Rates Of Oppositional Defiant Disorder Research Articles

Examining the clinical correlates of conduct disorder in youth with bipolar disorder

BackgroundConduct Disorder (CD) is highly comorbid with Bipolar Disorder (BP) and this comorbidity is associated with high morbidity and dysfunction. We sought to better understand the clinical characteristics and familiality of comorbid BP + CD by examining children with BP with and without co-morbid CD. Methods357 subjects with BP were derived from two independent datasets of youth with and without BP. All subjects were evaluated with structured diagnostic interviews, the Child Behavior Checklist (CBCL), and neuropsychological testing. We stratified the sample of subjects with BP by the presence or absence of CD and compared the two groups on measures of psychopathology, school functioning, and neurocognitive functioning. First-degree relatives of subjects with BP +/− CD were compared on rates of psychopathology in relatives. ResultsSubjects with BP + CD compared to BP without CD had significantly more impaired scores on the CBCL Aggressive Behavior (p < 0.001), Attention Problems (p = 0.002), Rule-Breaking Behavior (p < 0.001), Social Problems (p < 0.001), Withdrawn/Depressed clinical scales (p = 0.005), the Externalizing Problems (p < 0.001), and Total Problems composite scales(p < 0.001). Subjects with BP + CD had significantly higher rates of oppositional defiant disorder (ODD) (p = 0.002), any SUD (p < 0.001), and cigarette smoking (p = 0.001). First-degree relatives of subjects with BP + CD had significantly higher rates of CD/ODD/ASPD and cigarette smoking compared to first-degree relatives of subjects without CD. LimitationsThe generalization of our findings was limited due to a largely homogeneous sample and no CD only comparison group. ConclusionsGiven the deleterious outcomes associated with comorbid BP + CD, further efforts in identification and treatment are necessary.

Assessment of oppositional defiant disorder and oppositional behavior in children and adolescents with Down syndrome.

Children and adolescents with intellectual disability (ID) exhibit higher rates of oppositional defiant disorder (ODD) than typically developing (TD) peers. However, studies focusing on the investigation of ODD prevalence in youth with Down syndrome (DS) are still limited. The current study aimed to investigate the prevalence of ODD clinical and subclinical symptoms in a group of 101 youth with DS (63 boys, 38 girls) ranging in age from 6 to 18 years. Moreover, the prevalence of ODD symptoms, as detected by means of three parent-report questionnaires, was compared with that detected by a semi-structured psychopathological interview, namely, the Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime (K-SADS) Version Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). We found that 17% of participants met diagnostic criteria for ODD on the K-SADS, whereas 24% exhibited subclinical symptoms. Results also suggest good specificity of Swanson, Nolan, and Pelham-IV Rating Scale (SNAP-IV), Conners' Parent Rating Scales Long Version (CPRS) and Child Behavior Checklist (CBCL) in detecting ODD symptoms. The investigation of the agreement in the prevalence rates of clinical and subclinical symptoms of ODD between K-SADS and the parent-report questionnaires indicated CPRS as the parent-report questionnaire with the best agreement with K-SADS. This study provides support for the use of parent-report questionnaires to assess ODD symptoms in children and adolescents with DS by evaluating their levels of agreement with a semi-structured psychopathological interview. In particular, our results suggest that CPRS could be considered a suitable screening tool for ODD clinical and subclinical symptoms in youth with DS.

Defense-Oriented Psychoanalytic Psychotherapy as a Tailored Treatment for Boys: Neurobiological Underpinnings to Male-Specific Response Tested in Regulation-Focused Psychotherapy for Children.

This paper presents defense-oriented psychoanalytic psychotherapy as a tailored treatment for boys through a neurophysiological hypothesis. Male central nervous system development is reviewed, with a focus on the development of the emotion regulation system. The organizational effects of pre- and post-natal androgens delay central nervous system development in males relative to females, following a caudal to rostral phylogenetic framework. Ventromedial prefrontal structures mature at an earlier developmental age than dorsolateral prefrontal structures, creating less of a gender gap in the available underlying neural architecture for responsivity to targeted therapeutic intervention. The hypothesized operation of defense analysis upon ventromedial prefrontal cortical structures and corticolimbic connectivity therefore positions boys to benefit from psychotherapy equally as girls. In this study, we explored gender differences in presentation and response to a short-term, manualized defense-oriented psychoanalytic psychotherapy named regulation-focused psychotherapy for children. In a sample size of 43 school-aged children, consisting of 32 boys and 11 girls, with oppositional defiant disorder, we found no statistically significant differences in participant characteristics upon entry nor in treatment response, as measured by changes in scores on the Oppositional Defiant Disorder Rating Scale, the oppositional defiant problems subscale of the Child Behavior Checklist, the suppression and reappraisal subscales of the Emotion Regulation Questionnaire for Children and Adolescents, and the lability and negativity subscale of the Emotion Regulation Checklist. The findings were comparable with the gendered findings of preexisting studies of play therapy, where boys and girls improve equally, but not of behaviorally predominant psychotherapy, where girls appear to have superior responses. Our findings suggest that the treatment as a general play therapy, but with a focus on the implicit emotion regulation system, was successful in meeting boys’ gendered treatment needs. Conclusions are drawn with implications for further study.

Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating “ADHD-simplex” and “ADHD-complex” syndromes?

BackgroundCurrent DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative “ADHD+ED” subphenotypes. Method4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments. ResultsFive LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes. LimitationsThe data for our LCA were cross-sectional and based primarily on parent ratings. ConclusionOur classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential “ADHD-complex” syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.

Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way.

Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group. Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.

Clinical features associated with an early onset in chronic tic disorders

In chronic tic disorders such as Tourette syndrome (TS), tics often appear between 4 and 8 years but they can also appear in early childhood, a period in which symptom expression may be affected by early brain development. The present study examined whether symptom expression in early-onset TS was distinct from that observed in TS with a later onset. We compared the clinical characteristics in children with TS who developed tics before age 4 or after age 6. Early-onset TS was significantly associated with an increased rate of stuttering and other speech disfluencies as well as an increased rate of oppositional defiant disorder, symptoms that often appear before age 4. Early-onset TS was also linked to maternal transmission of tics. Early-onset TS was not significantly associated with tic severity, obsessive–compulsive behavior or attention-deficit hyperactivity disorder. The results suggest that an early onset affects symptom expression in tic disorders.

Effectiveness of Metacognitive Therapy on the Symptom Reduction in Student with Oppositional Defiant Disorder

Abstract. The present study aims to explore the effectiveness of Metacognitive Therapy on reducing the symptoms of student with Oppositional Defiant Disorder (ODD). Having a quasi-experimental nature with pre-test and post-test, the methodology consists of a two-month follow-up period and a control group. The statistical population includes all male secondary school students with Oppositional Defiant Disorder studying at 7 th and 8 th grades in Tehran during the educational year 2013- 2014. Using multi-stage cluster sampling method, a total of 30 subjects were selected and randomly assigned in the two experimental and control groups. The Child Behavior Check List was used to evaluate the rate of Oppositional Defiant Disorder in students. To analyze the statistical data, a covariance method was applied as a result of which a meaningful reduction (p>0.001) was observed in the post-test and follow-up intensity of ODD symptoms for the experimental group in comparison to the control one. Moreover, Metacognitive therapy proved to be an effective intervention in reducing the symptoms of ODD.

Intellectual Disability in Children with Attention Deficit Hyperactivity Disorder

ObjectiveTo determine whether children with attention deficit hyperactivity disorder (ADHD) and mild intellectual disability (ID) are a clinically distinct ADHD subgroup.Study designThis was a cross-sectional study comparing clinical characteristics (ADHD subtypes, total number of symptoms, and rates of common comorbidities) between children with ADHD and mild ID and those with ADHD and IQ test scores >70, and also between children with ADHD and ID and a general population sample of children with ID alone. The sample comprised a clinical sample of children with ADHD with ID (n = 97) and without ID (n = 874) and a general population sample of children with ID and without ADHD (n = 58).ResultsAfter correcting for multiple statistical tests, no differences were found between the 2 ADHD groups on any measure except the presence of conduct disorder (CD) symptoms and diagnoses. Children with ADHD and ID had higher rates of both (OR, 2.38; 95% CI, 1.71-3.32 and OR, 2.69; 95% CI, 1.69-4.28, respectively). Furthermore, children with ADHD and ID had significantly higher rates of oppositional defiant disorder (OR, 5.54; 95% CI, 2.86-10.75) and CD (OR, 13.66; 95% CI, 3.25-57.42) symptoms and a higher incidence of oppositional defiant disorder diagnoses (OR, 30.99; 95% CI, 6.38-150.39) compared with children with ID without ADHD.ConclusionChildren with ADHD and mild ID appear to be clinically typical of children with ADHD except for more conduct problems. This finding has implications for clinicians treating these children in terms of acknowledging the presence and impact of ADHD symptoms above and beyond ID and dealing with a comorbid CD.

Oppositional Defiant Disorder: Prevalence based on parent and teacher ratings of Malaysian primary school children

BackgroundThis study examined the prevalence rate of Oppositional Defiant Disorder (ODD) in Malaysian primary school children. MethodsIn all 934 Malaysian parents and teachers completed ratings of their children using a scale comprising DSM-IV-TR ODD symptoms. ResultsResults showed rates of 3.10%, 3.85%, 7.49% and 0.64% for parent, teacher, parent or teacher (“or-rule”), and parent and teacher (“and-rule”) ratings, respectively. When the functional impairment criterion was not considered, the rate reported by parents was higher at 13.28%. DiscussionThe theoretical, diagnostic and cultural implications of the findings are discussed.

Prevalence of Oppositional Defiant Disorder in a Sample of Spanish Schoolchildren

The aim of this study is to determine the prevalence rate of ODD in school age children, and analyze the variability of the prevalence rates per informant, according to the sources of information, sex, age, and level of agreement between teachers and parents. This is an epidemiological study conducted using a community sample extracted by means of multi-stage stratified sampling. The sample consisted of 1,295 children of both sexes from 6 to 8 years old. For diagnostic evaluation, the Oppositional Defiant Disorder Rating Scale (ODDRS-IV) was used. The estimated global prevalence of ODD, detected by all sources is 16.1%. But if we consider the percentage of subjects detected by only one informant, the prevalence rate is 9.5%. The prevalence according to teachers is 5.1% (95% CI = 3.88-6.31), according to fathers is 9% (95% CI = 7.38-10.54), and according to mothers is 9.7% (95% CI = 8.02-11.29). Teachers report more boys with ODD than girls. Results support the idea of high variability in ODD prevalence rates. Our findings suggest that parents are more prone to detect the disorder than teachers, and that boys present ODD more frequently than girls, only when they are evaluated by their teachers.

Examining the Proposed Disruptive Mood Dysregulation Disorder Diagnosis in Children in the Longitudinal Assessment of Manic Symptoms Study

To examine the proposed disruptive mood dysregulation disorder (DMDD) diagnosis in a child psychiatric outpatient population. Evaluation of DMDD included 4 domains: clinical phenomenology, delimitation from other diagnoses, longitudinal stability, and association with parental psychiatric disorders. Data were obtained from 706 children aged 6-12 years who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study (sample was accrued from November 2005 to November 2008). DSM-IV criteria were used, and assessments, which included diagnostic, symptomatic, and functional measures, were performed at intake and at 12 and 24 months of follow-up. For the current post hoc analyses, a retrospective diagnosis of DMDD was constructed using items from the K-SADS-PL-W, a version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, which resulted in criteria closely matching the proposed DSM-5 criteria for DMDD. At intake, 26% of participants met the operational DMDD criteria. DMDD+ vs DMDD- participants had higher rates of oppositional defiant disorder (relative risk [RR] = 3.9, P < .0001) and conduct disorder (RR = 4.5, P < .0001). On multivariate analysis, DMDD+ participants had higher rates of and more severe symptoms of oppositional defiant disorder (rate and symptom severity P values < .0001) and conduct disorder (rate, P < .0001; symptom severity, P = .01), but did not differ in the rates of mood, anxiety, or attention-deficit/hyperactivity disorders or in severity of inattentive, hyperactive, manic, depressive, or anxiety symptoms. Most of the participants with oppositional defiant disorder (58%) or conduct disorder (61%) met DMDD criteria, but those who were DMDD+ vs DMDD- did not differ in diagnostic comorbidity, symptom severity, or functional impairment. Over 2-year follow-up, 40% of the LAMS sample met DMDD criteria at least once, but 52% of these participants met criteria at only 1 assessment. DMDD was not associated with new onset of mood or anxiety disorders or with parental psychiatric history. In this clinical sample, DMDD could not be delimited from oppositional defiant disorder and conduct disorder, had limited diagnostic stability, and was not associated with current, future-onset, or parental history of mood or anxiety disorders. These findings raise concerns about the diagnostic utility of DMDD in clinical populations.

Predicting Treatment Response for Oppositional Defiant and Conduct Disorder Using Pre-treatment Adrenal and Gonadal Hormones.

Variations in adrenal and gonadal hormone profiles have been linked to increased rates of oppositional defiant disorder (ODD) and conduct disorder (CD). These relationships suggest that certain hormone profiles may be related to how well children respond to psychological treatments for ODD and CD. The current study assessed whether pre-treatment profiles of adrenal and gonadal hormones predicted response to psychological treatment of ODD and CD. One hundred five children, 6 - 11 years old, participating in a randomized, clinical trial provided samples for cortisol, testosterone, dehydroepiandrosterone, and androstenedione. Diagnostic interviews of ODD and CD were administered up to three years post-treatment to track treatment response. Group-based trajectory modeling identified two trajectories of treatment response: 1) a High-response trajectory where children demonstrated lower rates of an ODD or CD diagnosis throughout follow-up, and 2) a Low-response trajectory where children demonstrated higher rates of an ODD or CD diagnosis throughout follow-up. Hierarchical logistic regression predicting treatment response demonstrated that children with higher pre-treatment concentrations of testosterone were four times more likely to be in the Low-response trajectory. No other significant relationship existed between pre-treatment hormone profiles and treatment response. These results suggest that higher concentrations of testosterone are related to how well children diagnosed with ODD or CD respond to psychological treatment over the course of three years.

Do Hyperactive Symptoms Matter in ADHD-I Restricted Phenotype?

The objective of the current study was to evaluate a proposed restrictive inattentive type of Attention Deficit Hyperactivity Disorder (ADHD) by comparing clinical correlates among youths with ADHD inattentive type (ADHD-I) as a function of the number of hyperactivity symptoms presented (none vs. 3 or less) and controls (individuals without ADHD). The sample for this community-based study was comprised of youths aged 6 to 18 years from 12 public schools in Porto Alegre, Brazil. ADHD-I groups had lower levels of adaptive functioning (p < .001) and a higher occurrence of familial ADHD (p < .001) when compared with the controls. There was no significant difference between the two ADHD-I groups. Also, both ADHD-I groups had higher rates of oppositional defiant disorder than controls (p < .001) without significant difference between them. For generalized anxiety disorder and social phobia, only the ADHD-I without HI group showed significant differences compared to controls.

Clinical Usefulness of the Oppositional Defiant Disorder Rating Scale (ODDRS)

The present study examined the reliability, validity, and clinical utility of the Oppositional Defiant Disorder Rating Scale (ODDRS) in a population of children referred for ADHD evaluation. The diagnostic benefit of using a rating scale specific to Oppositional Defiant Disorder (ODD), in addition to a broad range behavior scale, was also investigated. Parents and teachers of 177 clinic-referred children provided ratings on the ODDRS. The average correlation between parent and teacher ratings was minimal (r = .13). Children diagnosed with ODD through structured parent interviews were found to have elevated scores on the parent version of the ODDRS, as compared to children without a research diagnosis of ODD. However teacher ratings did not discriminate between the ODD and no-ODD groups. There was minimal evidence of incremental validity as classification rates for the ODDRS were almost identical to classification rates based on the Aggression subscale of the Behavior Assessment System for Children (BASC-2).

Understanding Trait and Sources Effects in Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Rating Scales: Mothers', Fathers', and Teachers' Ratings of Children From the Balearic Islands

Confirmatory factor analysis was used to model a multitrait (attention deficit hyperactivity disorder [ADHD]–inattention, ADHD–hyperactivity/impulsivity, oppositional defiant disorder [ODD]) by multisource (mothers, fathers, and teachers) matrix to determine the convergent and discriminant validity of ratings by mothers, fathers, and teachers. Participants were 1,749 elementary school children from the island of Majorca in the Balearic Islands. The results showed good convergent validity for the measures for mothers' and fathers' ratings with moderate support for the measures discriminant validity for mothers' and fathers' ratings. There was no convergent and discriminant validity, however, between mothers' and teachers' as well as fathers' and teachers' ratings for the ADHD-IN, ADHD-HI, and ODD measures. The results provide additional evidence that the construct validity of parent and teacher ADHD/ODD rating scales is mostly parent (home) and teacher (school) specific.

Prevalence of Psychiatric Disorders, Depression, and Suicidal Behavior in Child and Adolescent With Thalassemia Major

To study the rate of psychiatric disorder and suicidal behavior in children with thalassemia major. One hundred ten subjects with thalassemia major were interviewed according to the K-SADS Farsi version by face-to-face interview. The most common psychiatric disorders were major depressive disorder and separation anxiety disorder. The rate of oppositional defiant disorder, attention-deficit hyperactivity disorder, and bipolar mood disorder were 3.6%, 1.8%, and 0.9%, respectively. About 49% suffered from depressed mood and 62.7% suffered from irritability and anger. More than 43% of them had recurrent thought of death and 27.3% considered suicide in the last year. The rate of psychiatric disorders was very low than that in the prior studies and the most common was major depressive disorder. However, the rate of psychiatric symptoms was very common. The rate of suicidal behavior was not more than that in the general population.

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.

Ages of Onset and Rates of Syndromal and Subsyndromal Comorbid DSM-IV Diagnoses in a Prepubertal and Early Adolescent Bipolar Disorder Phenotype

To study rates and ages of onset of DSM-IV syndromal and subsyndromal comorbidity in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) (N = 93) compared to attention-deficit/hyperactivity disorder (ADHD) (N = 81). The WASH-U-KSADS was given by raters blinded to subject group separately to mothers about their children and to children about themselves. PEA-BP was defined as DSM-IV mania with at least one cardinal symptom of mania (elation or grandiosity) to avoid diagnosing using only symptoms that overlapped with those for ADHD. Syndromal diagnoses required a CGAS score of 60 or less to ensure severity at a level of definite "caseness." PEA-BP subjects were aged 10.9 (SD = 2.6) at baseline and 6.8 (SD = 3.4) at onset of first mania episode. Rates of oppositional defiant disorder and total number of comorbidities were significantly higher in the PEA-BP group than the ADHD group. In PEA-BP subjects, mean ages of onset of ADHD occurred before the first manic episode, and obsessive compulsive, oppositional defiant, social phobia, generalized anxiety, separation anxiety, and conduct disorders occurred after. Onsets of ADHD before mania and of oppositional defiant disorder/conduct disorder after mania have clinical and research implications. These include the need to examine for mania symptoms in children with ADHD and/or oppositional defiant disorder/conduct disorder and to develop scales to differentiate preschool mania from ADHD. Comparison with other studies demonstrated the importance of DSM system and severity scales in reporting comorbidity rates.

Psychiatric Status of Sexually Abused Children 12 Months after Disclosure of Abuse

The assessment of psychiatric status of sexually abused children 12 months after the disclosure of recent sexual abuse. Ninety-five children, aged from 4 through 16 years, were recruited to the study from a variety of agencies other than psychiatric units. Sixty-six (69.5%) were assessed for psychiatric diagnosis on DSM-III-R using data from parents, teachers, and children 12 months after disclosure of abuse. Abuse was extra- and intrafamilial. Overall 63.5% of the children warranted a diagnosis on Axis I. There was a wide range of diagnoses, with particularly high rates of oppositional defiant disorder (19.6%), post-traumatic stress disorder (18.2%), anxiety disorders (30.3%), depressive disorders (12.1%), and attention-deficit hyperactivity disorder (13.6%). Boys had a higher rate of diagnosis than girls. Abuse and social variables did not predict diagnoses but mothers' mental status rated on the General Health Questionnaire did. Subjects not located at follow-up were more often male and more likely to be socioeconomically disadvantaged. Thus the estimates of psychopathology here are likely to be conservative. This study highlights the need of sexually abused children for skilled long-term therapy tailored to individual presentation.