Testing Multiple Conceptualizations of Oppositional Defiant Disorder in Youth

Abstract

Recent theories conceptualize oppositional defiant disorder (ODD) as a two-dimensional construct with angry/irritable (i.e., affective) and argumentative/defiant (i.e., behavioral) components. This view has been supported by studies of nonreferred youth but not yet examined in clinic-referred youth. In a reanalysis of data regarding children who received one of two psychosocial ODD treatments, we examined multiple conceptualizations of ODD, whether children showed improvements across these ODD dimensions, and whether main and joint effects of ODD dimension improvement predicted clinical outcome. One hundred thirty-four clinic-referred youth (ages 7–14 years, 38% female, 84% White) who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD received 1 of 2 psychosocial treatments. At pretreatment, 1-week follow-up, and 6-month follow-up, mothers reported child aggression and conduct problems, clinicians reported global clinical impairment and clinical improvement, and ODD symptom counts were collected from a semistructured diagnostic interview with mothers. Baseline ODD symptom were used to test previously supported multidimensional models. One- and two-factor conceptualizations were supported; however, the two-factor solution was preferred. With this solution, each dimension significantly and similarly improved across treatment conditions. Improvements across affective and behavioral ODD factors also had significant effects on clinician- and mother-reported clinical outcomes. The current findings provide empirical support for the ongoing study of multidimensional ODD conceptualizations in clinic-referred youth.

Funding

This work was supported by the National Institute of Mental Health (NIMH) Grant R01 MH59308 from NIMH and by the Institute for Society, Culture, and Environment at Virginia Tech.

Ethical Approval

All procedures performed in the current study were in accordance with the ethical standards of the Institutional Review Board at the site of study and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For each participating family, consent was obtained from the participating child’s caregiver(s) and assent was obtained from the participating child.

Public Health Significance Statement

The current study provides support for a reconceptualization of ODD as a bidimensional construct, using a clinical sample of youth. Both dimensions of ODD showed improvement following completion of a randomly assigned ODD intervention (PMT, CPS).

Conflict of Interest

Dr. Greene has received royalties from four books and two DVDs related to the Collaborative & Proactive Solutions intervention used in this study.

Notes

¹ Fit indices included measures of absolute fit (χ², weighted root mean square residual [WRMR]), relative fit (Tucker–Lewis index [TLI]), and a non-centrality-based indicator (root mean square error of approximation [RMSEA]). The recommendations of Hu and Bentler (1999; for TLI and RMSEA) and Yu and Muthén (2002; for WRMR) were used to evaluate model indices. Nonsignificant chi-square values, WRMR values of 1.00 or lower, TLI values of .95 or greater, and RMSEA values of .06 or lower support adequate model fit. Ninety-five percent confidence intervals can also be tested for RMSEA values, with smaller intervals supporting confidence in model fit.

Additional information

Funding

This work was supported by the National Institute of Mental Health (NIMH) Grant R01 MH59308 from NIMH and by the Institute for Society, Culture, and Environment at Virginia Tech.