Abstract
Oppositional defiant disorder (ODD) frequently co-occurs with depression in youth, and it has been proposed that ODD Angry/Irritable Mood symptoms predict depression in these youth. Another explanation is that the ODD Angry/Irritable Mood dimension is a component of a broader emotion dysregulation syndrome. This study examined the relationship of ODD Angry/Irritable Mood symptoms with depression, and the Child Behavior Check List (CBCL) Dysregulation Profile with co-occurring ODD and depression in clinic-referred youth. Of 310 youth referred to an outpatient clinic, 86 were diagnosed with ODD without depression, and 78 were diagnosed with co-occurring ODD and depression. These groups did not differ in number of ODD Angry/Irritable Mood symptoms, and ODD affective symptoms showed a low correlation with youth-reported depression and parent- reported CBCL Anxious/Depressed symptoms. Logistic regression analysis with ODD Angry/Irritable Mood symptoms did not differentiate youth who were diagnosed with ODD without depressive disorder from youth who were diagnosed with co-occurring ODD and depression. The 55 youth who fit the CBCL – Dysregulation Profile were more likely to be diagnosed with depression than youth who did not fit the profile. Logistic regression analysis with this profile differentiated youth with co-occurring ODD and depression from youth diagnosed with ODD without co-occurring depression. Present results did not support the hypothesis that ODD Angry/Irritable Mood symptoms are differentially associated with depression in clinic-referred youth with ODD. However, the results did support the hypothesis that the parent-report CBCL dysregulation profile differentiates youth with co-occurring ODD and depression from ODD youth without depression.
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References
Achenbach, T. M. (1991). Manual for the child behavior check list/4-18 and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.
Althoff, R. R. (2010). Dysregulated children reconsidered. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4), 302–305. https://doi.org/10.1097/00004583-201004000-00004.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: Author. Text Revision.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: Author.
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87. https://doi.org/10.1111/1469-7610.00424.
Ayer, L., Althoff, R., Ivanova, M., Rettew, D., Waxler, E., Sulman, J., & Hudziak, J. (2009). Child behavior checklist juvenile bipolar disorder (CBCL-JBD) and CBCL posttraumatic stress problems (CBCL-PTSP) scales are measures of a single dysregulatory syndrome. Journal of Child Psychology and Psychiatry, 50(10), 1291–1300. https://doi.org/10.1111/j.1469-7610.2009.02089.x.
Bartko, J. J. (1966). The intraclass correlation coefficient as a measure of reliability. Psychological Reports, 19(1), 3–11. https://doi.org/10.2466/pr0.1966.19.1.3.
Bellani, M., Negri, G. A. L., & Brambilla, P. (2012). The dysregulation profile in children and adolescents: A potential index for major psychopathology? Epidemiology and Psychiatric Sciences, 21(2), 155–159. https://doi.org/10.1017/S2045796011000849.
Biederman, J., Wozniak, J., Kiely, K., Ablon, S., Faraone, S., Mick, E., & Kraus, I. (1995). CBCL clinical scales discriminate prepubertal children with structured interview-derived diagnosis of mania from those with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 34(4), 464–471. https://doi.org/10.1097/00004583-199504000-00013.
Boylan, K., Vaillancourt, T., Boyle, M., & Szatmari, P. (2007). Comorbidity of internalizing disorders in children with oppositional defiant disorder. European Child & Adolescent Psychiatry, 16(8), 484–494. https://doi.org/10.1007/s00787-007-0624-1.
Brotman, M. A., Kircanski, K., & Leibenluft, E. (2017). Irritability in children and adolescents. Annual Review of Clinical Psychology, 13, 317–341. https://doi.org/10.1146/annurev-clinpsy-032816-044941.
Burke, J., & Loeber, R. (2010). Oppositional defiant disorder and the explanation of the comorbidity between behavioral disorders and depression. Clinical Psychology Science and Practice, 17(4), 319–326. https://doi.org/10.1111/j.1468-2850.2010.01223.x.
Burke, J. D. (2012). An affective dimension within oppositional defiant disorder symptoms among boys: Personality and psychopathology outcomes into early adulthood. Journal of Child Psychology and Psychiatry, 53(11), 1176–1183. https://doi.org/10.1111/j.1469-7610.2012.02598.x.
Burke, J. D., Boylan, K., Rowe, R., Duku, E., Stepp, S. D., Hipwell, A. E., & Waldman, I. D. (2014). Identifying the irritability dimension of ODD: application of a modified bifactor model across five large community samples of children. Journal of Abnormal Psychology, 123(4), 841–851. https://doi.org/10.1037/a0037898.
Burke, J. D., Hipwell, A. E., & Loeber, R. (2010). Dimensions of oppositional defiant disorder as predictors of depression and conduct disorder in preadolescent girls. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 484–492. https://doi.org/10.1097/00004583-201005000-00009.
Burke, J. D., Loeber, R., Lahey, B. B., & Rathouz, P. J. (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46(11), 1200–1210. https://doi.org/10.1111/j.1469-7610.2005.00422.x.
Buss, A. H., Durkee, A., & Baer, M. B. (1956). The measurement of hostility in clinical situations. The Journal of Abnormal and Social Psychology, 52(1), 84–86. https://doi.org/10.1037/h0048398.
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46. https://doi.org/10.1177/001316446002000104.
Copeland, W. E., Shanahan, L., Costello, J., & Angold, A. (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry, 66(7), 764–772. https://doi.org/10.1001/archgenpsychiatry.2009.85.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60(8), 837–844. https://doi.org/10.1001/archpsyc.60.8.837.
Dodge, K. A., Lochman, J. E., Harnish, J. D., Bates, J. E., & Pettit, G. S. (1997). Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth. Journal of Abnormal Psychology, 106(1), 37–51. https://doi.org/10.1037/0021-843X.106.1.37.
Doerfler, L. A., Connor, D. F., & Toscano, Jr, P. F. (2011a). Aggression, ADHD symptoms, and dysphoria in children and adolescents diagnosed with bipolar disorder and ADHD. Journal of Affective Disorders, 131(1-3), 312–319. https://doi.org/10.1016/j.jad.2010.11.029.
Doerfler, L. A., Connor, D. F., & Toscano, Jr, P. F. (2011b). The CBCL bipolar profile and attention, mood, and behavior dysregulation. Journal of Child and Family Studies, 20(5), 545–553. https://doi.org/10.1007/s10826-010-9426-z.
Drabick, D. A. G., & Gadow, K. D. (2012). Deconstructing oppositional defiant disorder: Clinic-based evidence for an anger/irritability phenotype. Journal of the American Academy of Child & Adolescent Psychiatry, 51(4), 384–393. https://doi.org/10.1016/j.jaac.2012.01.010.
Edelbrock, C. S., Costello, A. J., Dulcan, M. K., Conover, N. C., & Kala, R. (1986). Parent–child agreement on child psychiatric symptoms assessed via structured interview. Child Psychology & Psychiatry & Allied Disciplines, 27(2), 181–190. https://doi.org/10.1111/j.1469-7610.1986.tb02282.x.
Evans, S. C., Pederson, C. A., Fite, P. J., Blossom, J. B., & Cooley, J. L. (2016a). Teacher-reported irritable and defiant dimensions of oppositional defiant disorder: social, behavioral, and academic correlates. School Mental Health, 8(2), 292–304. https://doi.org/10.1007/s12310-015-9163-y.
Evans, S. C., Pederson, C. A., Fite, P. J., Blossom, J. B., & Cooley, J. L. (2016b). Teacher-reported irritable and defiant dimensions of oppositional defiant disorder: social, behavioral, and academic correlates. School Mental Health, 8(2), 292–304. https://doi.org/10.1007/s12310-015-9163-y.
Green, B., Shirk, S., Hanze, D., & Wanstrath, J. (1994). The children’s global assessment scale in clinical practice: an empirical evaluation. Journal of the American Academy of Child & Adolescent Psychiatry, 33(8), 1158–1164. https://doi.org/10.1097/00004583-199410000-00011.
Grills, A. E., & Ollendick, T. H. (2002). Issues in parent-child agreement: the case of structured diagnostic interviews. Clinical Child and Family Psychology Review, 5(1), 57–83. https://doi.org/10.1023/A:1014573708569.
Guy, W. (1976). Assessment manual for psychopharmacology. Washington, DC: U S Department of Health, Education, and Welfare.
Hammen, C. L., Rudolph, K. D., & Abaied, J. L. (2014). Child and adolescent depression. In E.J. Mash & R.A. Barkley (Eds.), Child psychopathology., 3rd ed. (pp. 225-263). New York, NY: Guilford Press.
Hipwell, A. E., Stepp, S., Feng, X., Burke, J., Battista, D. R., Loeber, R., & Keenan, K. (2011). Impact of oppositional defiant disorder dimensions on the temporal ordering of conduct problems and depression across childhood and adolescence in girls. Journal of Child Psychology and Psychiatry, 52(10), 1099–1108. https://doi.org/10.1111/j.1469-7610.2011.02448.x.
Holtmann, M., Buchmann, A. F., Esser, G., Schmidt, M. H., Banaschewski, T., & Laucht, M. (2011). The child behavior checklist‐dysregulation profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis. Journal of Child Psychology and Psychiatry, 52(2), 139–147. https://doi.org/10.1111/j.1469-7610.2010.02309.x.
Kovacs, M. (1992). Children’s depression inventory. North Tonawanda, NY: Western Psychological Services.
Leibenluft, E., & Stoddard, J. (2013). The developmental psychopathology of irritability. Development and Psychopathology, 25(4, Pt 2), 1473–1487. https://doi.org/10.1017/S0954579413000722.
Mattison, R. E., Bagnato, S. J., Mayes, S. D., & Felix, B. C. (1990). Reliability and validity of teacher diagnostic ratings for children with behavioral and emotional disorders. Journal of Psychoeducational Assessment, 8(4), 509–517. https://doi.org/10.1177/073428299000800406.
Maughan, B., Rowe, R., Messer, J., Goodman, R., & Meltzer, H. (2004). Conduct Disorder and Oppositional Defiant Disorder in a national sample: developmental epidemiology. Journal of Child Psychology and Psychiatry, 45(3), 609–621. https://doi.org/10.1111/j.1469-7610.2004.00250.x.
Merikangas, K. R., He, J.-p, Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the national comorbidity survey replication-adolescent supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017.
Nock, M. K., Kazdin, A. E., Hiripi, E., & Kessler, R. C. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the national comorbidity survey replication. Journal of Child Psychology and Psychiatry, 48(7), 703–713. https://doi.org/10.1111/j.1469-7610.2007.01733.x.
Ollendick, T. H., Booker, J. A., Ryan, S., & Greene, R. W. (2018). Testing multiple conceptualizations of oppositional defiant disorder in youth. Journal of Clinical Child and Adolescent Psychology, 47(4), 620–633. https://doi.org/10.1080/15374416.2017.1286594.
Orvaschel, H. (1995). Schedule for affective disorders and schizophrenia for school-aged children. Epidemiologic version - 5. Studies, Nova Southeastern University. Fort Lauderdale, FL: Center for Psychological.
Safer, D. J. (2009). Irritable mood and the diagnostic and statistical manual of mental disorders. Child and Adolescent Psychiatry and Mental Health, 3. https://doi.org/10.1186/1753-2000-3-35.
Schniering, C. A., Hudson, J. L., & Rapee, R. M. (2000). Issues in the diagnosis and assessment of anxiety disorders in children and adolescents. Clinical Psychology Review, 20(4), 453–478. https://doi.org/10.1016/S0272-7358(99)00037-9.
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231. https://doi.org/10.1001/archpsyc.1983.01790100074010.
Sorgi, P., Ratey, J. J., Knoedler, D. W., Markert, R. J., & Reichman, M. (1991). Rating aggression in the clinical setting: a retrospective adaptation of the overt aggression scale: preliminary results. The Journal of Neuropsychiatry and Clinical Neurosciences, 3(2), S52–S56.
Stringaris, A., & Goodman, R. (2009a). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child & Adolescent Psychiatry, 48(4), 404–412. https://doi.org/10.1097/CHI.0b013e3181984f30.
Stringaris, A., & Goodman, R. (2009b). Mood lability and psychopathology in youth. Psychological Medicine, 39(8), 1237–1245. https://doi.org/10.1017/S0033291708004662.
Stringaris, A., & Goodman, R. (2009c). Three dimensions of oppositionality in youth. Journal of Child Psychology and Psychiatry, 50(3), 216–223. https://doi.org/10.1111/j.1469-7610.2008.01989.x.
Stringaris, A., Maughan, B., & Goodman, R. (2010). What is a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: findings from the avon longitudinal study. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 474–483. https://doi.org/10.1097/00004583-201005000-00008.
Stringaris, A., Vidal‐Ribas, P., Brotman, M. A., & Leibenluft, E. (2018). Practitioner review: definition, recognition, and treatment challenges of irritability in young people. Journal of Child Psychology and Psychiatry, 59(7), 721–739. https://doi.org/10.1111/jcpp.12823.
Toohey, M. J., & DiGiuseppe, R. (2017). Defining and measuring irritability: construct clarification and differentiation. Clinical Psychology Review, 53, 93–108. https://doi.org/10.1016/j.cpr.2017.01.009.
Treiber, F. A., Musante, L., Riley, W. T., Mabe, P. A., Carr, T., Levy, M., & Strong, W. B. (1989). The relationship between hostility and blood pressure in children. Behavioral Medicine, 15(4), 173–178. https://doi.org/10.1080/08964289.1989.9934581.
Volk, H. E., & Todd, R. D. (2007). Does the child behavior checklist juvenile bipolar disorder phenotype identify bipolar disorder? Biological Psychiatry, 62(2), 115–120. https://doi.org/10.1016/j.biopsych.2006.05.036.
Wolff, J. C., & Ollendick, T. H. (2006). The comorbidity of conduct problems and depression in childhood and adolescence. Clinical Child and Family Psychology Review, 9(3-4), 201–220. https://doi.org/10.1007/s10567-006-0011-3.
Yudofsky, S. C., Silver, J. M., Jackson, W., Endicott, J., & Williams, D. (1986). The overt aggression scale for the objective rating of verbal and physical aggression. The American Journal of Psychiatry, 143(1), 35–39. https://doi.org/10.1176/ajp.143.1.35.
Author Contributions
L.A.D. designed the study, conducted the data analyses, and wrote the first draft of the paper. A.M.V. and D.F. C. collaborated with the design and writing of the paper, and D.F.C. conducted the clinical evaluations of the youth who participated in this study.
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The first author received support from the Assumption College Faculty Grant Program to write this research report.
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Doerfler, L.A., Volungis, A.M. & Connor, D.F. Co-occurence and Differentiation of Oppositional Defiant and Mood Disorders among Children and Adolescents. J Child Fam Stud 29, 2568–2579 (2020). https://doi.org/10.1007/s10826-020-01756-8
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DOI: https://doi.org/10.1007/s10826-020-01756-8