Oppositional Defiant and Conduct Disorders: Issues to be Resolved for DSM-IV

doi:10.1097/00004583-199205000-00023

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 31, Issue 3, May 1992, Pages 539-546

https://doi.org/10.1097/00004583-199205000-00023 Get rights and content

Abstract

Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.

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Oppositional defiant disorder (ODD) is characterized by contentious interpersonal behaviors and an irritable disposition. ODD typically has an onset in childhood and is often persistent through adolescence and into adulthood. ODD includes distinct symptom dimensions of chronic irritability and oppositional behavior; these differentially explain comorbidities with depression and anxiety or with externalizing behavioral disorders respectively. ODD creates impairments in interactions with family members, peers, teachers and colleagues in work environments, and predicts school dropout and increased risk for suicidality. Evidence-based treatments are available for children, but additional work is needed to validate interventions for ODD in late adolescence and adulthood.
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The recent inclusion of callous-unemotional traits in the diagnostic criteria for serious conduct problems has led to renewed interest in more comprehensive integrations of the construct of psychopathy into research and clinical classification of childhood disruptive behavior disorders. There have been a number of recent reviews of research focusing the many potential benefits for this integration. However, there are also a number of issues that could reduce these benefits and even potentially lead to harmful effects. The current paper focuses on several of these issues, some of which are common when attempting to integrate research findings across areas that have been conducted independently of each other. Other issues are more specific to the construct of psychopathy. Specifically, the current paper focuses on the lack of agreement on the necessary and sufficient dimensions needed to define psychopathy, the need to consider developmental relationships among these dimensions, the implications of the different associations among the dimensions of psychopathy with conduct problems in children and adolescents, the need to consider how these dimensions relate to existing constructs used in the classification of disruptive behavior disorders, and the potential harmful effects of labeling something “a dimension of psychopathy”. These issues have several clear implications for using the construct of psychopathy to guide research on and diagnostic classification of childhood disruptive behavior disorders.
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This chapter provides a summary of research on the use of callous–unemotional (CU) traits for designating a distinct and important subgroup of youth with serious conduct problems. The chapter starts by tying the construct of CU traits to research on the affective components of psychopathy, research on the normal development of conscience, and past attempts to find meaningful subtypes within children and adolescents with serious conduct problems. We then provide a review of research suggesting that CU traits designate a clinically important subgroup of antisocial youth who show more severe aggression and more severe and stable patterns of conduct problems. We also review research showing distinct genetic, biological, emotional, cognitive, family, and peer correlates to conduct problems in children with elevated CU traits and then provide a theoretical model for how these correlates may help to explain different causal pathways to serious conduct problems in youth with and without elevated CU traits. Finally, we conclude with the implications of this research on CU traits for diagnosis and treatment, focusing specifically on the new specifier the diagnosis of Conduct Disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders called “with Limited Prosocial Emotions” that is defined by the presence of CU traits.
Callous-unemotional traits
2018, Developmental Pathways to Disruptive, Impulse-Control, and Conduct Disorders
This chapter provides a summary of research on the use of callous–unemotional (CU) traits for designating a distinct and important subgroup of youth with serious conduct problems. The chapter starts by tying the construct of CU traits to research on the affective components of psychopathy, research on the normal development of conscience, and past attempts to find meaningful subtypes within children and adolescents with serious conduct problems. We then provide a review of research suggesting that CU traits designate a clinically important subgroup of antisocial youth who show more severe aggression and more severe and stable patterns of conduct problems. We also review research showing distinct genetic, biological, emotional, cognitive, family, and peer correlates to conduct problems in children with elevated CU traits and then provide a theoretical model for how these correlates may help to explain different causal pathways to serious conduct problems in youth with and without elevated CU traits. Finally, we conclude with the implications of this research on CU traits for diagnosis and treatment, focusing specifically on the new specifier the diagnosis of Conduct Disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders called “with Limited Prosocial Emotions” that is defined by the presence of CU traits.
Disentangling Heterogeneity of Childhood Disruptive Behavior Problems Into Dimensions and Subgroups
2017, Journal of the American Academy of Child and Adolescent Psychiatry
Irritable and oppositional behaviors are increasingly considered as distinct dimensions of oppositional defiant disorder. However, few studies have explored this multidimensionality across the broader spectrum of disruptive behavior problems (DBPs). This study examined the presence of dimensions and distinct subgroups of childhood DBPs, and the cross-sectional and longitudinal associations between these dimensions.
Using factor mixture models (FMMs), the presence of dimensions and subgroups of DBPs was assessed in the Generation R Study at ages 6 (n = 6,209) and 10 (n = 4,724) years. Replications were performed in two population-based cohorts (Netherlands Twin Registry, n = 4,402, and Swedish Twin Study of Child and Adolescent Development, n = 1,089) and a clinical sample (n = 1,933). We used cross-lagged modeling in the Generation R Study to assess cross-sectional and longitudinal associations between dimensions. DBPs were assessed using mother-reported responses to the Child Behavior Checklist.
Empirically obtained dimensions of DBPs were oppositional behavior (age 6 years), disobedient behavior, rule-breaking behavior (age 10 years), physical aggression, and irritability (both ages). FMMs suggested that one-class solutions had the best model fit for all dimensions in all three population-based cohorts. Similar results were obtained in the clinical sample. All three dimensions, including irritability, predicted subsequent physical aggression (range, 0.08–0.16).
This study showed that childhood DBPs should be regarded as a multidimensional phenotype rather than comprising distinct subgroups. Incorporating multidimensionality will improve diagnostic accuracy and refine treatment. Future studies need to address the biological validity of the DBP dimensions observed in this study; herein lies an important opportunity for neuroimaging and genetic measures.
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Substance use disorders (SUDs) are among the most common psychiatric conditions, resulting in serious behavioral impairments and cognition decline. Acute and chronic drug abuse, drug dependency and drug withdrawal result in significant alteration of the electroencephalogram (EEG). EEG biofeedback has been used in the treatment of alcohol and mixed substance abuse in residential inpatient populations. More recent outpatient approaches have used quantitative EEG (qEEG) guided neurofeedback, neurofeedback (NFB) integrated with motivational interviewing and LORETA neurofeedback. A recent review of the state-of-art of qEEG and NFB in SUD and earlier reviews have detailed the efficacy ratings and clinical uses of NFB for SUD. In these reviews NFB is rated “probably efficacious” as an add-on (adjunct) treatment to other therapies, namely 12-step programs and/or cognitive behavioral therapies, or other types of psychotherapies or residential programs. Neurofeedback is not yet validated as a stand-alone therapy for addictive disorders and cannot yet be considered a mainstream therapy for addiction. Many persons with SUD have comorbid conditions that need to be considered in designing a treatment plan that incorporates neurofeedback. These include mental conditions such as depression, posttraumatic stress disorder, and attention deficit hyperactivity disorder that may require separate neurofeedback treatment for those specific conditions either preceding neurofeedback treatment for addiction, or incorporated into it. This approach may require separate assessments during the course of therapy to determine response and the need to change protocols or seek other treatments, i.e., medication or psychotherapy, to integrate into the treatment plan update.

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: This paper was supported by grant 1-R01-MH42529-01 from the National Institute of Mental Health and prepared for the Disruptive Behavior Disorders Committee of the DSM-IV Child and Adolescent Disorders Work Group. The ideas expressed in this paper are not necessarily those of the full DSM-IV committees. The authors appreciate the comments of Douglas Feltman, Elizabeth Hart, David Shaffer, and Jon Shaw on an earlier draft of this paper.

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ARTICLESOppositional Defiant and Conduct Disorders: Issues to be Resolved for DSM-IV

Abstract

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Child Adolesc. Psychiatry

J Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

DSM-III disorders in preadolescent children

Arch. Gen. Psychiatry

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch. Gen. Psychiatry

Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family genetic study of American child psychiatry patients

Psychol. Med.

Epidemiology

Advancing knowledge about the onset of delinquency and crime

Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting

J. Consult. Clin. Psychol.

Juvenile delinquents revisited: adult criminal activity

Arch. Gen. Psychiatry

Types of personality structure encountered in child guidance clinics

Am. J. Orthopsychiatry

ARTICLES
Oppositional Defiant and Conduct Disorders: Issues to be Resolved for DSM-IV