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Deconstructing Oppositional Defiant Disorder: Clinic-Based Evidence for an Anger/Irritability Phenotype

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Objective

To examine risk factors and co-occurring symptoms associated with mother-reported versus teacher-reported anger/irritability symptoms (AIS) of oppositional defiant disorder (ODD) in a clinic-based sample of 1,160 youth aged 6 through 18 years.

Method

Participants completed a background history questionnaire (mothers), school functioning questionnaire (mothers, teachers), and DSM-IV–referenced symptom checklists (mothers, teachers). Youth meeting AIS criteria for ODD were compared to youth with ODD who met criteria for noncompliant symptoms (NS) but not AIS and to clinic controls.

Results

Compared with NS youth, youth with AIS were rated as exhibiting higher levels of anxiety and mood symptoms for both mother- and teacher-defined groups, and higher levels of conduct disorder symptoms for mother-defined younger and older youth. The remaining group differences for developmental, psychosocial, and psychiatric correlates varied as a function of informant and youth's age.

Conclusions

Evidence suggests that AIS may constitute a more severe and qualitatively different ODD clinical phenotype, but informant and age of youth appear to be important considerations.

Section snippets

Participants

Participants were parents (primarily mothers) and teachers of 1,160 youth who were consecutive referrals to a university hospital child psychiatry outpatient service that serves an ethnically and economically diverse clientele. Given the well-established developmental differences in the emergence of psychiatric symptomatology, we divided the sample into a younger (6-11-year-olds; n = 546; 72.7% males) and older (12-18-year-olds; n = 614; 67.1% males) cohort (full sample mean = 12.1, SD = 3.4

Distribution of Subgroups

When mothers' ratings were the basis of group classification, 212 younger (69.8% male) and 284 older (69.4% male) youth met symptom criteria for ODD, of whom 53% (63.4% male) and 64% (70.2% male), respectively, were classified as having AIS. Using teachers' ratings to construct groups, 204 younger (78.9% male) and 195 older (76.9% male) youth were classified as having ODD, of whom 61% in each age group (younger: 82.4% male, older: 77.3% male) were classified as having AIS.

Background Variables

The two ODD groups

Discussion

Recent evidence suggests that different types of ODD symptoms have distinct correlates and outcomes,6, 7, 8, 9, 10, 11, 12 which in part contributed to a suggestion by the DSM-5 ADHD and Disruptive Behavior Disorders Workgroups to consider AIS and NS separately. Nevertheless, few studies have explicitly examined their divergent diagnostic validity or considered the implications of contextual variation. Our findings for a large, heterogeneous, clinic-based sample provide additional support for

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      Nonetheless, clinically experienced PhD students revised the parents’ responses and parent reports have been show to be good indicators of ODD symptoms (Aebi et al., 2010). Parent reports are preferable to self-assessments, as there is evidence that those affected by disruptive behavior disorders generally have low insight about their symptoms (Termine et al., 2011; Drabick and Gadow, 2012; Aebi et al., 2013). Furthermore, in our sample, most parents were accustomed to questionnaires and interviews since their children have undergone evaluations by different professionals on various occasions.

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    This research was supported in part by the National Institute of Mental Health 1K01MH073717-01A2 (D.A.G.D.)

    Disclosure: Dr. Gadow is a shareholder in Checkmate Plus which publishes the Child and Adolescent Symptom Inventory. Dr. Drabick reports no biomedical financial interests or potential conflicts of interest.

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