Oppositional Defiant Disorder Symptoms Research Articles

Amygdala Volume is Associated with ADHD Risk and Severity Beyond Comorbidities in Adolescents: Clinical Testing of Brain Chart Reference Standards.

Aim was to examine, whether brain charts can be applied in a sample of adolescents (N=140, 38% female) to determine whether atypical brain subcortical and total volumes are associated with ADHD at-risk status and severity of parent-rated symptoms, accounting for self-rated anxiety and depression, and parent-rated oppositional defiant disorder (ODD) as well as motion. Smaller bilateral amygdala volume was associated with ADHD at-risk status, beyond effects of comorbidities and motion, and smaller bilateral amygdala volume was associated with inattention and hyperactivity/impulsivity, beyond effects of comorbidities except for ODD symptoms, and motion. Individual differences in amygdala volume meaningfully add to estimating ADHD risk and severity. Conceptually, amygdalar involvement is consistent with behavioral and functional imaging data on atypical reinforcement sensitivity as a marker of ADHD-related risk. Methodologically, results show that brain chart reference standards can be applied to address clinically informative, focused and specific questions.

Parent training for disruptive behavior symptoms in attention deficit hyperactivity disorder: a randomized clinical trial.

Attention-Deficit/Hyperactivity Disorder (ADHD) affects 5% of children and 2.5% of adults worldwide. Comorbidities are frequent, and Oppositional Defiant Disorder (ODD) reaches 50%. Family environment is crucial for the severity of behaviors and for prognosis. In middle-income countries, access to treatment is challenging, with more untreated children than those under treatment. Face-to-face behavioral parent training (PT) is a well-established intervention to improve child behavior and parenting. A clinical trial was designed to compare PT-online and face-to-face effects to a waiting list group. Outcomes were the ADHD and ODD symptoms, parental stress and styles, and quality of life. Families were allocated into three groups: standard treatment (ST), ST + PT online, and ST + Face-to-Face PT. We used repeated measures ANOVA for pre × post treatment analysis corrected for multiple comparisons. Parent training was effective in reducing symptoms of ADHD (p = 0.030) and ODD (p = 0.026) irrespective of modality (p = 1.000). The combination of ST and PT was also associated with better quality of life in the physical domain for patients (p = 0.009) and their parents (p = 0.050). In addition to preliminary data, online intervention seems effective for parenting and improving social acceptance of children. The potential to reach many by an online strategy with a self-directed platform may imply effectiveness with a low cost for public health to support parents' symptoms management.

Are Family Factors Differentially Associated with Externalizing Symptoms Among Youth with Perinatally Acquired HIV?

Youth with perinatally-acquired HIV (PHIV) face unique psychosocial stressors. They are at risk for externalizing problems, including symptoms of oppositional defiant disorder, conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD), as well as risk-taking behaviors, such as substance use (SU). Although family factors have been differentially associated with externalizing and SU behaviors based on youth sex in prior research, there is a dearth of literature considering these processes among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88years, SD = 3.08years; 50.80% male; 85.30% Black or Latinx). Boys exhibited higher levels of ADHD symptoms than girls. Among boys, lower levels of consistency in discipline were associated with higher CD symptoms. Lower levels of family cohesion were associated with higher levels of SU among girls, and higher levels of CD symptoms across youth sex. Findings support the need for family-focused behavioral interventions among youth with PHIV.

Effectiveness of Parental Behavioral Training on Distress Tolerance, Family Cohesion, and Maternal Parenting Self-Efficacy in Mothers of Children with Oppositional Defiant Disorder Symptoms

Objective: Oppositional Defiant Disorder (ODD) is one of the behavioral disorders classified under destructive and harmful behavior disorders. Children with this disorder tend to destroy objects around them and defy the commands of parents and school authorities. Therefore, the purpose of this study was to examine the effectiveness of parental behavioral training on distress tolerance, family cohesion, and maternal parenting self-efficacy in mothers of children with symptoms of ODD. Methods and Materials: This study employed an experimental method. It was designed as a quasi-experimental study with pre-test, p1-10ost-test, follow-up, and control groups. The population of this study included all mothers of children with symptoms of ODD under the coverage of the Imam Khomeini Relief Committee in Sari city during the academic year 2021-2022. Thirty individuals were selected through purposive sampling from among mothers of children with ODD and divided into two groups of 15 (one experimental and one control group). The experimental group received parenting training based on Choice Theory in eight 90-minute sessions, while the control group was placed on a waiting list. Measurement tools included the Distress Tolerance Scale by Simons and Gaher (2005), the Family Cohesion Scale by Olson (1999), and the Parenting Self-Efficacy Questionnaire by Dumka. Descriptive statistics (such as frequency tables, mean indexes, and standard deviation) and inferential statistics (univariate analysis of covariance and Bonferroni post-hoc test) were used for data analysis, with SPSS-22 software facilitating the analysis process. Findings: The F-value of univariate analysis of covariance for the distress tolerance variable in the post-test (F=59.57, P=0.001) and follow-up (F=57.85, P=0.001), family cohesion in the post-test (F=45.52, P=0.001) and follow-up (F=47.13, P=0.001), and finally for the parenting self-efficacy variable in the post-test (F=39.48, P=0.001) and follow-up (F=41.14, P=0.001) were significant. Conclusion: Based on the findings, it can be concluded that parental behavioral training is effective in improving distress tolerance, family cohesion, and maternal parenting self-efficacy in mothers of children with symptoms of ODD.

Longitudinal relationship between oppositional defiant disorder symptoms and attention-deficit/hyperactivity disorder symptoms in Chinese children: insights from cross-lagged panel network analyses.

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common childhood mental disorders, and they have substantial comorbidity. The developmental precursor model has long been widely used to explain the mechanisms of comorbidity between ODD and ADHD, however whether it is equally effective at the symptomatic level is unclear. Therefore, this study aimed to (a) examine the stability of the ODD and ADHD comorbidity network in a longitudinal sample of high-risk children in China; and (b) examine the longitudinal relationship between the ODD and ADHD symptom networks based on a developmental precursor model. Two hundred sixty-three Chinese children aged 6 to 13years with ODD and/or ADHD were assessed for symptoms of ODD and ADHD in two surveys conducted 1year apart. We used data from these two time points to construct two cross-sectional networks and a cross-lagged panel network (CLPN) to explore the symptom network for comorbidity of ODD and ADHD. The analysis shows that: (1) the two cross-sectional networks are highly similar in terms of structure, existence of edges, centrality estimates, and the invariance test shows that there is no significant difference between them. The symptoms "follow through", "interrupts/intrudes", "difficulty playing quietly" and "concentration" had the highest expected influence centrality at both time points. (2) Combined with the results of the cross-sectional and cross-lagged networks, we found that "annoy" and "blame" are potential bridge symptoms between the ODD and ADHD symptom networks. The symptom "annoy" forms a reciprocal predictive relationship with "interrupts/intrudes", while "blame" unidirectionally predicts "close attention". In addition, we found that "vindictive" predicted numerous ADHD symptoms, whereas "angry" was predicted by numerous ADHD symptoms. The findings emphasize the broad predictive relationship between ODD and ADHD symptoms with each other, and that ODD symptoms may lead to activation of the ADHD symptom network and vice versa. These findings suggest that the developmental precursor model at the symptom level may partially explain the comorbidity mechanisms of ODD and ADHD, and future studies should further investigate the underlying multiple mechanisms.

Emotion regulation as central to psychopathology across childhood and adolescence: a commentary on Nobakht etal. (2023).

An important goal of clinical/developmental research is to identify factors contributing to the onset and maintenance of psychopathology - particularly factors that could bemodified through intervention. Large-scale, multi-informant, longitudinal studies provide valuable opportunities for testing such etiological hypotheses, as illustrated by Nobakht etal.'s recent six-wave cohort study spanning ages 4-14. At a within-person level, emotion regulation (ER) deficitsconsistently predicted oppositional defiant disorder (ODD) symptoms (including both irritability and defiance), whereas victimization did not. These results comport with growing evidence highlighting ER's centrality to ODD and psychopathology more broadly. While the ER findings carry promising implications, caution is warranted in interpreting the results for victimization given that its association with psychopathology is well-documented. More research is needed to test precise questions about within- and between-person processes involving ER, victimization, and psychopathology across development. Pressing research questions include whether, how, and when youths' ER can be modified, and with what effects on clinical outcomes.

Reciprocal relations between interparental aggression and symptoms of oppositional defiant and conduct disorders: a seven-wave cohort study of within-family effects from preschool to adolescence.

Interparental aggression is believed to increase the risk of behavioral disorders in offspring, and offspring behavioral problems may forecast interparental aggression. However, these assumptions have yet to be put to a strong test. This study, therefore, examined whether increased interparental aggression predicted increased symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) from preschool to adolescence and vice versa. A sample (n = 1,077; 49.6% girls) from two birth cohorts of children in Trondheim, Norway, was assessed biennially from age 4 to 16. Children's symptoms of ODD and CD were assessed using semi-structured clinical interviews of parents (from age 4) and children (from age 8). One of the parents reported on their own and their partner's verbal and physical aggression. A random intercept cross-lagged model was estimated to test the within-family relations between interparental aggression, CD, and ODD symptoms. Across development, increased interparental aggression predicted increased CD symptoms 2 years later, whereas an increased number of ODD symptoms forecasted increased interparental aggression. The argumentative/defiant, aggressive, and vindictive behaviors seen in ODD are often directed toward parents and may take a toll on their relationship and possibly foster interparental aggression, whereas aggression between parents may promote symptoms of CD in their offspring, which commonly extend beyond the home. Incorporating effective and non-aggressive means to solve interparental conflict into parental management programs may reduce the development of symptoms of CDs in children.

Assessing aetiological overlap between child and adult attention-deficit hyperactivity disorder symptoms in an extended family design.

Several longitudinal studies have cast doubt on the aetiological overlap between child and adult attention-deficit hyperactivity disorder (ADHD). However, a lack of genetically sensitive data following children across adulthood precludes direct evaluation of aetiological overlap between child and adult ADHD. We circumvent the existing gap in longitudinal data by exploring genetic overlap between maternal (adult) and offspring (child) ADHD and comorbid symptoms in an extended family cohort. Data were drawn from the Norwegian Mother, Father and Child Cohort Study, a Norwegian birth registry cohort of 114 500 children and their parents. Medical Birth Registry of Norway data were used to link extended families. Mothers self-reported their own ADHD symptoms when children were aged 3 years; reported children's ADHD symptoms at age 5 years; and children's ADHD, oppositional defiant disorder (ODD), conduct disorder, anxiety and depression symptoms at age 8 years. Genetic correlations were derived from Multiple-Children-of-Twins-and-Siblings and extended bivariate twin models. Phenotypic correlations between adult ADHD symptoms and child ADHD, ODD, conduct disorder, anxiety and depression symptoms at age 8 years were underpinned by medium-to-large genetic correlations (child ADHD: rG = 0.55, 95% CI 0.43-0.93; ODD: rG = 0.80, 95% CI 0.46-1; conduct disorder: rG = 0.44, 95% CI 0.28-1; anxiety: rG = 0.72, 95% CI 0.48-1; depression: rG = 1, 95% CI 0.66-1). These cross-generational adult-child genetic correlations were of a comparable magnitude to equivalent child-child genetic correlations with ADHD symptoms at age 5 years. Our findings provide genetically sensitive evidence that ADHD symptoms in adulthood share a common genetic architecture with symptoms of ADHD and four comorbid disorders at age 8 years. These findings suggest that in the majority of cases, ADHD symptoms in adulthood are not aetiologically distinct from in childhood.

Negative Parenting Mediates the Longitudinal Association between Parental Internalizing Symptoms and Child Oppositional Symptoms.

Research has pointed to both cross-sectional and longitudinal associations between parental internalizing symptoms and child externalizing symptoms. This study analyzed whether the association is mediated by negative parenting behavior in view of previous reports that both parental internalizing symptoms and child externalizing symptoms are related to parenting behaviors. Longitudinal data for the current analyses were derived from a randomized controlled trial on the efficacy of a web-assisted self-help intervention for parents of children with elevated levels of externalizing symptoms. Two different mediation models were analyzed, one using attention-deficit/hyperactivity disorder (ADHD) symptoms as the dependent variable and the other using oppositional defiant disorder (ODD) symptoms. Both models included parental internalizing symptoms as the independent variable, negative parenting behavior as a mediator, and study condition as a confounder. The longitudinal analyses support the mediating role of negative parenting behavior in the association between early parental internalizing symptoms and later child ODD symptoms.

Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD.

Impulsivity is viewed as key to attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item-level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence. Participants were 310 children over-recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes. Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross-sectional and longitudinal parent-reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher-rated social skills 5 years later compared to total DBD scores. Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence.

Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders-A general population-based birth cohort study.

Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69-5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70-3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.

Development of symptoms of oppositional defiant disorder from preschool to adolescence: the role of bullying victimization and emotion regulation.

Childhood oppositional defiant disorder (ODD) is associated with adverse outcomes which can continue to impair life well into adulthood. Identifying modifiable etiological factors of ODD is therefore essential. Although bullying victimization and poor emotion regulation are assumed to be risk factors for the development of ODD symptoms, little research has been conducted to test this possibility. A sample (n = 1,042) from two birth cohorts of children in the city of Trondheim, Norway, was assessed biennially from age 4 to 14 years. Parents and children (from age 8) were assessed with clinical interviews to determine symptoms of ODD, children reported on their victimization from bullying, and teachers reported on children's emotion regulation. Oppositional defiant disorder symptoms increased from age 4 to 6, from age 8 to 10, and then started to wane as children entered adolescence. A Random Intercept Cross-Lagged Panel Model revealed that increased emotion regulation predicted a reduced number of ODD symptoms across development (β = -.15 to -.13, p < .001). This prediction was equally strong for the angry/irritable and argumentative/defiant dimensions of ODD. No longitudinal links were observed between bullying victimization and ODD symptoms. Improving emotion regulation skills may protect against ODD symptoms throughout childhood and adolescence.

The good, the bad, and the ugly: a comprehensive study of temperament and personality traits as correlates of self-reported disruptive behavior problems in male and female adolescents

PurposeThe aim of the present study was to provide a comprehensive picture of temperament and personality traits as correlates of self-reported disruptive behavior problems in male and female adolescents.MethodsTwo-hundred-and-sixty-three non-clinical adolescents aged 12–18 years completed a survey containing standardized scales to measure the HEXACO personality traits, impulsivity, effortful control, Dark Triad traits, and symptoms of oppositional-defiant disorder (ODD) and conduct disorder (CD).ResultsThe results showed that good traits (in particular, honesty-humility, agreeableness, and the regulative trait of effortful control) were negatively associated, while bad and ugly traits (especially impulsivity and the Dark Triad traits of psychopathy and Machiavellianism) were positively associated with symptoms of ODD and CD. In addition, regression analyses indicated that both types of disruptive behavior problems were associated with a unique set of temperament and personality correlates, and that specific correlates also differed for both genders.ConclusionsIt is concluded that research on the role of temperament and personality should adopt a broad perspective, taking good, bad, and ugly traits from various theoretical models as well as gender differences into account.

Oppositional Defiant Disorder Symptoms and Multi-level Family Factors in Chinese Migrant Children: A Network Perspective.

Based on the network theory of mental disorders, this study used network analysis to examine the network of ODD symptoms and multilevel family factors and identify the most crucial family factors influencing ODD symptoms in children. A total of 718 Chinese migrant children aged 7-14 years participated in this study. This study measured ODD symptoms, family system-level variables (3 factors), family dyadic-level variables (6 factors), and family individual-level variables (6 factors) with factors selected based on the multilevel family factors theory of ODD symptoms. The results indicated that (1) "annoy" was the center symptom of ODD, (2) "annoy" and "vindictive" was the main bridge connecting the multilevel family factors, and (3) family cohesion at the family system level, parent-child conflict at the family dyadic level, and parental depression at the family individual level were critical central and bridging influencing factors. The findings of this study highlight the critical role of "annoy" and "vindictive" symptoms in the activation of ODD symptom networks in children and provide a basis for future improvements in diagnostic criteria. These potential core and bridge factors might become key intervention targets for childhood ODD.

Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study

Emotional/behaviour problems and exposure to stressful life events are thought to contribute to new onset of urinary incontinence (UI) amongst children who have attained bladder control. However, very few prospective studies have examined these associations. We assessed whether mental health problems and stressful life events were associated with subsequent new onset in UI using multivariable logistic regression in a prospective UK cohort (n = 6408). Mothers provided information on their child’s symptoms of common mental disorders (Development and Wellbeing Assessment, 7 years), stressful life events (7–8 years) and wetting (day and night, 9 years). There was strong evidence that separation anxiety symptoms were associated with new-onset UI in the fully adjusted model (OR (95% CI) = 2.08 (1.39, 3.13), p < 0.001). Social anxiety, attention-deficit hyperactivity disorder and oppositional defiant disorder symptoms were associated with new-onset UI, but these associations attenuated following adjustment for child developmental level and earlier emotional/behaviour problems. There was weak evidence for a sex interaction with stressful life events (p = 0.065), such that females experiencing more stressful life events were at higher risk of new-onset UI (fully adjusted model OR (95% CI) = 1.66 (1.05, 2.61), p = 0.029), but there was no association in males (fully adjusted model OR (95% CI) = 0.87 (0.52, 1.47), p = 0.608). These results suggest that separation anxiety and stressful life events in girls may lead to an increase in UI.

Examination of the Transdiagnostic Role of Impulsivity in the Development of ADHD and ODD Symptoms in Primary and Secondary School Students

Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) exhibit high comorbidity and variability in terms of dominant comorbid factors across the lifespan. Given the high comorbidity between these disorders, the transdiagnostic factors that may underlie them and could be used to develop effective treatments are of great importance. The focus of this research was on the role of impulsivity as a transdiagnostic factor in the development of ADHD and ODD symptoms in primary and secondary school students. Data were collected from 1161 primary (5th to 8th grade) and secondary (1st to 4th grade) school students (624 females and 537 males). Two models were tested, one for primary and one for secondary school students. Both models propose a significant relationship between ADHD symptoms and ODD, with an emphasis on the relationship between impulsivity and angry/irritable mood. The model for secondary school students does not fit the data, while the model for primary school students fits the data but emphasises attention as the most important factor. These results can be explained by the context of developmental changes and the school environment, both of which influence the stability and intensity of ADHD symptoms.

Vicious cycle of emotion regulation and ODD symptoms among Chinese school-age children with ODD: a random intercept cross-lagged panel model

A strong link between children’s emotion regulation and oppositional defiant disorder (ODD) symptoms has been documented; however, the within-person mechanisms remain unclear. Based on the self-control theory and self-regulation theory, our study investigated the longitudinal, bidirectional relationship between emotion regulation and ODD symptoms in school-age children with ODD using parent- and teacher-reported data, respectively. A total of 256 Chinese elementary school students participated in a three-wave longitudinal study spanning two years. We used the random intercept cross-lagged panel model (RI-CLPM) to investigate the concurrent and longitudinal associations between emotion regulation and ODD symptoms. Results from the RI-CLPMs revealed that ODD symptoms were negatively correlated with emotion regulation and positively correlated with emotion lability/negativity at both the between-person and within-person levels across settings. Additionally, in the school setting, emotion regulation negatively predicted subsequent ODD symptoms but not vice versa, whereas emotion lability/negativity was bidirectionally associated with ODD symptoms over time. The longitudinal associations of ODD symptoms with emotion regulation and lability/negativity were not observed in the home setting. These findings suggest a circular mechanism between children’s emotion regulation and ODD symptoms and support the view that emotion regulation, particularly emotion lability/negativity, plays an important role in the development of ODD symptoms.

The effect of child-centered play therapy (CCPT) on the symptoms of oppositional defiant disorder in preschool children

ABSTRACT This study aimed to evaluate the effect of child-centered play therapy (CCPT) on the symptoms of ODD in preschool children. In this quasi-experimental study, using a randomized pretest, posttest, follow-up (RPPF) design with a control group, 24 children in the age range of 5-7 years were selected based on the cut off point of CSI-4 and were randomly assigned into two equal groups of experimental and control (n = 12 each). The experimental group underwent CCPT intervention for 12 weeks, while the control group did not receive any intervention. Data were analyzed using the repeated measures ANOVA. The results showed a significant difference between the intervention and control groups in the symptoms of ODD (P < 0.05), so that CCPT intervention could reduce the symptoms of ODD in preschool children. Comparison of the scores of the evaluation stages showed that the symptoms were continuously decreasing in the experimental group in the 6-month follow-up. Based on these findings, it can be concluded that CCPT is an effective method to reduce the symptoms of ODD in preschool children. Therefore, it is recommended that this method be used for preschool children with ODD in educational institutions and psychological clinics.

Identifying Symptoms of ADHD and Disruptive Behavior Disorders Most Strongly Associated with Functional Impairment in Children: A Symptom-Level Approach

To enhance the understanding of how symptoms of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD = 1.49, 81% male) registered for participation in the ESCAschool trial (ESCAschool: Evidence-based, Stepped Care of ADHD in school-aged children). Clinicians assessed the severity of individual symptoms and five FI domains specifically associated with ADHD symptoms or ODD/CD/CU symptoms using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined with relative importance analyses, to determine the impact of individual symptoms on global FI associated with ADHD and ODD/CD/CU symptoms. Next, we estimated two networks and identified the strongest associations of ADHD symptoms or ODD/CD/CU symptoms with the five FI domains. Symptoms varied substantially in their associations with global FI. The ADHD symptom Easily Distracted (15%) and ODD symptom Argues with Adults (10%) contributed most strongly to the total explained variance. FI related to academic performance, home life and family members, and psychological strain were most strongly associated with ADHD inattention symptoms, whereas FI related to relationships with adults and relationships with children and recreational activities were most strongly associated with hyperactivity-impulsivity symptoms. By comparison, the ODD/CD/CU symptoms most closely linked to FI domains originated from the ODD and CD dimensions. Our findings contribute to a growing body of literature on the importance of analyzing individual symptoms and highlight that symptom-based approaches can be clinically useful.

Comparing the effectiveness of child-centered cognitive behavioral therapy (CCBT) and mother-child attachment intervention on the symptoms of oppositional defiant disorder

Comparing the effectiveness of child-centered cognitive behavioral therapy (CCBT) and mother-child attachment intervention on the symptoms of oppositional defiant disorder