Oppositional Defiant Symptoms Research Articles

Estimating the Heterogeneous Causal Effects of Parent-Child Relationships among Chinese Children with Oppositional Defiant Symptoms: A Machine Learning Approach.

Oppositional defiant symptoms are some of the most common developmental symptoms in children and adolescents with and without oppositional defiant disorder. Research has addressed the close association of the parent-child relationship (PCR) with oppositional defiant symptoms. However, it is necessary to further investigate the underlying mechanism for forming targeted intervention strategies. By using a machine learning-based causal forest (CF) model, we investigated the heterogeneous causal effects of the PCR on oppositional defiant symptoms in children in Chinese elementary schools. Based on the PCR improvement in two consecutive years, 423 children were divided into improved and control groups. The assessment of oppositional defiant symptoms (AODS) in the second year was set as the dependent variable. Additionally, several factors based on the multilevel family model and the baseline AODS in the first year were included as covariates. Consistent with expectations, the CF model showed a significant causal effect between the PCR and oppositional defiant symptoms in the samples. Moreover, the causality exhibited heterogeneity. The causal effect was greater in those children with higher baseline AODS, a worse family atmosphere, and lower emotion regulation abilities in themselves or their parents. Conversely, the parenting style played a positive role in causality. These findings enhance our understanding of how the PCR contributes to the development of oppositional defiant symptoms conditioned by factors from a multilevel family system. The heterogeneous causality in the observation data, established using the machine learning approach, could be helpful in forming personalized family-oriented intervention strategies for children with oppositional defiant symptoms.

Validity and Reliability of a Thai Behavioral and Emotional Screening Tool for Children with Enuresis (TBEST-E)

Objective: Psychological comorbidity in children with enuresis is common and its screening is recommended. A brief validated screening instrument is needed for a busy medical practice. This study focused on the development of the Thai Behavioral and Emotional Screening Tool for children with Enuresis (TBEST-E) and aimed to examine its psychometric properties. Materials and Methods: Using the Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) as a template, the 15-item with a yes/no answer format of the TBEST-E was developed for the screening of emotional problems (7 items), attention and hyperactivity/impulsivity problems (3 items each), and oppositional defiant symptoms (2 items). The parents of the children with enuresis completed the TBEST-E and the behavioral rating scale “Thai Youth Checklist” (TYC). The optimal cut-off for further assessment, the sensitivity, and the specificity the TBEST-E were identified using receiver operating characteristic (ROC) curves. Results: After an adaptation following comments from three child psychiatrists, the TBEST-E showed a content validity of 0.9, an internal consistency of 0.71. A total of 33 children with enuresis (median age = 9, interquartile range = 6.5-11 years) were recruited. Further assessment was indicated when one of the following occurred; at least 3 emotional problems; 3 attention problems; or 2 hyperactivity/impulsivity together with 2 oppositional defiant symptoms. The overall sensitivity and specificity were 0.88 and 0.71 respectively with the accuracy of 0.84 (95% CI = 0.68-0.95). Conclusion: The TBEST-E is time-efficient and has acceptable psychometric properties in early detection of common psychological problems in children with enuresis.

Co-occurrence of internalizing difficulties and aggression in early childhood and risk of mental health problems in middle childhood

The goal of this prospective longitudinal study was to explore whether co-occurrent internalizing difficulties and aggression in early childhood convey increased risk for later mental health problems in middle childhood. Participants were mothers from the Norwegian Mother, Father and Child Cohort Study (MoBa), who provided assessments of child internalizing difficulties and aggression at ages 3 years (n = 54,644; 26,750 girls) and 5 years (n = 38,177; 18,794 girls), as measures of child depressive, anxiety, conduct-related, and oppositional defiant (OD) symptoms at age 8 years. Using latent profile analyses (LPA) of internalizing difficulties and aggression, four profiles were identified: low-symptom/normative; primarily internalizing; primarily aggressive; and co-occurrent. Among the other results, the co-occurrent group exhibited the highest levels of depressive, anxiety, and oppositional defiant symptoms at 8 years. Most children (78%) remained stable in their profile between ages 3 and 5 years. Among the transition patterns that emerged, transitions were observed both from the normative to a risk profile and vice versa. Children who remained stable within the co-occurrent profile or who transitioned from the co-occurrent profile to one of the other two risk profiles also exhibited more depressive, anxiety, and OD symptoms at 8 years of age, when compared with children who transitioned from the co-occurrent to the normative profile. The heterogeneity between early manifestation of internalizing difficulties and aggression, and specific type of later mental health symptoms not only supports a shared etiology between internalizing and externalizing difficulties but also points toward the need for person-centered monitoring in early childhood with further implications for early identification of difficulties and preventive measures.

Comorbid Psychiatric Symptom Associated With Oppositional Defiant Symptom in Community School-Age Children.

Oppositional defiant disorder (ODD) is often comorbid with other psychiatric disorders in childhood. This study aimed to investigate comorbid psychiatric symptoms and associated factors in elementary school children with symptoms of ODD. The participants consisted of 205 mother-offspring pairs. Psychiatric symptoms were measured using the Diagnostic Predictive Scales and Korean Child Behavior Checklist. Psychiatric comorbid symptoms were compared between children with ODD symptom and those without ODD symptom. Multivariate logistic regression analysis was used to estimate the odds ratio of psychiatric symptom on ODD. ODD group had a significant association with internalizing and externalizing problem (p=0.001, p<0.001, respectively). ODD group were more comorbid with anxiety disorder, depressive disorder, attention-deficit/hyperactivity disorder, and conduct disorder. Among psychiatric disorder, generalized anxiety disorder (GAD) (adjusted odds ratio [AOR]=18.620, p<0.001) and conduct disorder (AOR=9.529, p=0.014) were associated with ODD symptom. These findings suggest that children with ODD symptom had significantly higher rates of comorbid psychiatric symptoms. And GAD and conduct disorder are related to ODD symptom.

The Disruptive Behavior Disorders Rating Scale: Updated Factor Structure, Measurement Invariance, and National Caregiver Norms.

To provide the first caregiver-report national norms for the Disruptive Behavior Disorders Rating Scale (DBDRS) and an updated evaluation of its factor structure and measurement invariance across child sex, informant sex, and child age. Caregivers of children aged 5-12 years (N = 962) based in the United States completed the four DBDRS subscales. Using both severity scoring and dichotomous scoring procedures, confirmatory factor analyses supported a four-factor model of inattentive and hyperactive/impulsive symptoms, oppositional defiant symptoms, and conduct disorder symptoms. Measurement invariance was supported, indicating that the DBDRS functions similarly across demographic characteristics. Boys were reported to have more severe symptoms than girls (Cohen's d = 0.33 [inattention], 0.30 [hyperactivity/impulsivity], 0.18 [oppositional defiant disorder], 0.14 [conduct disorder]), female caregivers rated ADHD symptoms as more severe than male caregivers (ds = 0.15 and 0.19 for inattention and hyperactivity/impulsivity, respectively), and older children were reported to experience more inattention than younger children (d = 0.18). Overall, group differences were modest in magnitude. This psychometric study supports the continued use of the DBDRS in school-aged youth and will enhance the measure's clinical and research utility by providing the first caregiver-report norms.

Relationship between Bullying Victimization and Quality of Life in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) in Taiwan: Mediation of the Effects of Emotional Problems and ADHD and Oppositional Defiant Symptoms.

This cross-sectional study investigated the mediating effects of emotional problems including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) symptoms on the association between bullying victimization and quality of life (QoL) among adolescents with ADHD in Taiwan. A total of 171 adolescents diagnosed as having ADHD participated in this study. Adolescents completed the School Bullying Experience Questionnaire, the Taiwanese Quality of Life Questionnaire for Adolescents, the Taiwanese version of the Children’s Depression Inventory and the Multidimensional Anxiety Scale for Children. Caregivers completed the Chinese version of the Swanson, Nolan, and Pelham Version IV Scale. Structural equation modeling (SEM) was used to examine the relationships among the variables. The results of SEM revealed that bullying victimization indirectly correlated with QoL through the mediation of emotional problems in adolescents with ADHD, whereas ADHD and ODD symptoms did not mediate the association between bullying victimization and QoL. Bullying victimization should be actively prevented and intervened on to ensure better QoL in adolescents with ADHD. Moreover, emotional problems should be alleviated among adolescents with ADHD with bullying victimization experience to maintain their QoL.

Effectiveness of Parenting Training on Emotional and Behavioral Problems in First through Fourth Grade Thai Children with ADHD: A Randomized Controlled Study.

To evaluate the effectiveness of parenting training on emotional and behavioral problems of first through fourth grade Thai children with ADHD compared with routine clinical care in a university hospital in southern Thailand. Caregivers of the children were invited and assessed for eligibility. Eighty children with ADHD were randomly assigned to either a parenting training group or a routine clinical care group. The primary caregivers of the parenting training group participated in 6 120-minute weekly sessions in addition to routine clinical care. Caregiver and teacher ADHD ratings and oppositional-defiant disorder ratings were collected at the time of enrollment and after the 6 weeks of training in both groups. The differences in scores in both groups were analyzed using a mixed model ANOVA. Each arm had 40 participants. The mean (SD) age of the children was 8.3 (1.1) years and their mean (SD) age at the first diagnosis of ADHD was 6.8 (1.3) years. Most of them were receiving methylphenidate for treatment of their ADHD. The mother was the primary caregiver for 83.5% of the children. The ADHD symptoms and oppositional-defiant symptoms showed significant improvement after receiving the treatment in both groups; however, no significant differences were found between groups. Adding parenting training to the routine clinical care for children with uncomplicated ADHD who are being medicated was not more effective than the routine clinical care alone. However, the power of this study is limited, and follow-up is needed to evaluate the long-term effectiveness.

Effectiveness of behavioral parent training in the outpatient setting for preschoolers at risk for ADHD

Abstract In 2019, the American Pediatric Association released updated guidelines regarding assessing and treating attention-deficit/hyperactivity disorder (ADHD). These guidelines prescribe behavioral parent training (BPT) as the first line of treatment for preschool-aged children with ADHD symptomatology. However, there are few studies documenting the effectiveness of BPT administered in real-word settings, outside the context of controlled research trials. Further, many available BPT programs are lengthy and costly. Here we investigate the effectiveness of an 8-session group-based BPT, previously shown effective in school-aged children with ADHD, in an outpatient clinic. Ratings of parental confidence, child impairment, number and severity of non-compliance in multiple situations, and ADHD and oppositional symptoms, were collected from 132 parents of preschoolers at risk for ADHD before and after the BPT groups. Improvements with a large effect size were observed for overall severity of impairment and parental confidence ratings. Improvements with a moderate effect size were observed for academic progress, severity of non-compliance, and ADHD symptom ratings. Small effect sizes were observed for reduced impairment in family functioning, peer and parental relationships, and self-esteem, frequency of non-compliance, and oppositional defiant symptom ratings. Together these findings support the effectiveness of a BPT program to treat preschool ADHD and ADHD-like behaviors that is accessible to families and clinicians.

Executive Function Training for Preschool Children With ADHD: A Randomized Controlled Trial

Objective: This randomized controlled study explored the efficacy, feasibility, and acceptability of executive function training (EFT) for preschool children with ADHD. Method: The current study design was an 8 week randomized parallel groups, single-blinded trial, using EFT-P. A total of 96 children with an ADHD diagnosis at age 4 to 5 years old were randomized into the intervention group and waitlist group. In the intervention group, 46 out of 50 participants completed the 8-week program, compared with 39 out of 46 in the waiting group. The level of ADHD symptoms and the executive function (EF) were evaluated by both neuropsychological tests from NEPSY Second Edition (NEPSY-II) and Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P). Results: The EFT is feasible to administer and is acceptable for preschool children, with a 93% retention rate. Results showed that following the intervention, the visual-motor precision (p = .024), ADHD diagnostic state (p = .01), and oppositional defiant symptoms (p = .023) improved significantly in preschool children. However, the symptoms of ADHD and other EF evaluations were found to be insignificant. Conclusion: The EFT is feasible, acceptable, and potentially effective to reduce symptoms and improve EF for preschool children with ADHD. The next step is to extend the program time and provide more frequent practice of activities between the children and the therapist and/or parent, to improve the effectiveness.

Increased attention deficit/hyperactivity and oppositional defiance symptoms of 6-12 years old Chinese children with atopic dermatitis.

Atopic dermatitis (AD), a prevalent chronic skin disease in children, has been associated with psychosocial illness and reduced quality of life because of severe itching and sleep deprivation. Previous studies have found a consistent association between AD and attention deficit hyperactivity disorder (ADHD). However, little is known about this relationship in Chinese children with AD.To investigate co-occurrence of ADHD symptoms, oppositional defiant disorder (ODD) symptoms, and the relevant risk factors of AD, as well as its impact on the quality of life in Chinese school-aged children with AD.Outpatients aged 6 to 12 years with confirmed AD and healthy controls matched for age were randomly included in this study from October 2018 to October 2019. AD severity was evaluated using the Severity Scoring of Atopic Dermatitis scale (SCORAD). Inattention, hyperactivity, and oppositional defiant symptoms were evaluated by using the Swanson, Nolan and Pelham IV Teacher and Parent 26-Item Rating Scale (SNAP-IV) questionnaires and quality of life was evaluated using the Children's Dermatology Life Quality Index (CDLQI).The study included 89 AD patients and 184 healthy controls. AD patients were more likely to have ADHD symptoms (10.1% vs. 3.8%; P = .04) and ODD symptoms (5.6% vs 0%; P < .001) than controls, especially hyperactive/impulsive (P = .03). The severity of itching and sleep loss in AD patients were positively correlated with inattention (P = .03; P < .001), hyperactivity/impulsiveness (P = .01; P = .03), and oppositional defiance scores (P < .01; P = .04). Sleep loss in AD patients was independently associated with an increased risk of ADHD symptoms (OR, 1.78; 95% CI, 1.07–2.98; P = .03). The mean CDLQI scores of AD patients were 6.98 ± 5.02, and CDLQI scores were significantly higher in AD patients with ADHD symptoms than in those without ADHD symptoms (11.44 vs. 6.48; P = .01).AD is a prevalent chronic condition associated with an increased likelihood of ADHD symptoms and ODD symptoms in school-aged children. Sleep deprivation caused by AD may be a risk factor for ADHD. AD affects quality of life, especially in patients with ADHD symptoms. AD patients with symptoms of inattention and hyperactivity should be evaluated for ADHD.

Auditory processing, co-morbidities, and parental report of sleep disturbance in children with auditory processing disorder (APD)

ObjectivesTo evaluate the prevalence of sleep disturbance and its relationship with auditory processing (AP) and co-morbidities in children diagnosed with auditory processing disorder (APD). MethodsData from 109 children (Males = 59, Females = 50) with mean non-verbal intelligence quotient (NVIQ) of 89.44 (SD:18.16), aged between 6 and 16 years (mean: 10 years 7 months; SD: 2 years 9 months) with a diagnosis of APD were analysed. Participants performed ≤1.33 SD below the mean in two or more out of five SCAN-3 diagnostic APD tests that included ‘Filtered Words’ (FW), ‘Auditory Figure Ground 0 dB’ (AFG0), ‘Competing Words-Directed Ear’ (CW-DE), ‘Competing Sentences’ (CS) and ‘Time Compressed Sentences’ (TCS). Concern about sleep in addition to other symptoms and medical history were documented from structured parental history sheet which forms part of the routine APD assessment. Language impairment (LI), attention-deficit-hyperactivity-disorder (ADHD) and oppositional defiant disorder (ODD), and anxiety were evaluated using the ‘Children's Communication Checklist-2’ (CCC-2), ‘Swanson Nolan and Pelham rating scale’ (SNAP-IV) and ‘Anxiety Scale for Children-Autism Spectrum Disorder’ (ASC-ASD) respectively. ResultsSixty children had sleep disturbance, a prevalence of 55% (95% CI 45.2%–64.6%). The two groups of APD children, with (n = 49) and without sleep (n = 60) disturbance, did not vary in their auditory processing abilities. The sleep disturbed group had significant issues with pragmatic language impairment, hyperactivity/impulsivity, oppositional defiant symptoms and anxiety compared to the group without sleep disturbance when they were analysed separately. After the variables were considered in step wise fashion in binary logistic regression analyses, only pragmatic language impairment and anxiety predicted sleep disturbance (p < .01). ConclusionIn APD the prevalence of sleep disturbance is high, justifying screening within a transdisciplinary APD assessment protocol. Sleep disturbance in APD is predicted by pragmatic language impairment and anxiety, but not by ADHD symptoms or ODD.

The change in the intensity of symptoms in children and adolescents with attention deficit hyperactivity disorder after "Workshops for Parents of Hyperactive Children".

To evaluate changes in the intensity of ADHD symptoms and size effects after the completion of the twelve-week "Workshops for Parents of Hyperactive Children". Intervention group included parents (N = 199) of children and adolescents diagnosed with ADHD, who completed the twelve-week parental training. The reference group included parents (N = 24) of children and adolescents diagnosed with ADHD, who received 1-2 standard psychiatric visits within twelve weeks (treatment-as-usual). The following questionnaires were completed by the participants at the beginning and at the end of the training: CBCLand Conners-IOWA-10 (parent's assessment of the child), TRF and Conners-RCTRS-28 (assessment of the child by the teacher/educator), and YSR (in children of 11 years and over). The same diagnostic regime was used in the reference group - the patients were assessed during the first visit and after twelve weeks. The majority of attendees were parents of boys diagnosed with: ADHD mixed type with or without ODD and ADHD predominantly inattentive type. The intervention resulted in significant reduction of inattentive-impulsive-hyperactive and oppositional-defiant symptoms in Conners-IOWA-10 and significant reduction of symptoms in the following CBCL scales: "Social problems", "Attention problems", "Aggressive behavior", "Externalizing behavior", as well as the overall score, as rated by mothers. The improvement was age, diagnosis and pharmacotherapy independent. The therapeutic program used in our study resulted in small to moderate reduction of symptoms in children and adolescents with attention deficit hyperactivity disorder irrespective of subtype, comorbid disorders or pharmacotherapy (if implemented).

Auditory processing and non-auditory factors associated with hyperacusis in children with auditory processing disorder (APD)

Purpose Prevalence of hyperacusis in children presenting with listening difficulties (LiD) or developmental auditory processing disorder (APD) is uncertain. The relationships between hyperacusis, auditory profiles and non-auditory factors are unclear, information which is important in understanding and managing APD and hyperacusis. Method A retrospective study of 282 children with APD (165 males and 117 females) aged 6–16 years. Hyperacusis was ascertained by parental response to question about ‘oversensitivity to sounds’. Auditory and non-auditory features including anxiety, attention deficit hyperactivity disorder and oppositional defiant symptoms, language profile and non-verbal ability (NVIQ) were compared between those with and without hyperacusis. Results Of the 282 children 200 (70.9%) had hyperacusis. There were no significant differences in age, NVIQ and auditory processing profiles between the two groups (p > .05). In addition to poor speech perception in noise 79% of children performed poorly mainly in temporal processing and/or dichotic listening tests. The hyperacusis group had significantly more anxiety, hyperactivity/impulsivity, oppositional defiant symptoms and pragmatic language impairment when analyzed separately. However, only anxiety and language impairment were significant in binary logistic regression analyses. Conclusions The prevalence of hyperacusis is high in APD, but auditory processing profiles were similar in those with and without hyperacusis. The high prevalence of anxiety, externalising behaviour, pragmatic language impairment in those with hyperacusis noted in APD is similar to those reported in children with autism spectrum disorder and Williams syndrome. However, when shared variances are addressed only anxiety and language impairment predicted hyperacusis. Holistic auditory processing assessment is suggested in hyperacusis.

Behavior Problems Following Childhood TBI: The Role of Sex, Age, and Time Since Injury

To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors. Children's hospitals in the Midwestern/Western United States. 381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago. Secondary data analysis of a multistudy cohort. Child Behavior Checklist (CBCL) administered pretreatment. Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys. Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.

Clinical and Neuropsychological Predictors of Methylphenidate Response in Children and Adolescents with ADHD: A Naturalistic Follow-up Study in a Spanish Sample.

Background:Methylphenidate (MPH) is the most commonly used medication for Attention-Deficit/Hyperactivity Disorder (ADHD), but to date, there are neither consistent nor sufficient findings on conditions differentiating responsiveness to MPH response in ADHD.Objective:To develop a predictive model of MPH response, using a longitudinal and naturalistic follow-up study, in a Spanish sample of children and adolescents with ADHD.Methods:We included all children and adolescents with ADHD treated with MPH in our outpatient Clinic (2005 to 2015), evaluated with the K-SADS interview. We collected ADHD-RS-IV.es and CGI-S scores at baseline and at follow up, and neuropsychological testing (WISC-IV, Continuous Performance Test (CPT-II) & Stroop). Clinical response was defined as >30% reduction from baseline of total ADHD-RS-IV.es score and CGI-S final score of 1 or 2 maintained for the previous 3 months.Results:We included 518 children and adolescents with ADHD, mean (SD) age of patients was 11.4 (3.3) years old; 79% male; 51.7% had no comorbidities; and 75.31% had clinical response to a mean MPH dose of 1.2 mg/kg/day. Lower ADHD-RS-IV.es scores, absence of comorbidities (oppositional-defiant symptoms, depressive symptoms and alcohol/cannabis use), fewer altered neuropsychological tests, higher total IQ and low commission errors in CPT-II, were significantly associated with a complete clinical response to methylphenidate treatment.Conclusion:Oppositional-defiant symptoms, depressive symptoms, and a higher number of impaired neuropsychological tests are associated with worse clinical response to methylphenidate. Other stimulants or non-stimulants treatment may be considered when these clinical and neuropsychological variables converged in the first clinical interview.

Reciprocity in Undesirable Parent–Child Behavior? Verbal Aggression, Corporal Punishment, and Girls’ Oppositional Defiant Symptoms

Parental verbal aggression and corporal punishment are associated with children’s conduct problems and oppositional defiant disorder (ODD). The strength of bidirectional relationships among specific disruptive behaviors has been inconsistent across gender, and the direction of influence between parental aggression and girls’ ODD symptoms is particularly understudied. This study tested reciprocal effects between aggressive parent behaviors and girls’ ODD dimensions of oppositionality, antagonism, and irritability. Data from the Pittsburgh Girls Study (N = 2,450) were used, including annual child and parent-reported aggressive discipline and girls’ parent-reported ODD symptoms between ages 5 and 16. Separate clustered Poisson regression models examined change in parent or child behavior outcomes using predictors lagged by one time point. After controlling for demographic factors, behavior stability, and other disruptive behaviors, parent-reported corporal punishment predicted girls’ increasing antagonism and irritability, whereas child-reported corporal punishment was unrelated to ODD symptom change. Both parent- and child-reported verbal aggression predicted increases across ODD dimensions. Girls’ oppositionality and antagonism predicted increasing parent-reported verbal aggression over time, but only oppositionality was significantly related to child-reported verbal aggression. Although ODD symptoms were unrelated to change in corporal punishment, attention deficit/hyperactivity disorder (ADHD) predicted increasing parental aggression of both types. Bidirectional associations emerged such that parental verbal aggression escalates reciprocally with girls’ behavioral ODD symptoms. Verbal aggression contributed to increasing irritability, but irritability did not influence parenting behavior. “Child effects” may be most salient for behavioral ODD symptoms in transaction with verbal aggression and for ADHD symptoms in predicting worsening corporal punishment and verbal aggression.

Family Burden of Raising a Child with ADHD.

The purpose of the study was to estimate the burden to families of raising a child with attention-deficit/hyperactivity disorder (ADHD). Data were drawn from a longitudinal sample recruited in western Pennsylvania. When participants were between 14 and 17years old, parents completed a questionnaire assessing economic burden over the course of raising their children. Domains of economic burden to families included direct costs related to child's behaviors (excluding treatment expenses) and indirect costs related to caregiver strain. On average, participants with ADHD incurred a total economic burden over the course of child development that was more than five times greater compared to youths without ADHD (ADHD=$15,036 per child, Control = $2,848 per child), and this difference remained significant after controlling for intellectual functioning, oppositional defiant symptoms, or conduct problems. Parents of participants with ADHD were more likely to have changed their job responsibilities or been fired and reported lower work efficiency. The current evaluation of economic burden to individual families extends previous estimates of annual societal cost of illness (COI) of ADHD. Our rough annual estimate of COI for ADHD in children and adolescents is $124.5 billion (2017 US Dollars). Findings underscore the need for interventions to reduce the costly dysfunctional outcomes in families of children with ADHD.

Social skills training and play group intervention for children with oppositional-defiant disorders/conduct disorder: Mediating mechanisms in a head-to-head comparison

Objective: Social-cognitive information processing, social skills, and social interactions are problem-maintaining variables for aggressive behavior in children. We hypothesized that these factors may be possible mediators of the mechanism of change in the child-centered treatment of conduct disorders (CDs). The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine putative mechanisms of change for the decrease in oppositional-defiant behavior resulting from child-centered treatment of patients with oppositional-defiant disorder (ODD) or CD. Method: 91 children (age 6–12 years) with ODD/CD were randomized to receive either social skills training or to a resource activating play group. Mediator analyses were conducted using path analyses. Results: The assumed mediating effects were not significant. However, alternative models with the putative mediators and outcome in reversed positions showed significant indirect effects of the oppositional-defiant symptoms as mediator for the decrease of disturbance of social-information processing, social skills, and social interactions. Conclusions: The proposed model for mechanisms of change could not be confirmed, with the results pointing to a reversed causality. Variables other than those hypothesized must be responsible for mediating the effects of the intervention on child oppositional-defiant behavior. Possible mechanisms of change were discussed.

Longitudinal Associations between Oppositional Defiant Symptoms and Interpersonal Relationships among Chinese Children.

Children with oppositional defiant disorder (ODD) are at increased risk for developing poor relationships with people around them, but the longitudinal links between ODD symptoms and subsequent interpersonal functioning remain unclear. In the current study, we examined the bidirectional associations between ODD symptoms and children's relationships with parents, peers, and teachers. We included separate analyses for parent vs. teacher reports of ODD symptoms, with regard to subsequent interpersonal relationships. Participants included 256 children with ODD, recruited in China, along with their parents and teachers, assessed at three time points roughly two years apart. Parents and teachers reported child ODD symptoms at each time point, and children reported their perceptions of father- and mother-child attachment, peer relationships, and teacher-student relationships across the three time points. ODD symptoms reported either by parents or teachers predicted impairments in interpersonal functioning. Meanwhile, child interpersonal impairments with peers and teachers predicted subsequent increase in teacher-reported ODD symptoms. These findings highlight the importance of transactional models of influence-and of considering early intervention for ODD in protecting children from developing further deficits and impairments. Additionally, we discuss the perspectives of multiple informants on ODD symptoms, including their different patterns of association with subsequent interpersonal relationships.

The protective effect of character maturity in child aggressive antisocial behavior

BackgroundChildhood aggressive antisocial behavior (CD) is one of the strongest predictors of mental health problems and criminal behavior in adulthood. The aims of this study were to describe personality profiles in children with CD, and to determine the strength of association between defined neurodevelopmental symptoms, dimensions of character maturity and CD. MethodsA sample of 1886 children with a close to equal distribution of age (9 or 12) and gender, enriched for neurodevelopmental and psychiatric problems were selected from the nationwide Child and Adolescent Twin Study in Sweden. Their parents rated them according to the Junior Temperament and Character Inventory following a telephone interview during which information about the children's development and mental health was assessed with the Autism-Tics, AD/HD and other Comorbidities inventory. ResultScores on the CD module significantly and positively correlated with scores on the Novelty Seeking temperament dimension and negatively with scores on character maturity (Self-Directedness and Cooperativeness). In the group of children with either neurodevelopmental or behavioral problems, the prevalence of low or very low character maturity was 50%, while when these two problems coexisted the prevalence of low or very low character maturity increased to 70%. Neurodevelopmental problems (such as: oppositional defiant disorder, symptoms of attention deficit/hyperactivity disorder and autism spectrum disorder) and low scores on character maturity emerged as independently significant predictors of CD; in a multivariable model, only oppositional defiant symptoms and impulsivity significantly increased the risk for coexisting CD while a mature self-agency in a child (Self-Directedness) remained a significant protective factor. ConclusionThese results suggest that children's willpower, the capacity to achieve personally chosen goals may be an important protective factor – even in the presence of neurodevelopmental and psychiatric problems – against progressing into persistent negative outcomes, such as aggressive antisocial behaviors.