Mary Anne G. Christ

Oppositional defiant disorder and conduct disorder: A meta-analytic review of factor analyses and cross-validation in a clinic sample

Abstract This study is a meta-analytic summary of 60 factor analyses from 44 published studies of 28,401 children and adolescents. The results suggested that, strictly in terms of behavioral covariation, conduct problems in children may best be conceptualized in terms of two orthogonal dimensions of behavior: (1) an overt/covert dimension and (2) a destructive/nondestructive dimension. The four quadrants created by the intersection of these two bipolar dimensions corresponded well to distinctions among norm-violating behaviors made by legal systems and previous diagnostic conceptualizations: oppositional, aggressive, property violations, and status offenses. The results of this meta-analysis were cross-validated in a clinic sample of 177 boys age 7–12. One major finding from the validation sample was a strong correspondence between empirically derived syndromes based on the meta-analysis and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev., American Psychiatric Association, 1987) (DSM-III-R) definitions of conduct disorder and oppositional defiant disorder. A second major finding from the validation study was that age of onset may be a critical variable in explaining the results of the meta-analysis.

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

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.

Anxiety, Inhibition, and Conduct Disorder in Children: I. Relations to Social Impairment

Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Grays model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.

Anxiety, Inhibition, and Conduct Disorder in Children: II. Relation to Salivary Cortisol

The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Grays biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.

A sensation seeking scale for children: Further refinement and psychometric development

A revision of the Sensation Seeking Scale for Children (SSSC) was standardized and validated on a community sample of 660 elementary- and middle-school children and 168 clinic-referred male children. Factor analysis of the combined samples yielded three unique factors, entitled Thrill and Adventure Seeking, Drug and Alcohol Attitudes, and Social Disinhibition. Psychometric indices of reliability and validity were acceptable, but test-retest reliability was only moderate. Differences in SSSC scores according to sex, ethnic group, age, and intellectual status were similar to those found previously with the adult Sensation Seeking Scales. Consistent with documented relations between adult antisocial personality and sensation seeking, the SSSC distinguished boys with conduct disorder (CD) from clinic controls, but the SSSC scores of boys with CD did not differ from those of the community sample boys. Discussion includes suggestions as to the continued study of the assessment of sensation seeking in children.

Somatic complaints in anxious children

Although stomachaches and headaches are considered characteristic of children with anxiety disorders, there is converging evidence that a broader range of somatic symptoms may be associated with childrens expressions of anxiety. The purpose of this study was to determine the prevalence of somatic complaints in anxious children. The results indicated that children with anxiety disorders endorsed the presence of many different somatic complaints, and that contrary to clinical intuition, stomaches and headaches were not among the most commonly reponed symptoms. In addition, the anxious children endorsed significantly more somatic complaints when compared to normal controls. Furthermore, the symptom pattern reported by anxious children indicated the presence of both the somatic and cognitive components usually associated with panic attacks, although none of the children met diagnostic criteria for panic disorder. The results are discussed in terms of the contribution of somatic symptoms to the understanding of anxiety disorders in children.

Comparison of DSM-III and DSM-III-R diagnoses for prepubertal children: changes in prevalence and validity.

A structured and reliable diagnostic procedure based on a revised version of the Diagnostic Interview Schedule for Children for children, parents, and teachers was used to assign both DSM-III and DSM-III-R diagnoses to 177 outpatient boys aged 7 to 12 years. Compared to their DSM-III counterparts, DSM-III-R oppositional defiant disorder was 25.5% less prevalent, DSM-III-R dysthymia was 37.8% less prevalent, and DSM-III-R conduct disorder (CD) was 44.3% less prevalent. However, DSM-III-R attention deficit hyperactivity disorder was 14.4% more prevalent than DSM-III attention deficit disorder with hyperactivity. The two definitions of CD were compared to exemplify an empirical approach to diagnostic validation. The DSM-III-R diagnosis of CD appears to be more valid as it is more strongly associated with police contacts, school suspensions, and history of antisocial personality disorder in the biological father, but both CD diagnoses are associated with family histories of criminal convictions.

Preliminary development of a sensation seeking scale for children

Abstract A sensation seeking scale designed for use with school-aged children (SSSC) was standardized on an elementary school population. Test-retest reliability was adequate and gender differences were comparable to the adult sensation seeking scale. The SSSC was administered to 176 clinic-referred boys aged 7–12 years. Factor analysis of the scores of the combined school and clinic samples yielded two factors which corresponded to the Boredom Susceptibility (BS) and Thrill and Adventure Seeking (TAS) factors of the adult Sensation Seeking Scales. Boys with diagnoses of conduct disorder (CD), childhood anxiety disorders (ANX), and attention deficit-hyperactivity disorder (ADHD) were compared to a clinic control group in a 2 × 2 × 2 factorial design. Main effects for ADHD and CD were significant for the BS subscale, reflecting higher scores in children with CD and lower scores in children with ADHD. A marginally significant CD × ANX interaction for total SSSC score may indicate a moderating effect of anxiety on sensation seeking in children with CD. These results tentatively suggest that sensation seeking can be validly measured in prepubertal children, but argue for further refinements in the SSSC.

Behavior Disorders of Children

Behavior disorders can occur at any age among adults and children alike. Prevalence estimates in children have varied widely depending on the age group studied, types of behavior problems identified, method of assessment, and classification system used. Moderate to severe preschool behavior problems are reported in 7% to 11% of this age group, whereas 15% to 24% have mild behavior problems (Earls, 1980; Richman, Stevenson, & Graham, 1975). Community-based samples of school-aged children in the United States (Costello et al., 1988), New Zealand (Anderson, Williams, McGee, & Silva, 1987), New Zealand (Anderson, Williams, McGee, & Silva, 1987), Ontario (Offord etal., 1987), and Puerto Rico (Bird et al., 1988) have estimated the rate of clinically significant psychopathol ogy in this age group as being somewhere between 12% and 22%. Similarly, the estimated rate of disorders found in adolescents has been between 19% and 22% (Offord et al., 1987; Rutter, Graham, Chadwick, & Yule, 1976).