHD is highly controversial. A possible link has been postulated between ADHD and hypersensitivity to some foods. Colourings and preservatives have been implicated in some studies, but not additives. A Dutch group randomised children aged 4–8 years with ADHD to 5 weeks of a restricted elimination diet (n = 50) or to healthy eating advice controls (n = 50).1 After 5 weeks, 32 (64%) of the elimination diet intervention group had “responded”, defined as an improvement in the ADHD rating scale of 40% or greater. The mean difference in rating scale scores significantly favoured the elimination group compared with controls (p < 0.0001) and there was also a highly significant improvement in oppositional defiant disorder criteria. The researchers tested for an immunological basis by measuring food-specific Ig E and IgG levels. There was no association with IgE levels. Some foods induced higher specific IgG levels than others. However, when 30 of the 32 responders were challenged with “high IgG” or “low IgG” foods, 19 (63%) relapsed and the relapse rate was no different whether high or low IgG foods were re-introduced. Although this study suggests that food hypersensitivity plays an important role in some children with ADHD, a limitation is that neither parents nor teachers were masked to treatment allocation, and the improvement in symptoms was short-term. Nevertheless, the intervention is relatively harmless and could benefit some children. The hypersensitivity is not apparently IgE- or IgG-mediated and the study leaves us no wiser to the mechanism. Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au

The Relationship between Social Defiance, Vindictiveness, Anger, and Brain Morphology in Eight‐year‐old Boys and Girls

AbstractThe goal of this study is twofold: (1) to assess brain anatomical differences between children meeting diagnostic criteria for oppositional defiant disorder (ODD) and healthy controls, and (2) to investigate whether morphological brain characteristics associated with ODD differ in boys and girls. Eight‐year‐old participants (N = 38) were scanned using magnetic resonance imaging. ODD symptoms were assessed using the Dominic‐R interactive. In ODD participants, we observed a significant reduction of gray matter density in the left orbitofrontal cortex—a prefrontal region that plays a pivotal role in emotional self‐regulation and impulse control—and, conversely, an increase in the left temporal area—an area that has been associated with aggressive, impulsive, and antisocial personality. Furthermore, ODD boys showed a reduction of both gray matter density in the left orbitofrontal cortex and of white matter density in the left superior frontal area. The structural abnormalities found in the present study, in particular, the correlation between ODD symptoms and reduction of gray matter density in the left orbitofrontal cortex, may present some evidence for the existence of neuropathology associated with ODD symptoms during childhood. Furthermore, our findings indicate morphometric differences between boys and girls with ODD, which may be associated with gender differences in social behavior in children showing ODD symptoms.

Building an evidence base for DSM–5 conceptualizations of oppositional defiant disorder and conduct disorder: Introduction to the special section.

The DSM-5 ADHD and Disruptive Behavior Disorders Work Group recently outlined a research agenda designed to support possible revisions to the diagnostic criteria for oppositional defiant disorder (ODD) and conduct disorder (CD). Some of the areas in need of further investigation include (a) examining the clinical utility of the current diagnostic system in girls, (b) further clarifying the developmental progression from ODD to CD, (c) determining whether facets of ODD symptoms can help explain heterotypic continuity and enhance predictive validity, (d) evaluating the clinical utility of a new subtyping scheme for CD on the basis of the presence of callous-unemotional traits, and (e) comparing the clinical utility of dimensional versus categorical conceptualizations of ODD and CD. This special section was organized in an attempt to provide data on these issues using a diverse array of longitudinal data sets consisting of both epidemiological and clinic-based samples that collectively cover a large developmental span ranging from childhood through early adulthood.

Using household survey data to inform policy decisions regarding the delivery of evidence‐based parenting interventions

This study used household survey data on the prevalence of child, parent and family variables to establish potential targets for a population-level intervention to strengthen parenting skills in the community. The goals of the intervention include decreasing child conduct problems, increasing parental self-efficacy, use of positive parenting strategies, decreasing coercive parenting and increasing help-seeking, social support and participation in positive parenting programmes. A total of 4010 parents with a child under the age of 12 years completed a statewide telephone survey on parenting. One in three parents reported that their child had a behavioural or emotional problem in the previous 6 months. Furthermore, 9% of children aged 2-12 years meet criteria for oppositional defiant disorder. Parents who reported their child's behaviour to be difficult were more likely to perceive parenting as a negative experience (i.e. demanding, stressful and depressing). Parents with greatest difficulties were mothers without partners and who had low levels of confidence in their parenting roles. About 20% of parents reported being stressed and 5% reported being depressed in the 2 weeks prior to the survey. Parents with personal adjustment problems had lower levels of parenting confidence and their child was more difficult to manage. Only one in four parents had participated in a parent education programme. Implications for the setting of population-level goals and targets for strengthening parenting skills are discussed.

A Double-Blind, Placebo-Controlled, Crossover Study of Osmotic Release Oral System Methylphenidate in Adults With ADHD With Assessment of Oppositional and Emotional Dimensions of the Disorder

The realization that attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood has led to increased frequency of diagnosis and treatment in adults. Osmotic release oral system (OROS) methylpheni-date is a long-acting stimulant demonstrated to be effective in the treatment of children and adolescents with ADHD. Forty-seven adults entered and 41 completed this double-blind, placebo-controlled, crossover trial of OROS methylphenidate. Each double-blind arm lasted 4 weeks; data were collected from August 2004 through December 2005. Subjects met both DSM-IV-TR and Utah Criteria for ADHD in adults. Outcome measures included the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), the adult ADHD-Rating Scale (ADHD-RS), and the Clinical Global Impressions-Improvement scale (CGI-I). At baseline, subjects were categorized as having significant emotional symptoms with the WRAADDS and/or significant oppositional-defiant symptoms using a self-report scale assessing the DSM-IV criteria for oppositional defiant disorder. 17% of the sample (N = 8) had ADHD alone, 38% (N = 18) had ADHD plus significant emotional symptoms, and 40% (N = 19) had ADHD with both significant emotional and oppositional symptoms. At a mean +/- SD dose of 64.0 +/- 23.3 (0.75 mg/kg), OROS methylphenidate proved superior to placebo for all clinical measures: total WRAADDS score decrease of 42% versus 13%, respectively, p < .001 and total ADHD-RS score decrease of 41% versus 14%, respectively, p = .003, plus the subscales addressing inattention, hyperactivity/ impulsivity, and emotional dysregulation. OROS methylphenidate proved effective in treating adult ADHD. ADHD alone was relatively uncommon. Over 80% of our patients had ADHD with a combination of emotional and/or oppositional symptoms.

Externalizing and Oppositional Behaviors and Karate-do: The Way of Crime Prevention

Childhood disruptive behaviors can be precursors to later deviance. To verify the efficacy of karate, a complex psychomotor activity that enhances self-regulation and executive skills, as an intervention for externalizing behaviors, 16 children, ranging in age from 8 to 10 years, and meeting diagnostic criteria for oppositional defiant disorder were studied. Eight were randomly assigned to a 10-month Wa Do Ryu karate program, whereas 8 children received no intervention. The children were assigned to a larger karate class, composed of typically developing youngsters. Three domains of temperament--intensity, adaptability, and mood regulation--were measured at the beginning and the end of the training period in all 16 participants. A significant improvement in temperament scale scores was measured in the karate group for all tested items compared to controls. Karate, when properly taught, can be a useful adjunct in multimodal programs aimed at externalizing behavior reduction.

Oppositional Defiant Disorder Rating Scale

In this article, the authors report the psychometric properties of a parent-completed rating scale based on the criteria for oppositional defiant disorder (ODD) in the Diagnostic and Statistical Manual of Mental Disorders— Fourth Edition—Text Revision ( DSM-IV-TR). Mothers of 294 boys and 48 girls with attention-deficit/hyperactivity disorder (ADHD) and 53 boys and 45 girls without behavior problems completed the Oppositional Defiant Disorder Rating Scale (ODDRS). Fathers of 44 boys with ADHD also completed the scale,and 71 mothers of boys with ADHD provided 1-year test—retest data.The ODDRS had high internal consistency, high interrater reliability, and moderate 1-year test—retest reliability.The scale had one principal component and correlated as expected with related subscales from the Child Behavior Checklist and with overreactive parenting. Scores were not significantly correlated with parent or child age or with socioeconomic status.The strong psychometric properties indicate that this measure holds considerable promise for briefly assessing ODD in a manner consistent with the DSM-IV-TR.

A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings

A modified skills training component of dialectical behavior therapy (DBT) was implemented in a group therapy format for non-suicidal outpatient young adolescents who met criteria for oppositional defiant disorder (ODD). Thirty-two youths completed the 16-week program, as well as pre- and post-treatment measures. The treatment was effective not only in decreasing negative behaviors, but also in increasing positive behaviors, per caregiver report. The youths reported a significant reduction in externalizing and internalizing symptoms and in depression. Reliable change indices indicated that far more participants were in the improved category than in the deteriorated category on the measures of interest. Despite the absence of control groups but consistent with the treatment outcome research literature for DBT-based treatments for other disorders, this study demonstrated that DBT skills training is feasible and shows promise in improving the behavior of ODD young adolescents.

Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior.

Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct disorder (n = 132; 35 girls, 97 boys; ages 7-14) but varied in comorbidity (up to 5 additional disorders). In addition to comorbidity, 4 domains of case complexity were evaluated: scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, and barriers that emerged during treatment. Comorbidity was associated with greater therapeutic change. Children who varied in comorbidity did not differ on outcome measures at the end of treatment. Complexity was either unrelated or positively related to therapeutic change. As an exception, perceived barriers were associated with less child improvement, but, even with high barriers, effect sizes for these children were large. The findings suggest that comorbidity or complexity of cases does not necessarily influence outcome or limit the applicability of EBTs.