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Dimensions and subtypes of oppositionality and their relation to comorbidity and psychosocial characteristics

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Abstract

The symptoms of oppositional defiant disorder (ODD), or oppositionality, seem to constitute a three-dimensional structure of angry/irritable, vindictiveness and argumentative behavior dimensions. Also, subjects with oppositionality are characterized by different comorbidity and longitudinal trajectories, suggesting that they could be divided into subtypes. This study is the first to examine the dimensions and subtypes of oppositionality in Nordic children. Study participants included 3435 children aged 7–10 years from the Danish National Birth Cohort. Information was collected using the Development and Well-Being Assessment (DAWBA) online version. A three-factor ODD model was identified. The angry/irritable dimension was associated with emotional problems and disorders, fewer social skills and fewer personal positive attributes. The argumentative behavior dimension was associated with hyperactivity/conduct problems, reduced social skills and positive attributes. The vindictiveness dimension was associated with externalizing, internalizing and prosocial problems. Four ODD subtypes were identified. The subtypes with many or mainly angry/irritable symptoms were characterized by comorbid psychopathology, increased functional impairment and psychosocial problems. Children with ODD had fewer positive attributes, more friendship/school problems and higher functional impairment than children with emotional disorders and control group children. Oppositionality consists of three dimensions differently associated with comorbidity and psychosocial characteristics, and the same pattern is seen for the four ODD subtypes identified in this study. Children with ODD experience more adversities and functional impairment than children with emotional disorders. Our results indicate that treatment of children with ODD would improve from extended knowledge on individual ODD dimensions and subtypes and the related child psychosocial characteristics.

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Acknowledgements

The Danish National Research Foundation has established the Danish Epidemiology Science Centre that initiated and created the Danish National Birth Cohort. The cohort is furthermore a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort is obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation. The DNBC 7-year follow-up is supported by the Lundbeck Foundation (195/04) and the Danish Medical Research Council (SSVF 0646). This study was funded by grants from the Psychiatric Research Fund of the Region of Southern Denmark, the Lundbeck Foundation and the University of Southern Denmark. The funders had no involvement in any aspect of the study and the authors report no conflicts of interest.

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Authors and Affiliations

  1. Research Unit of Child and Adolescent Mental Health, Department of Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Institute of Clinical Research, University of Southern Denmark, J. B. Winsløwsvej 16, 5000, Odense C, Denmark

    Rikke Wesselhoeft

  2. Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA

    Argyris Stringaris

  3. Center for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark

    Christian Sibbersen & Anders Bo Bojesen

  4. Kolding Hospital, the Region of Southern Denmark, Kolding, Denmark

    Rune Voss Kristensen

  5. Division of Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA

    Ardesheer Talati

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  1. Rikke Wesselhoeft
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Wesselhoeft, R., Stringaris, A., Sibbersen, C. et al. Dimensions and subtypes of oppositionality and their relation to comorbidity and psychosocial characteristics. Eur Child Adolesc Psychiatry 28, 351–365 (2019). https://doi.org/10.1007/s00787-018-1199-8

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