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Oppositional defiant disorder includes distinct but inseparable dimensions of chronic irritability and oppositional behavior. The dimensions have been identified in early childhood to adulthood, and show discriminant associations with internalizing and externalizing psychopathology. The introduction of disruptive mood dysregulation disorders and the requirements that it take precedence over oppositional defiant disorder diagnostically are not supported by evidence and introduce confusion about the structure and linkages of irritability and oppositional behavior, and obscure the importance of the behavioral dimension in explaining and predicting poor outcomes. A dimensional framework with irritability, oppositionality, callous-unemotional traits, and aggression may more fully describe antisocial outcomes.

Oppositional defiant disorder (ODD) is a valid mental health disorder, characterized by negativistic defiant behavior and angry, irritable mood. The very low and stable prevalence rate over development from early childhood into adulthood suggests that ODD does not erroneously medicalize normative childhood behavior. ODD is associated with significant impairments across multiple contexts and raises risks for other future psychopathology. Although simplistic tropes often suggest that ODD is merely the product of bad parenting, substantial evidence shows that it is instead influenced by a variety of factors, including genetic and neurobiological factors. Individuals with ODD evoke negative interactions with peers, teachers, coworkers, romantic partners, and parents. ODD is often misunderstood as being a mild form of conduct disorder (CD). Rather, in stark contrast to ODD, CD reflects a pattern of aggressive behaviors, violations of laws or status offenses, and psychopathic features. Mounting evidence for their distinction led to diagnostic changes distinguishing ODD and CD nearly a decade ago. Empirically supported treatments are available and help caregivers to develop specific parenting practices to meet the needs of children with ODD. Minimizing and mischaracterizing ODD increases the likelihood that families who are suffering may not seek the treatment that they need.

Questions persist about whether attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder are in fact distinct from one another. When such questions arise, ODD is often suggested to be subsumed under one or the other condition. Modeling approaches that can evaluate whether specific subfactors can be distinguished from general psychopathology are of great interest, and the general bifactor model has been increasingly applied in studies evaluating the structure of psychopathology. However, evidence for bias in the model, the frequency of anomalous indicators, and theoretical concerns about the applicability of the general bifactor model to these questions raise doubts about whether it is reliable or appropriate to do so. Burns and colleagues propose the bifactor S-1 model as a psychometrically sounder alternative. Their systematic examination provides a compelling argument that it is psychometrically sounder, but it is not clear that it is a true alternative. It may not be answering the same questions, cannot test hypotheses regarding the same sets of specific subfactors, and relies on a priori decisions on the part of the researcher that may change the interpretation of the results. The bifactor S-1 model approach appears to be a valuable, psychometrically sound approach to test the structure of psychopathology, particularly in regard to ADHD and ODD.

Irritability and behavioral symptom dimensions of oppositional defiant disorder (ODD) in youth exhibit differential associations with adult psychopathology. Recently, researchers have begun to examine ODD in adults, with evidence that symptoms persist into adulthood and continue to cause impairment above and beyond other types of psychopathology. Based on this emerging literature, there is a need to understand how ODD symptoms in adulthood relate to novel frameworks for characterizing adult psychopathology. Three-hundred and four young adult college students completed measures of ODD symptoms, DSM-5 pathological personality traits, ADHD, depression, and anxiety. Poisson regression was used to predict ODD severity score from the five DSM-5 personality traits, while controlling for sex, race, and comorbid psychopathology. Structural equation modeling was used to test competing models of ODD structure, and then to examine ODD dimensions and their specific associations with other psychopathology and the DSM-5 traits. Results show that ODD severity was positively associated with negative affectivity, antagonism, and disinhibition, and negatively associated with psychoticism. The two-factor model, with correlated irritability and behavioral dimensions, fit better than the unidimensional model. Irritability was uniquely associated with anxiety, depression, negative affectivity, and detachment, while the behavioral dimension was uniquely associated with ADHD, antagonism, and disinhibition. These analyses provide evidence that symptoms of ODD in young adults are associated with DSM-5 pathological personality traits above and beyond other psychopathology. These findings provide a framework for future studies and clinical consideration of ODD among adults.

Most families of children with behavior problems do access treatment. The purpose of this study was to test a parental measure of readiness to seek help for their child’s behavior problems. Data was collected annually from 148 parents at their child’s first contact with either mental health services or juvenile justice court or services. Psychopathology, service use, and factors related to service use were assessed. The majority of the sample was male (64%) and Black/African American (63%) with a mean age of 11.93 years (SD = 2.75). We administered a measure specifically developed for this study to assess stages of change in parents’ readiness to seek help for their child’s behavior problems. We used confirmatory factor analysis (CFA) to evaluate the stages of change and regression modeling to assess construct and criterion validity of the resulting readiness score. CFA of the revised subscales showed acceptable fit. Readiness scores were associated with current and future use of specialty mental health services. Higher readiness scores were associated with parents perceiving their child’s behavior as worse compared to peers, more child attention-deficit/hyperactivity disorder symptoms, and greater parental burden. Higher readiness scores were not associated with total family resources, symptoms of oppositional defiant disorder or conduct disorder. Scores from this measure were associated with factors that predict service engagement, and predict current and future mental health service utilization. These results indicate construct and criterion validity of measuring parental help-seeking for child behavior problems within a stages of change framework.

BACKGROUND: 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. METHODS: 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 to 16. Separate clustered Poisson regression models examined change in parent or child behavior outcomes using predictors lagged by one timepoint. RESULTS: 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. While ODD symptoms were unrelated to change in corporal punishment, ADHD predicted increasing parental aggression of both types. CONCLUSIONS: 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.

In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.

Parent satisfaction with neurodevelopmental evaluations may influence the pursuit of intervention. Parent satisfaction with a neurodevelopmental evaluation for toddlers at risk for autism (n = 257; 128 with autism) was examined using the Post-Evaluation Satisfaction Questionnaire, which collected quantitative and qualitative information. Fewer ethnic/racial minority than non-minority parents returned the questionnaire. Factor analysis indicated a one-factor model, Total score, which did not differ significantly by diagnosis, autism severity, child's cognitive or adaptive delay, family race/ethnicity, maternal education, family annual income, or parental stress. Examination of 24 individual items showed a race/ethnicity difference for only one item; minority parents scored the evaluation as meeting their needs less. Qualitative data stressed the importance of fully explaining diagnoses/recommendations and providing direct and clear feedback.

Millions of children across the USA have unmet mental health needs. When these include the disruptive behavior disorders (DBDs)-oppositional defiant disorder (ODD), conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD)-this can mean significant long-term consequences. Since children rarely seek treatment themselves, parents are central to the help-seeking process. This paper reviews research on the rates of problem recognition and help-seeking for DBDs, and on perceptual barriers that might hinder service engagement. Most children with DBDs are neither identified as such nor engaged in treatment, although this may be less true for ADHD than ODD or CD. Factors associated with DBDs that may reduce service engagement include seeing the behaviors as "normative," interpreting the symptoms as willful, and expecting to be blamed for the child's problems. Implications of these findings are discussed with particular focus on the widespread dissemination of evidence-based information about DBDs.

Autism Spectrum Disorder (ASD) diagnostic tools are not designed for mental ages (MA) below 12 months. Autism Diagnostic Observation Schedule (ADOS) and Childhood Autism Rating Scale (CARS) were examined in 2-year-olds with ASD-low MA (n = 53), Global Developmental Delay (GDD; n = 175), and ASD-higher MA (n = 425). ADOS and CARS demonstrated similar agreement with clinical diagnosis, but ADOS over-classified ASD in low MA, whereas CARS both over- and under-classified. All ADOS items differentiated GDD from ASD. Elementary social behaviors (e.g., eye contact, social interest) were similar across ASD groups, although advanced skills (e.g., pointing, play) were more impaired in ASD-low MA. ASD-low MA, a severe presentation, may require a modified ADOS algorithm to account for developmental delays.

Long-considered a disorder restricted to children and adolescents, more research is needed to understand how oppositional defiant disorder (ODD) affects adults. Recent research suggests that symptoms of ODD persist into adulthood and are associated with specific negative functional outcomes. This current study seeks to investigate the prevalence and associated impairments of ODD symptoms in young adults. Two large samples of college students between the ages of 18–24 years old (N = 1792; N = 1497) completed self-report measures of ODD symptoms, ADHD symptoms, psychiatric diagnoses, and functional impairments. Rates and internal consistency of ODD symptoms were calculated, and multiple regression was used to estimate the association between high levels of ODD severity scores and social and authority-related impairments, as well as online antagonistic behavior. In the two samples, the proportion of individuals reporting four or more symptoms of ODD was estimated to be 3.39 and 4.12% respectively, and did not vary significantly by gender. Higher ODD severity was associated with social impairment, online antagonistic behavior, and greater conflict with authority figures, even after controlling for ADHD symptoms and self-reported depression or anxiety diagnoses. ODD symptoms measured in college students demonstrate acceptable reliability and are uniquely associated with specific impairments. The findings from this study support greater consideration of ODD symptoms in adult populations.

In preparation for the World Health Organization's development of the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11) chapter on Mental and Behavioral Disorders, this article reviews the literature pertaining to severe irritability in child and adolescent psychopathology. First, research on severe mood dysregulation suggests that youth with irritability and temper outbursts, among other features of hyperactivity and arousal, demonstrate cross-sectional correlates and developmental outcomes that distinguish them from youth with bipolar disorder. Second, other evidence points to an irritable dimension of Oppositional Defiant Disorder symptomatology, which is uniquely associated with concurrent and subsequent internalizing problems. In contrast to the Diagnostic and Statistical Manual of Mental Disorders' (5th ed.) Disruptive Mood Dysregulation Disorder, our review of the literature supports a different solution: a subtype, Oppositional Defiant Disorder with chronic irritability/anger (proposal included in Appendix). This solution is more consistent with the available evidence and is a better fit with global public health considerations such as harm/benefit potential, clinical utility, and cross-cultural applicability. Implications for assessment, treatment, and research are discussed.

OBJECTIVE. Research supports the clinical importance of childhood irritability, as well as its developmental implications for later anxiety and depression. Appropriate treatment may prevent this progression; however, little evidence exists to guide clinician decision-making regarding treatment for chronic irritability symptoms. Given the empirical support for irritability as a dimension of oppositional defiant disorder (ODD), behavioral interventions that improve ODD symptoms, especially through emotion regulation training, are strong candidates for identifying effective treatment strategies for irritability. METHOD. Data from a randomized controlled effectiveness trial were used to assess hypotheses regarding irritability. The Stop Now and Plan (SNAP) Program was developed for pre-adolescent youths demonstrating clinically high rates of conduct problems. 252 boys ages 6 to 11 were assigned to participate in either SNAP or standard services; data were collected at four time points over 15 months. RESULTS. Although lower irritability scores over time were seen for the SNAP group compared to standard services, the main effect for treatment was small and did not reach statistical significance. However, a significant indirect effect of SNAP treatment on irritability via improved emotion regulation skills was found; improved emotion regulation skills were associated with significant and substantial reduction in irritability. CONCLUSIONS. Specific effects of SNAP for the improvement of emotion regulation skills function as a mechanism for subsequent reductions in irritability, supporting the distinction between emotion regulation and irritability symptoms. Enhancing increased emotion regulation skills within existing evidence-based interventions for children with ODD should provide a strong foundation for treatments to target irritability symptoms.

The relationship between perceived neighborhood contentedness and physical activity was evaluated in the Add Health study population. Wave I includes 20,745 respondents (collected between 1994 and 1995) and wave II includes 14,738 (71 %) of these same students (collected in 1996). Multinomial logistic regression was used to evaluate this relationship in both wave I and wave II of the sample. Higher levels of Perceived Neighborhood Contentedness were associated with higher reports of physical activity in both males and females and in both waves. For every one-point increment in PNS, males were 1.3 times as likely to report being highly physically active than low (95 % CI 1.23–1.37) in wave 1 and 1.25 times as likely in wave 2 (95 % CI 1.17–1.33). Females were 1.17 (95 % CI 1.12–1.22) times as likely to report being highly active than low and 1.22 times as likely in wave 2 (95 % CI 1.17–1.27) with every one-point increment. PNC appears to be significantly associated with physical activity in adolescents. Involving the community in the development of intervention programs could help to raise the contentedness of adolescents in these communities.

Dimensions of irritability and defiant behavior, though correlated within the structure of ODD, convey separable developmental risks through adolescence and adulthood. Irritability predicts depression and anxiety, whereas defiant behavior is a precursor to antisocial outcomes. Previously we demonstrated that a bifactor model comprising irritability and defiant behavior dimensions, in addition to a general factor, provided the best-fitting structure of ODD symptoms in five large datasets. Herein we extend our previous work by externally validating the bifactor model of ODD using multiple regression and multivariate behavior genetic analyses. We used parent ratings of DSM IV ODD symptoms, and symptom dimensions for ADHD (i.e., inattention and hyperactivity−impulsivity), conduct disorder (CD), depression/dysthymia, and generalized anxiety disorder (GAD) from 846 6−18-year-old twin pairs. We found that the ODD irritability factor was associated only with depression/dysthymia and GAD and the ODD defiant behavior factor was associated only with inattention, hyperactivity−impulsivity, and CD, whereas the ODD general factor was associated with all five symptom dimensions. Multivariate behavior genetic analyses found all five symptom dimensions shared genetic influences in common with the ODD general, irritability, and defiant behavior factors. In contrast, the defiant behavior factor shared genetic influences uniquely with inattention and hyperactivity−impulsivity, whereas the irritability factor shared genetic influences uniquely with depression/dysthymia and GAD, but not vice versa. This suggests that genes that influence irritability in early childhood also predispose to depression and anxiety in adolescence and adulthood. These multivariate genetic findings also support the external validity of the three ODD dimensions at the etiological level. Our study provides additional support for subtyping ODD based on these symptom dimensions, as in the revisions in the ICD-11, and suggests potential mechanisms underlying the development from ODD to behavioral or affective disorders.

Oppositional defiant disorder (ODD) is identified by persistent defiant, noncompliant, and antagonistic behavior and by persisting irritability and anger. It typically has an onset early in childhood. Despite often being regarded as a disorder of childhood, ODD persists into adulthood. ODD pervasively impairs functioning over the life span, causing difficulties in interpersonal relationships and social functioning, academic and occupational functioning, and in familial relationships. Dimensions among the symptoms include distinct irritability and behavioral dimensions. The irritability dimension robustly predicts depression and anxiety, while the behavioral dimensions predict persisting and worsening behavioral psychopathology. This, along with the ability to distinguish ODD from normative behaviors as early as preschool, suggests that ODD may be a useful marker of risk for diverse outcomes. Genetic factors help to explain both ODD and its dimensions, and transactions with the environment, particularly in interpersonal contexts, contribute to the persistence of ODD and its impairments. Clinical assessment strategies for ODD are well established, although the concordance between specific ODD symptoms and item wording varies across measures in ways that might influence diagnostic conclusions. Assessment and treatment decisions are also complicated by the introduction of disruptive mood dysregulation disorder, which markedly overlaps with the irritability dimension of ODD. Effective treatments for ODD are well established, but suffer from confounding with age and behavioral severity, such that fewer validated treatments are available for older individuals with ODD who do not develop conduct disorder. This is particularly true regarding the treatment of adult ODD, which has received almost no attention. Established treatments for ODD may also not give sufficient attention to irritability as a distinct aspect of the disorder.

Dimensions of irritability and defiant behavior, though correlated within the structure of ODD, convey separable developmental risks through adolescence and adulthood. Irritability predicts depression and anxiety, whereas defiant behavior is a precursor to antisocial outcomes. Previously we demonstrated that a bifactor model comprising irritability and defiant behavior dimensions, in addition to a general factor, provided the best-fitting structure of ODD symptoms in five large datasets. Herein we extend our previous work by externally validating the bifactor model of ODD using multiple regression and multivariate behavior genetic analyses. We used parent ratings of DSM IV ODD symptoms, and symptom dimensions for ADHD (i.e., inattention and hyperactivity-impulsivity), conduct disorder (CD), depression/dysthymia, and generalized anxiety disorder (GAD) from 846 6-18-year-old twin pairs. We found that the ODD irritability factor was associated only with depression/dysthymia and GAD and the ODD defiant behavior factor was associated only with inattention, hyperactivity-impulsivity, and CD, whereas the ODD general factor was associated with all five symptom dimensions. Multivariate behavior genetic analyses found all five symptom dimensions shared genetic influences in common with the ODD general, irritability, and defiant behavior factors. In contrast, the defiant behavior factor shared genetic influences uniquely with inattention and hyperactivity-impulsivity, whereas the irritability factor shared genetic influences uniquely with depression/dysthymia and GAD, but not vice versa. This suggests that genes that influence irritability in early childhood also predispose to depression and anxiety in adolescence and adulthood. These multivariate genetic findings also support the external validity of the three ODD dimensions at the etiological level. Our study provides additional support for subtyping ODD based on these symptom dimensions, as in the revisions in the ICD-11, and suggests potential mechanisms underlying the development from ODD to behavioral or affective disorders.

The aim of this study was to determine whether borderline personality disorder (BPD) can be differentiated from other disorders in a clinical sample of adolescent girls. Participants (N = 75) were grouped based on the pattern of BPD symptom endorsement using a latent class analysis. Four latent classes were identified. The most impaired class endorsed seven BPD symptoms and an average of three comorbid disorders. An intermediate class endorsed three BPD symptoms and had the highest prevalence of PTSD (41.7%). A third class reported two BPD symptoms and had a high prevalence of anxiety disorders (62%). The fourth class had no BPD symptoms and, on average, one comorbid disorder. Only a small subset of these teenage girls met criteria for BPD, and they had distinct and severe impairment. The results suggest the modest likelihood of a BPD diagnosis in clinical samples of teenage girls, and to also be vigilant for PTSD.

Aggression and violence are heterogeneous constructs, but subtyping approaches, including distinctions by developmental course, by progression of severity, and by types of behaviors, illustrate methods to bring greater clarity to their description and identification. Over development, violent behavior shows a course similar to that of the general age–crime curve, whereas aggressive behavior reveals high rates of aggression in early childhood that, for most individuals, desist by adolescence. Several key intraindividual factors, including social cognition, callous–unemotional features, and intelligence, help to explain why some individuals show greater aggression or violence than others. Effective intervention strategies exist, but important barriers remain in the identification and engagement in services of those most in need of intervention. Keywords: aggression; desistance; development; persistence; subtyping; violence

Abnormalities in reward and punishment processing are implicated in the development of conduct problems (CP), particularly among youth with callous-unemotional (CU) traits. However, no studies have examined whether CP children with high versus low CU traits exhibit differences in the neural response to reward and punishment. A clinic-referred sample of CP boys with high versus low CU traits (ages 8–11; n = 37) and healthy controls (HC; n = 27) completed a fMRI task assessing reward and punishment processing. CP boys also completed a randomized control trial examining the effectiveness of an empirically-supported intervention (i.e., Stop-Now-And-Plan; SNAP). Primary analyses examined pre-treatment differences in neural activation to reward and punishment, and exploratory analyses assessed whether these differences predicted treatment outcome. Results demonstrated associations between CP and reduced amygdala activation to punishment independent of age, race, IQ and co-occurring ADHD and internalizing symptoms. CU traits were not associated with reward or punishment processing after accounting for covariates and no differences were found between CP boys with high versus low CU traits. While boys assigned to SNAP showed a greater reduction in CP, differences in neural activation were not associated with treatment response. Findings suggest that reduced sensitivity to punishment is associated with early-onset CP in boys regardless of the level of CU traits. Keywords: Conduct problems, Callous-unemotional (CU) traits, Reward, Punishment, fMRI

Among the available treatments for disruptive behavior problems, a need remains for additional service options to reduce antisocial behavior and prevent further development along delinquent and violent pathways. The Stop Now and Plan (SNAP) Program is an intervention for antisocial behavior among boys between 6 and 11. This paper describes a randomized controlled treatment effectiveness study of SNAP versus standard behavioral health services. The treatment program was delivered to youth with aggressive, rule-breaking or antisocial behavior in excess of clinical criterion levels. Outcomes were measured at 3, 9 and 15 months from baseline. Youth in the SNAP condition showed significantly greater reduction in aggression, conduct problems and overall externalizing behavior, as well as counts of Oppositional Defiant Disorder and Attention Deficit Hyperactivity Disorder symptoms. Additional benefits for SNAP were observed on measures of depression and anxiety. Further analyses indicated that the SNAP program was more effective among those with a higher severity of initial behavioral problems. At one year follow-up, treatment benefits for SNAP were maintained on some outcome measures (Aggression, ADHD and ODD, depression and anxiety) but not others. Although overall juvenile justice system contact was not significantly different, youth in SNAP had significantly fewer charges against them relative to those standard services. The SNAP Program, when contrasted with standard services alone, was associated with greater, clinically meaningful, reductions in targeted behaviors. It may be particularly effective for youth with more severe behavioral problems, and may result in improvements in internalizing problems as well.

The active involvement of parents - whether as recipients, extenders, or managers of services - during their youth's experience with the juvenile justice system is widely assumed to be crucial. Parents and family advocacy groups note persisting concerns with the degree to which successful parental involvement is achieved. Justice system providers are highly motivated and actively working to make improvements. These coalescing interests provide a strong motivation for innovation and improvement regarding family involvement, but the likely success of these efforts is severely limited by the absence of any detailed definition of parental involvement or validated measure of this construct. Determining whether and how parental involvement works in juvenile justice services depends on the development of clear models and sound measurement. Efforts in other child serving systems offer guidance to achieve this goal. A multidimensional working model developed with parents involved in child protective services is presented as a template for developing a model for parental involvement in juvenile justice. Features of the model requiring changes to make it more adaptable to juvenile justice are identified. A systematic research agenda for developing methods and measures to meet the present demands for enhanced parental involvement in juvenile justice services is presented.

Callous-unemotional (CU) traits have been shown to delineate a unique subgroup of children with severe and persistent conduct problems that seem to have unique etiological origins. However, commonly used measures of CU traits in children may not adequately capture the full range of these characteristics in a developmentally appropriate manner. As a result, the 24-item Inventory of Callous-Unemotional Traits (ICU; self-, parent-, and teacher-report versions; Frick, 2004) was recently developed as a more extensive assessment of CU traits. However, studies to date have focused almost exclusively on the self-report version ICU in adolescents and have identified problems with the factor structure of the measure. The current study is the 1st to examine the factor structure of the parent-report version ICU in a sample of 250 boys (ages 6-12 years) exhibiting significant conduct problems. Initial analyses indicated that factor models reported for the parent-report version of the ICU demonstrated a relatively poor fit to the data. Item response theory techniques were used to develop a more psychometrically sound and efficient short form of the ICU consisting of 2 factors (i.e., Callous and Uncaring) using 12 of the original 24 items. The revised version scores demonstrated high internal consistency, good discrimination across the continuum of the CU construct, and adequate short-term test-retest reliability. The revised measure total score also exhibited evidence of convergent and discriminant validity, although the subscales exhibited some differential correlations with theoretically meaningful constructs. Avenues for future measure refinement and use with children are discussed.

BACKGROUND: Oppositional defiant disorder(ODD) is considered to be a disorder of childhood, yet evidence suggests that prevalence rates of the disorder are stable into late adolescence and trajectories of symptoms persist into young adulthood. Functional outcomes associated with ODD through childhood and adolescence include conflict within families, poor peer relationships, peer rejection, and academic difficulties. Little examination of functional outcomes in adulthood associated with ODD has been undertaken. METHOD: Data for the present analyses come from a clinic referred sample of 177 boys aged 7-12 followed up annually to age 18 and again at age 24. Annual parental report of psychopathology through adolescence was used to predict self-reported functional outcomes at 24. RESULTS: Controlling for parent reported symptoms of attention deficit hyperactivity disorder (ADHD), Conduct disorder (CD), depression and anxiety, ODD symptoms from childhood through adolescence predicted poorer age 24 functioning with peers, poorer romantic relationships, a poorer paternal relationship, and having nobody who would provide a recommendation for a job. CD symptoms predicted workplace problems, poor maternal relationship, lower academic attainment, and violent injuries. Only parent reported ODD symptoms and child reported CD symptoms predicted a composite of poor adult outcomes. CONCLUSION: Oppositional defiant disorder is a disorder that significantly interferes with functioning, particularly in social or interpersonal relationships. The persistence of impairment associated with ODD into young adulthood calls for a reconsideration of ODD as a disorder limited to childhood. Language: en

Three subdimensions of ODD symptoms have been proposed -angry/irritable (IR), argumentative/defiant (DF) and antagonism (AN). This study tested whether longitudinal symptom trajectories could be identified by these subdimensions. Group-based trajectory analysis was used to identify developmental trajectories of IR, DF and AN symptoms. Multi-group trajectory analysis was then used to identify how subdimension trajectories were linked together over time. Data were drawn from the Pittsburgh Girls Study (PGS; N = 2450), an urban community sample of girls between the ages of five--eight at baseline. We included five waves of annual data across ages five-13 to model trajectories. Three trajectories were identified for each ODD subdimension: DF and AN were characterized by high, medium and low severity groups; IR was characterized by low, medium stable, and high increasing groups. Multi-trajectory analysis confirmed these subdimensions were best linked together based on symptom severity. We did not identify girls' trajectory groups that were characterized predominantly by a particular subdimension of ODD symptoms. Membership in more severe symptom groups was significantly associated with worse outcomes five years later. In childhood and early adolescence girls with high levels of ODD symptoms can be identified, and these youth are characterized by a persistently elevated profile of IR, DF and AN symptoms. Further studies in clinical samples are required to examine the ICD-10 proposal that ODD with irritability is a distinct or more severe form of ODD.

Characterization of academic functioning in children with autism spectrum disorder (ASD), particularly predictors of achievement, may have important implications for intervention. The current study aimed to characterize achievement profiles, confirm associations between academic ability and concurrent intellectual and social skills, and explore preschool predictors of school-age academic achievement in a sample of children with ASD.Children with ASD (n = 26) were evaluated at the approximate ages of two, four, and ten. Multiple regression was used to predict school-age academic achievement in reading and mathematics from both concurrent (i.e. school-age) and preschool variables.Children with ASD demonstrated a weakness in reading comprehension relative to word reading. There was a smaller difference between mathematics skills; math reasoning was lower than numerical operations, but this did not quite reach trend level significance. Concurrent IQ and social skills were associated with school-age academic achievement across domains. Preschool verbal abilities significantly predicted school-age reading comprehension, above and beyond concurrent IQ, and early motor functioning predicted later math skills.Specific developmental features of early ASD predict specific aspects of school-age achievement. Early intervention targeting language and motor skills may improve later achievement in this population.

Background: A dimension of negatively oriented affect within oppositional defiant disorder (ODD) symptoms, which has been described as irritability, has been shown to predict depression and anxiety. Related constructs have been linked to temperament and personality constructs. However, only a few studies have examined the prediction from irritability within ODD to psychopathology or personality outcomes. Further, no studies have investigated whether irritability distinguishes among classes of youth. Methods: Data from a clinic-referred sample of 7–12-year-old boys followed up to age 18 were used. Measures included structured clinical interviews with parents through adolescence, and youth self-report of depression and personality domains at age 18. Results: Variable-oriented analyses found predictive links between irritability and outcomes of depression, anxiety, and Neuroticism. Latent classes of youth were distinguished by the presence or absence of irritability symptoms. Youth classified by irritability symptoms at baseline were significantly more likely to show anxiety and depression through adolescence and depression and Neuroticism at 18. No relationship was observed for the other of the Big Five personality factors. Conclusion: Irritability symptoms within ODD distinguish youth at risk for persisting problems with internalizing disorders and Neuroticism into adulthood. The findings are suggestive of a model in which the early emergence of irritability marks life-course risks for specific types of psychopathology and personality problems.

Background: Little is known about the role of oppositional defiant disorder (ODD) dimensions on the temporal unfolding of conduct disorder (CD) and depression in girls between childhood and adolescence. Method: The year‐to‐year associations between CD and depressive symptomatology were examined using nine waves of annually collected data (ages 8 through 16 years) from 1215 participants of the Pittsburgh Girls Study. A series of autoregressive path models were tested that included ODD‐Emotion Dysregulation (ODD‐ED) and ODD‐Defiance, as time‐varying covariates on CD predicting depression severity in the following year, and vice versa. Results: Conduct problems, depression, and ODD dimensions were relatively stable throughout childhood and adolescence, and a moderate degree of covariance was observed between these variables. Path analyses showed that CD often preceded depression across this developmental period, although the effect sizes were small. There was less consistent prediction from depression to CD. The overlap between ODD‐ED and CD partially explained the prospective relations from CD to depression, whereas these paths were fully explained by the overlap between ODD‐ED and depression. The overlap between ODD‐Defiance and CD did not account for the prospective relations from CD to depression. In contrast, the overlap between ODD‐Defiance and depression accounted for virtually all paths from CD to depression. Accounting for the overlap between ODD dimensions and both CD and depression eliminated all significant predictive paths. Conclusions: Symptoms of CD tend to precede depression in girls during childhood and adolescence. However, covariance between depression and both ODD‐ED and ODD‐Defiance accounts for these prospective relations. ODD dimensions should be assessed when evaluating risk for comorbid depression in girls with conduct problems, and emotion dysregulation and defiance aspects of ODD should be identified as targets for treatment in order to prevent depression in the future.

This article summarizes the empirical studies showing pathways in the development of externalizing and delinquent behaviors. Pathways are defined as the orderly temporal development between more than two problem behaviors. The paper addresses the following questions: (1) What are the developmental pathways between different diagnoses of Disruptive Behavior Disorders, including Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and Antisocial Personality Disorder (APD)? (2) What is a parsimonious model of pathways in externalizing problems that incorporates psychiatric symptoms of Disruptive Behaviors Disorders, other externalizing behaviors, and delinquent acts? And do the data best fit a single or multiple pathways? (3) Which pathways have been documented from externalizing to internalizing behaviors? (4) What are the limitations of past studies and what are the prospects of future studies on developmental pathways? Implications are discussed of the findings for assessments and interventions.

[Clin Psychol Sci Prac 17: 319–326, 2010] Many studies have shown that conduct disorder (CD) and depression often co-occur in late childhood and adolescence and have historically been regarded as the primary point of comorbidity between internalizing and behavioral disorders. On the other hand, recent evidence suggests that oppositional defiant disorder (ODD), and not CD, may best explain the comorbidity between disruptive behavior disorders and depression. ODD typically onsets before CD and depression, changes in ODD symptoms predict changes in symptoms of CD and depression from one year to the next, and ODD in childhood and adolescence predicts depression in adulthood. Emerging evidence suggests that there are affective and behavioral dimensions of ODD symptoms, and those affective ODD symptoms (and not the behavioral symptoms) best predict later depression. These results are highly relevant not only for our understanding of the etiology of the disorders, but also for optimizing early interventions aimed at reducing irritability in some ODD children. The new findings also stimulate new questions to be addressed with future research.

Objective To examine whether oppositional defiant disorder (ODD) rather than conduct disorder (CD) may explain the comorbidity between behavioral disorders and depression; to test whether distinct affective and behavioral dimensions can be discerned within the symptoms of ODD; and to determine whether an affective dimension of ODD symptoms is specifically predictive of later depression. Method The dimensions of ODD and their prediction to later CD and depression were examined in a community sample of 2,451 girls between the ages of 5 and 8 years, followed up annually over a 5-year period, using parent, child, and teacher questionnaire ratings of the severity of symptoms of psychopathology. Results Dimensions of negative affect, oppositional behavior, and antagonistic behavior were found within ODD symptoms. Negative affect predicted later depression. Oppositional and antagonistic behavior predicted CD overall, and for Caucasian girls, negative affect also predicted later CD. CD was not predictive of later depression, controlling for comorbid conditions. Conclusions ODD plays a key role in the early development of psychopathology. It is central in the comorbidity between internalizing and externalizing psychopathology, which may be caused by a dimension of negative affective symptoms within ODD. How this dimension relates to later CD appears to vary by race.

Theoretical models suggest that child behaviors influence parenting behaviors, and specifically that unpleasant child behaviors coerce parents to discontinue engaging in appropriate discipline. This study examined reciprocal relationships between parenting behaviors (supervision, communication, involvement, timid discipline and harsh punishment) and child disruptive disorder symptoms (ADHD, ODD and CD) in a clinic-referred sample of 177 boys. Annual measures, including structured clinical interviews, were obtained from the beginning of the study (when boys were between the ages of 7 to 12) to age 17. Specific reciprocal influence was observed; only timid discipline predicted worsening behavior, namely ODD symptoms, and ODD symptoms predicted increases in timid discipline. Greater influence from child behaviors to parenting practices was found: ODD also predicted poorer communication and decreased involvement, and CD predicted poorer supervision. ADHD was neither predictive of, nor predicted by, parenting behaviors. The results are specifically supportive of a coercive process between child behaviors and parenting behaviors, and generally suggestive of greater influence of child behaviors on parenting behaviors than of parenting behaviors on child behaviors.

This study compares 6–11-year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder, either with (ODD + CD, n = 40) or without Conduct Disorder (ODD only; n = 136), to a matched sample of healthy control children (HC; n = 69). Multiple informants completed intake diagnostic interviews and self-reports to evaluate constructs examining the child’s functioning and contextual influences on functioning (e.g., parent, family, peer, community). ODD + CD and ODD only children were each distinguished from HCs by greater exposure to delinquent peers and lowered parental self-efficacy. In further comparisons to the HC group, ODD only status was associated with parental use of psychological aggression and more stressful life events, whereas ODD + CD status was associated with greater parental hostility. Relative to ODD alone status, ODD + CD status was comparable on all but one variable (greater parental hostility). Similar findings were reported using a subset of girls only. The characteristics that distinguish children with DBDs from controls and, in particular, ODD + CD from ODD only, bear implications for understanding and treating both CD and ODD.

Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress partially mediated improvements in child aggression. Improved emotion regulation skills partially mediated treatment-related child anxious-depressed outcomes. Improvements in parenting behaviors did not differ between treatment conditions. The results suggest that independent processes may drive affective and behavioral outcomes, with some specificity regarding the mechanisms related to differing treatment outcomes.

The authors examined the prediction from inattention to tobacco use among 2 cohorts (ages 7 and 13) of a community sample followed to young adulthood. Changes in self-reported tobacco use were tested with marginal transitional regression models, using parent and teacher ratings of inattention, hyperactivity– impulsivity, and other psychopathology, along with other factors, as predictors. Inattention, but not hyperactivity–impulsivity, significantly predicted adolescent tobacco use and young adult daily tobacco use. Peer substance use, parental substance use, and conduct disorder also predicted increases in tobacco use. African American ethnicity was strongly protective against later tobacco use. The results support the hypothesis that problems of inattention play a key role in increased tobacco use.

It is known that youth engaged in the juvenile justice system show high rates of psychiatric disorders. However, little is known about the course of those disorders over time, or about mental health service use on the part of children and families during justice system involvement. Boys and girls recruited from their first contact with juvenile court (n=75), at a mean age of 13.6 years, completed three waves of interviews, each consisting of a structured clinical interview and questionnaires regarding service use, family functioning, parental burden, parental psychopathology. High rates of psychiatric disorders were evident. Three quarters (n = 56) met criteria for a mood, anxiety or behavioral disorder by parent or child report. Despite the high prevalence of mental health concerns, relatively few youth (approximately 20%) were involved in mental health services in follow-up waves. The presence of ODD and higher levels of family communication problems were associated with involvement in mental health services. Although parents experienced burden associated with their child's mental health problems, burden was not a strong correlate of help-seeking. Mental health problems declined from the point of initial involvement with juvenile justice; only ODD symptoms showed stability over time. Low rates of engagement in mental health services are found for juveniles subsequent to their first contact with juvenile justice. ODD and family communication problems most influenced service engagement, while burden due to mental health problems did not. The results provide potential targets for efforts to enhance parental motivation towards service engagement.

Background Attrition presents a serious problem to researchers collecting longitudinal data. Participant loss threatens both the internal and external validity of research findings. This study sought to examine predictors related to contact difficulty and refusals in a longitudinal study. Method Data for this paper came from the Developmental Trends Study, a longitudinal study investigating the development of disruptive behaviour disorders in a sample of 177 clinic-referred boys. Annual follow-up assessments were conducted, ages for the periods examined ranged from 11 to 19 years. The predictor domains during project years 1–4 included demographics, child functioning, parental functioning, parenting skills and participant dispersion. Results These indicated that participant's older age, low socioeconomic status, the presence of callous and unemotional behaviours, and having a father with antisocial personality disorder predicted contact difficulty, while participant's older age, living in a rural environment and attention deficit hyperactivity disorder were predictive of refusals. Participant dispersion was not significantly related to either contact difficulty or refusal status. Conclusions Investigating a broader range of variables may better allow researchers to identify participants who may be at risk of attrition. Early identification of ‘difficult’ participants enables development of retention strategies to minimize attrition. Copyright © 2005 Whurr Publishers Ltd.

Participant retention is essential to the success of longitudinal research projects. Locating participants for follow-up is often time consuming and expensive, which may result in researchers limiting their contact efforts for budgetary reasons. Yet if such a protocol is instituted a fair number of participants will likely be lost. This paper examines the impact of restricted persistence on participant retention and selective attrition in longitudinal research. The data was collected from the developmental trends study (DTS), a longitudinal study of the development of disruptive behavior disorders, consisting of 177 clinic-referred boys who were followed from childhood through young adulthood. The results indicated that limiting contact efforts would have resulted in significant participant loss and selective attrition for participants with disruptive behavior disorders. Cost-estimates showed that the extra effort required to retain ‘difficult’ participants was minimal compared to the initial investment in study costs. Implementing systematic and comprehensive approaches to retention will result in favorable retention rates and can be done in a cost-effective manner.

Minimizing participant attrition is vital to the success of longitudinal research. The Developmental Trends Study (DTS), a longitudinal study of the development of disruptive behavior disorders, has achieved a low attrition rate throughout the study. The development of early retention strategies, managing contact and scheduling history through the use of electronic databases, interviewer persistence, and the emergence of new electronic search methods have contributed to the success of our study. A literature review of retention methodology and practical solutions to maintain participant cooperation is described. A case study of the DTS is presented to inform researchers in longitudinal research on new methods used to maintain high retention rates.

Background Conduct disorder (CD), a psychiatric index of antisocial behaviour, shares similarities with delinquency, a criminological index. This study sought to examine which factors in childhood predict a repeated diagnosis of CD in adolescence, and whether self-reported delinquent acts enhance the utility of symptoms of CD in predicting later persistent CD. Method Longitudinal data used in this paper come from a clinic-referred sample of 177 boys, along with their parents and teachers, who were assessed using a structured clinical interview. The boys also reported on their delinquent behaviours, as well as a broad range of other family and life events. Results Before age 13, 77 boys met criteria for CD according to their parent, 69 according to their own report, and 36 reported three or more delinquent acts. Forty-eight boys (29%) met criteria for CD three or more times between 13 and 17. In childhood, delinquency overlapped, but was distinct from CD. Both were present in 28 cases, while 41 cases had CD without delinquency, and eight had delinquency without CD. When tested as predictors of later persistent CD, child-reported CD was the strongest predictor of later persistent CD, but self-reported delinquency was stronger than parent-reported CD. A final model of significant predictors included child-reported CD, delinquency, poor child communication with parents, and maternal prenatal smoking. Conclusions It appears that delinquency does add uniquely to the prediction of persistent CD. It may be useful to expand the diagnostic criteria for CD accordingly. Copyright © 2002 Whurr Publishers Ltd.

Much remains to be learned about the adolescent outcomes of clinic-referred boys whose childhood conduct problems are serious enough to meet diagnostic criteria for conduct disorder (CD). Six structured diagnostic assessments were conducted over 7 years of 73 clinic-referred 7‐12-year-old boys who met criteria for CD in Wave 1. There were substantial individual differences in the adolescent outcomes of CD, ranging from worsening to sustained recovery, with most boys showing persistent, but fluctuating levels of CD. Improvement in CD was not accounted for by treatment or incarceration, but more positive outcomes over Waves 2‐7 were predicted prospectively with substantial accuracy, using a combination of baseline predictors: less initial severity of CD, fewer symptoms of attention-deficit hyperactivity disorder, higher child verbal intelligence, greater family socioeconomic advantage, and not having antisocial biological parents.

Objective: To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD). Method: Selected summaries of the literature over the past decade are presented. Results: Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models.Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains. Conclusions: Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD. J. Am. Acad. Child Adolesc. Psychiatry, 2002, 41(11):1275‐1293. Key Words: oppositional defiant disorder, conduct disorder, risk factors, treatment.

The importance of irritability as measured among the symptoms of oppositional defiant disorder (ODD) has dramatically come to the fore in recent years. New diagnostic categories rely on the distinct clinical utility of irritability, and models of psychopathology suggest it plays a key role in explaining developmental pathways within and between disorders into adulthood. However, only a few studies have tested multidimensional models of ODD, and the results have been conflicting. Further, consensus has not been reached regarding which symptoms best identify irritability. The present analyses use data from five large community data sets with five different measures of parent-reported ODD, comprising 16,280 youth in total, to help resolve these questions. Across the samples, ages ranged from 5 to 18, and included both boys and girls. Confirmatory factor analyses demonstrated that a modified bifactor model showed the best fit in each of the five data sets. The structure of the model included two correlated specific factors (irritability and oppositional behavior) in addition to a general ODD factor. In four of the five models, the best fit was obtained using the items of being touchy, angry and often losing temper as indicators of irritability. Given the structure of the models and the generally high correlation between the specific dimensions, the results suggest that irritability may not be sufficiently distinct from oppositional behavior to support an entirely independent diagnosis. Rather, irritability may be better understood as a dimension of psychopathology that can be distinguished within ODD, and which may be related to particular forms of psychopathology apart from ODD.