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Separating the Domains of Oppositional Behavior: Comparing Latent Models of the Conners’ Oppositional Subscale

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Objective

Although oppositional defiant disorder (ODD) is usually considered the mildest of the disruptive behavior disorders, it is a key factor in predicting young adult anxiety and depression and is distinguishable from normal childhood behavior. In an effort to understand possible subsets of oppositional defiant behavior (ODB) that may differentially predict outcome, we used latent class analysis of mother report on the Conners’ Parent Rating Scales Revised Short Forms (CPRS-R:S).

Method

Data were obtained from mother report for Dutch twins (7 years old, n = 7,597; 10 years old, n = 6,548; and 12 years old, n = 5,717) from the Netherlands Twin Registry. Samples partially overlapped at ages 7 and 10 years (19% overlapping) and at ages 10 and 12 years (30% overlapping), but not at ages 7 and 12 years. Oppositional defiant behavior was measured using the six-item Oppositional subscale of the CPRS-R:S. Multilevel LCA with robust standard error estimates was performed using the Latent Gold program to control for twin–twin dependence in the data. Class assignment across ages was determined and an estimate of heritability for each class was calculated. Comparisons with maternal report Child Behavior Checklist (CBCL) scores were examined using linear mixed models at each age, corrected for multiple comparisons.

Results

The LCA identified an optimal solution of four classes across age groups. Class 1 was associated with no or low symptom endorsement (69–75% of the children); class 2 was characterized by defiance (11–12%); class 3 was characterized by irritability (9–11%); and class 4 was associated with elevated scores on all symptoms (5–8%). Odds ratios for twins being in the same class at each successive age point were higher within classes across ages than between classes. Heritability within the two “intermediate” classes was nearly as high as for the class with all symptoms, except for boys at age 12. Children in the Irritable class were more likely to have mood symptoms on the CBCL scales than children in the Defiant class but demonstrated similar scores on aggression and externalizing scales. Children in the All Symptoms class were higher in both internalizing and externalizing scales and subscales.

Conclusions

The LCA indicates four distinct latent classes of oppositional defiant behavior, in which the distinguishing feature between the two intermediate classes (classes 2 and 3) is the level of irritability and defiance. Implications for the longitudinal course of these symptoms, association with other disorders, and genetics are discussed.

Section snippets

Method

This study proceeded in three steps. First, latent class analysis was performed within each age group, and heritability was estimated. Next, the across-age stability of these classes was tested by comparing across ages 7 to 10 years and 10 to 12 years. Third, a comparison of concurrent validity was performed within each age group. This can be seen graphically in Figure 1.

Results

The LCA identified an optimal solution of four classes across age groups co-varying for sex (FIGURE 2, FIGURE 3, FIGURE 4). The best model that controlled for twin dependence did not include sex as a covariate, and included direct effects (except age 10) to account for significant bivariate residuals. Distributions of the groups are shown in Table 2.

The across-twin intraclass correlations and estimated heritabilities are provided in Table 3. On the whole, twin correlations within a particular

Discussion

The current findings indicate four distinct latent classes of ODB. As expected, the majority of children had low or no symptom endorsement. This should be expected in a general population sample of children. Furthermore, consistent with the literature, which suggest a decrease in ODD diagnoses at 3-year follow-up,1, 13 approximately 75% of children were in the low symptom class by age 12, compared with 69% at both age 7 and 10. The level of either irritability or defiance was the distinguishing

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    Supplemental material cited in this article is available online.

    This article was reviewed under and accepted by ad hoc editor, Daniel S. Pine, M.D.

    Drs. Kuny and Althoff contributed equally to this article.

    Drs. Kuny, Althoff, Baer and Hudziak are with the Vermont Center for Children, Youth, and Families at the University of Vermont. Dr. Kuny is also with the New Mexico Veterans Administration Hospital in Albuquerque, New Mexico. Dr. Baer is also with the Nationwide Children's Hospital in Columbus, Ohio. Dr. Copeland is with Duke University. Drs. Bartel, Van Beijsterveldt, and Hudziak are with Vrije Universiteit Amsterdam, the Netherlands. Dr. Hudziak is also with Erasmus Medical Center, Rotterdam, the Netherlands.

    This work was supported by National Institute of Mental Health (NIMH) grants MH082116 and MH58799, and the Netherlands Organisation for Scientific Research grants 575-25-006, 575-25-012, and 904-57-94.

    The authors thank Dorret Boomsma of Vrije Universiteit Amsterdam, the Netherlands, for allowing the use of Netherlands Twin Registry data.

    Disclosure: Dr. Althoff has received grant or research support from NIMH and the Klingenstein Third Generation Foundation. Dr. Copeland has received grant or research support from NIMH and the Brain and Behavior Research Foundation. Dr. Bartels has received funding from the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). Dr. Hudziak has received funding from NIMH and NIDDK. His primary appointment is with the University of Vermont. He has additional appointments with Erasmus University in Rotterdam, Vrije University in Amsterdam, Dartmouth Medical School in Hanover, New Hampshire, and the Avera Institute of Human Behavioral Genetics in Sioux Falls, South Dakota. Drs. Van Beijesterveldt, Kuny, and Baer report no biomedical financial interests or potential conflicts of interest.

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