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First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9.

ABSTRACT: OBJECTIVE:To examine the 1-year first incidence and prevalence of oppositional defiant disorder (ODD), the outcomes on psychopathology and functioning by age of onset and the risk factors of onset of ODD from ages 3 to 9 in children from the Spanish general population. DESIGN:Longitudinal with seven follow-ups and double cohort (ODD and non-ODD children). SETTING:General population of preschool and elementary school children in Barcelona (Spain). PARTICIPANTS:On a first phase, the parent-rated Strengths and Difficulties Questionnaire conduct problems scale plus ODD Diagnostic and Statistical Manual of Mental Disorders, fourth version, symptoms were used to screen for behavioural problems. The second phase sample size contained 622 cases at age 3 and, at age 9, 418 remained in the study. RESULTS:The probability of the onset of ODD showed increasing values at ages 4 (R=2.7%) and 5 years (R=4.4%). These values decreased until age 7 (R=1.9%) and increased again until age 9 (R=3.6%). Up to 9 years old, the cumulative risk of new cases of ODD was 21.9%. Early onset was associated with a higher risk of depression comorbidity and later onset with higher functional impairment and symptomatology. Subthreshold ODD, high scores in irritability and headstrong dimensions, attention deficit/hyperactivity disorder and other comorbidity, negative affectivity until age 7, difficulties in inhibit and emotional control, punitive parenting and maternal internalising problems were risk factors of a first episode of ODD during this 7-year period. CONCLUSIONS:The risk of new cases of ODD in the general population at preschool age and during childhood is high. Preschool age is a target period for preventive interventions. Identified risk factors are objectives for targeted and indicated interventions.

SUBMITTER: Ezpeleta L

PROVIDER: S-EPMC6475188 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9.

Ezpeleta Lourdes L Navarro J Blas JB de la Osa Nuria N Penelo Eva E Domènech Josep Maria JM

BMJ open 20190330 3

<h4>Objective</h4>To examine the 1-year first incidence and prevalence of oppositional defiant disorder (ODD), the outcomes on psychopathology and functioning by age of onset and the risk factors of onset of ODD from ages 3 to 9 in children from the Spanish general population.<h4>Design</h4>Longitudinal with seven follow-ups and double cohort (ODD and non-ODD children).<h4>Setting</h4>General population of preschool and elementary school children in Barcelona (Spain).<h4>Participants</h4>On a fi ...[more]

PMID: 30928923

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Project description:BackgroundVagal reactivity to stress in children has been associated with future psychiatric outcomes. However, results have been mixed possibly because these effects are in opposite direction in boys and girls. These sex differences are relevant in the context of development of psychopathology, whereby the rates of psychiatric disorders differ by sex. In this study, we aimed to examine the association between vagal reactivity, assessed as a reduction in respiratory sinus arrhythmia (RSA) in response to a challenge, and the development of future oppositional defiant disorder (ODD) symptoms in boys and girls. In addition, we examine the specific associations with ODD symptom dimensions, named irritability and headstrong. We hypothesized that increased vagal reactivity was associated with increased ODD symptoms in girls and a reduction in ODD symptoms in boys.MethodsParticipants were members of the Wirral Child Health and Development Study, a prospective epidemiological longitudinal study of 1,233 first-time mothers recruited at 20 weeks' gestation. RSA during four nonstressful and one stressful (still-face) procedures was assessed when children were aged 29 weeks in a sample stratified by adversity (n = 270). Maternal reports of ODD symptoms were collected when children were 2.5 years old (n = 253), 3.5 years old (n = 826), and 5 years old (n = 770). Structural equation modeling (SEM) was employed to test our hypotheses.ResultsThere was a significant sex difference in the prediction of ODD symptoms due to the opposite directionality in which increasing vagal reactivity was associated with an increase in ODD symptoms in girls and a reduction of ODD symptoms in boys. This Sex by Vagal reactivity interaction was common for both ODD dimensions, with no sex by dimension-specific associations.ConclusionsPhysiological reactivity to a stressful situation predicts differently ODD symptoms in boys and girls very early in life, with no difference across irritability and headstrong components. Findings are discussed in the context of the several mechanisms involved on the later development of distinct psychiatric disorders in boys and girls.

Project description:In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication, and placebo (Basic therapy) versus parent training, stimulant, and risperidone (Augmented therapy) by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced impairment, and informant discrepancy.Children (6-12 years of age; N = 168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks.Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p = .002, Cohen's d = 0.27) and peer aggression (p = .02, Cohen's d = 0.32) but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at week 9/endpoint (p = .008). Teacher ratings indicated greater reduction in ADHD severity (p = .02, Cohen's d = 0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated as impaired for at least 1 targeted disorder at week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%).Augmented therapy was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context specific, and effect sizes ranged from small to moderate. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/; NCT00796302.

Dataset Information

First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9.

Publications

First incidence, age of onset outcomes and risk factors of onset of DSM-5 oppositional defiant disorder: a cohort study of Spanish children from ages 3 to 9.

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