对立违抗性障碍

本对对立违抗性障碍的流行病学、病因学、临床表现、诊断、鉴别诊断、治疗及其预后进行综述。     

对立违抗性障碍

本文对对立违抗性障碍的流行病学、病因学、临床表现、诊断、鉴别诊断、治疗及其预后进行了综述。     

对立违抗性障碍的研究现状

对立违抗性障碍是儿童常见的一种心理障碍。童年早期出现,青春期达到高峰。以不服 从、对抗、消极抵抗、易激惹或挑衅等行为特征为主要的临床表现。虽然对立违抗性障碍没有严重的违 法或冒犯他人的攻击行为,然而对于患儿的家庭、学校,以及社会生活仍会带来较大的麻烦。家长和学 校往往对于对立违抗性障碍缺乏认识,因而导致就诊率低,缺乏早期有效的干预。现就对立违抗性障 碍的发病机制、临床特征、诊断及治疗方面做全面综述。     

长沙市中小学生对立违抗性障碍的现况及对照研究

目的 了解长沙市中小学生中罹患对立违抗性障碍（ODD）的现况及临床特征。方法 应用自制儿童行为学习调查表、Conners父母问卷（PSQ）、教师问卷（TRS）及Pieers-Harris儿童自我意识量表（CSCS）,于2000年6－7月对长沙市某中学及某小学（ 其中有效人数为589人）的47例ODD儿童（研究组）和47名非0DD儿童（对照组）进行评定和病例－对照分析。结果 （1）ODD发生率：在589人中符合ODD者为47例（8．0％）,其中男性为11％（31例）,女性为5％（16例）;发生率超过50％的症状中：经常发脾气（92％）,常与大人争吵（81％）,常拒绝服从大人的要求或违反规则（68％）,常因自己的错误或所做的坏事责备旁人（68％）,常发怒或怨恨他人（62％）。（2）ODD合并其他疾病的发生率：合并注意缺陷多动障碍为51％（24例）,合并学习障碍为38％（18例）,与对照组[分别为17％（8例）和15％（15例）]比较差异有非常显著性（均P＜0．01）。（3）各量表评分：经t检验,PSQ中品行问题、学习问题、冲动－多动、焦虑及多动指数,以及CSCS中的行为、焦虑及总分两组比较,差异有非常显著性或显著性（P＜0．01或P＜0．05）。结论 在长沙市某中学及某小学的学生中存在ODD,这些患儿的自我评价低,存在更多的行为、情绪问题和学习障碍。     

对立违抗性障碍儿童的临床特征及血清单胺类神经递质水平的研究

目的探讨对立违抗性障碍（ODD）患儿的临床特征及血清单胺类神经递质水平的变化。方法对31例ODD儿童（研究组）和36名正常儿童（对照组）测评Piers—Harris儿童自我意识量表（PHCSS）、儿童焦虑性情绪障碍筛查表（SCRED）、儿童抑郁障碍自评量表（DSRSC）及儿童冲动量表（BIS），测量其血清5-羟色胺（5-HT）、多巴胺（DA）等生物胺神经递质的含量。结果（1）研究组PHCSS中的合群性分[（7．36±1．81）分]、幸福与满足感分[（5．45±1．69）分]低于对照组[（8．56±2．50）分和（6．31±1．72）分；P=0．030，P=0．045]。（2）两组SCRED和DSRSC评分的差异无统计学意义（P〉0．05）。研究组BIS的冲动总分[（51．81±9．97）分]、运动分[（8．77±4．11）分]高于对照组[（48．30±11．57）分和（5．19±2．46）分；P=0．020，P：0．000]。（3）研究组血清高香草酸水平[中位数（M）=59nmol／L]、5-HT水平（M=20nmoI／L）低于对照组（M：130nmol／L和168nmoI／L；P=0．024，P=0．033）。（4）血清5-HT水平与冲动总分（r=-0．650）、注意凶子分呈负相关（r=-0．688）；血清DA水平与广泛焦虑冈子呈正相关（r=0．591）；血清5-羟吲哚乙酸水平与分离焦虑因子、社交恐怖因子均呈负相关（r=-0．593，r=-0．535）；血清高香草酸水平与抑郁（r=-0．694）、冲动吲子呈负相关（r=-0．608），均P〈0、05和P〈0．01。结论ODD儿童不合群，缺乏愉快感，冲动性高；其血清5-HT水平降低，而血清儿茶酚歧水平变化不明显。     

对立违抗性障碍的病因学研究进展

对立违杭性障碍(oppositional defiant disorder,ODD)是学龄期儿童极为常见的行为障碍,本文就ODD的可能发病因素进行综述,旨在为该障碍的治疗和预防提供依据.     

农村特殊家庭留守儿童自我意识及家庭环境状况

目的 了解农村特殊家庭留守儿童自我意识和家庭环境状况及其关系.方法 采用Piers-Harris儿童自我意识量表(CSCS)、家庭环境量表(FES-CV)对用分层随机抽样方法抽取的南充市阆中金城中心小学校四到六年级的203名在校学生的自我意识水平和家庭环境状况进行调查.结果 ①特殊家庭留守儿童(A组)49人,一般家庭留守儿童(B组)79人,非留守儿童(C组)75人;②A组儿童的行为、合群、幸福满足感因子得分均低于非留守儿童(P＜0.05);③方差分析显示,除焦虑因子分外,六年级特殊家庭留守儿童自我意识总分、身体、幸福因子分均高于四、五年级(P＜0.05);A组儿童的亲密度、情感表达、独立性、娱乐性、文化性、道德宗教因子分均低于C组,而矛盾因子分高于B、C两组(P＜0.01);④相关分析显示,家庭环境亲密度、情感表达、文化性、娱乐性、道德宗教和组织性6个因子分与CSCS总分、行为、智力、躯体、焦虑、合群和幸福因子分呈正相关(r=0.11～0.40,P＜0.05),矛盾性因子分与CSCS所有因子得分呈负相关(r=-0.31～-0.18,P＜0.05),家庭环境独立性和控制性因子分与CSCS中的智力因子分呈正相关(r=0.09～0.11,P＜0.05).结论 特殊家庭留守儿童的心理健康状况及家庭环境状况均较差,家庭环境状况可能是其心理健康水平的重要影响因素之一.     

注意缺陷多动障碍合并对立违抗性障碍患儿血清5-羟色胺的对照研究

为探讨注意缺陷多动障碍 (ａｔｔｅｎｔｉｏｎｄｅｆｉｃｉｔｈｙｐｅｒａｃｔｉｖｉｔｙｄｉｓｏｒｄｅｒ,ＡＤＨＤ)合并对立违抗性障碍 (ｏｐｐｏｓｉｔｉｏｎａｌｄｅｆｉａｎｔｄｉｓｏｒｄｅｒ,ＯＤＤ)的临床特征及与 5 羟色胺 ( 5 ＨＴ)的关系 ,我们检测了一组ＡＤＨＤ患儿的血清 5 ＨＴ水平。对象　为 1 998年 1月至 2 0 0 0年 6月在本所儿童心理卫生门诊就诊儿童 ,均符合美国精神障碍诊断与统计手册第 4版 (ＤＳＭ Ⅳ )中ＡＤＨＤ诊断标准。排除最近 2周服用过精神活性物质、患有严重躯体和内分泌系统疾病、神经系统疾病、孤独症、…     

注意缺陷多动障碍自我意识和家庭环境情况的初步研究

目的评定注意缺陷多动障碍（ＡＤＨＤ）儿童的自我意识和家庭环境，并探讨二者与ＡＤＨＤ儿童的关系。方法应用Ｐｉｅｒｓ－Ｈａｒｒｉｓ儿童自我意识量表和家庭环境量表对７７例ＡＤＨＤ儿童进行评定。结果ＡＤＨＤ儿童自我意识低者占５３％，在行为、智力和学校、合群等方面低于正常儿童，家庭环境在亲密度、文化性等方面低于正常儿童家庭，而矛盾性高于正常家庭（Ｐ＜００１～００５）。结论ＡＤＨＤ儿童自我意识水平偏低，家庭环境较差。因此，对ＡＤＨＤ儿童药物治疗的同时，不可忽视心理治疗     

未经药物治疗的对立违抗障碍患儿的执行功能特征

背景:对立违抗障碍(ODD)以显著的对立、违抗和破坏性行为为主要特征,和品行障碍(CD)一样,被认为是破坏性行为障碍(DBD)的一种.然而,相比较与CD,ODD并不包括严重的攻击或者反社会行为.目的:本研究旨在探索ODD患儿的执行功能(EF)特征.方法:采用病例对照的研究设计.入组研究的ODD组有43例(pure ODD患儿14例和ODD/ADHD患儿29例),和pure ADHD患儿39例.健康对照组参与研究的有52例.采用Stroop色词测试,韦克斯勒智力量表儿童版(第四版,WISC-Ⅳ),威斯康辛卡片分类测试(WCST),和剑桥成套神经心理测试(CANTAB)对ODD和单纯注意缺陷多动障碍(ADHD)儿童进行执行功能测试,并且在控制了年龄以后,与健康发育儿童作比较.采用Logistic回归分析,探索执行功能缺陷在ODD(包括单纯ODD和ODD/ADHD)和单纯ADHD发生中的风险.结果:控制年龄因素后,ANCOVA方差分析结果显示相比较于对照组,ODD组在Stroop色-词测试,WISC-Ⅳ的倒背数字广度、WCST的持续反应数和概念化水平的得分更低,而在CANTAB任务视觉空间记忆(SWM)的错误数和策略分的得分更高.Logistic回归分析发现Stroop色词测试乙表读数进入ODD的回归方程.总结:ODD的患儿在执行功能任务时表现得更差.反应抑制缺陷是ODD的风险因素,而反应抑制和工作记忆缺陷是ADHD的风险因素.     

The latent structure of oppositional defiant disorder in children and adults

An understanding of the latent structure of oppositional defiant disorder (ODD) is essential for better developing causal models, improving diagnostic and assessment procedures, and enhancing treatments for the disorder. Although much research has focused on ODD—including recent studies informing the diagnostic criteria for DSM-5—research examining the latent structure of ODD is sparse, and no known study has specifically undertaken a taxometric analysis to address the issue of whether ODD is a categorical or dimensional construct. To address this gap, the authors conducted two separate studies using a set of taxometric analyses with data from the NICHD Study of Early Child Care and Youth Development (child study; n = 969) and with data from a large mixed sample of adults, which included participants reporting psychiatric difficulties as well as healthy controls (adult study; n = 600). The results of a variety of non-redundant analyses across both studies revealed a dimensional latent structure for ODD symptoms among both children and adults. These findings are consistent with previous studies that have examined latent structure of related constructs (e.g., aggression, antisocial behavior) as well as studies that have examined the dimensional versus categorical structure of ODD using methods other than taxometric analysis.     

Parsing the familiality of oppositional defiant disorder from that of conduct disorder: a familial risk analysis

Background

Family risk analysis can provide an improved understanding of the association between attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), attending to the comorbidity with conduct disorder (CD).

Methods

We compared rates of psychiatric disorders in relatives of 78 control probands without ODD and CD (Control, N = 265), relatives of 10 control probands with ODD and without CD (ODD, N = 37), relatives of 19 ADHD probands without ODD and CD (ADHD, N = 71), relatives of 38 ADHD probands with ODD and without CD (ADHD + ODD, N = 130), and relatives of 50 ADHD probands with ODD and CD (ADHD + ODD + CD, N = 170).

Results

Rates of ADHD were significantly higher in all three ADHD groups compared to the Control group, while rates of ODD were significantly higher in all three ODD groups compared to the Control group. Evidence for co-segregation was found in the ADHD + ODD group. Rates of mood disorders, anxiety disorders, and addictions in the relatives were significantly elevated only in the ADHD + ODD + CD group.

Conclusions

ADHD and ODD are familial disorders, and ADHD plus ODD outside the context of CD may mark a familial subtype of ADHD. ODD and CD confer different familial risks, providing further support for the hypothesis that ODD and CD are separate disorders.     

Comorbidity of internalizing disorders in children with oppositional defiant disorder

Oppositional defiant disorder (ODD) is often comorbid with other psychiatric disorders in childhood. Its association with attention deficit hyperactivity disorder and conduct disorder has been well studied. Recent studies suggest that children with ODD have substantial comorbidity with anxiety and depressive (internalizing) disorders, as well. Identifying the pattern of internalizing comorbidity with ODD in childhood and adolescence and how this varies across age and gender may help to identify mechanisms of such comorbidity. This systematic review presents evidence on the association of internalizing disorders with ODD across childhood and adolescence. Data from cross-sectional and longitudinal studies in clinic, community and epidemiologic samples are considered separately. Findings suggest that while internalizing comorbidity with ODD is present at all ages, the degree of comorbidity may vary over time in particular groups of children. Girls and boys appear to have different patterns of ODD comorbidity with either anxiety or depression, as well as ages of onset of ODD, however more large studies are required. Children with ODD in early life require further study as they may be a subgroup at increased risk for anxiety and affective disorders. This could have important implications for the treatment of these ODD children and the prevention of sequential comorbidity.     

The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey

Abstract Objective The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in school age children in Sivas province centre and to examine the distribution of symptoms according to subtypes. Method The study population was made up of 1425 children between the ages of 6 and 15 from eight primary schools selected by random sampling method in Sivas province centre. All students were given a questionnaire prepared according to DSMIV criteria that was completed by their parents or teachers. This form includes 18 symptoms of ADHD and eight symptoms of ODD. Students t-test and variance analysis were used for statistical evaluation. Results A prevalence of 8.1% was found for ADHD in our study. According to subtypes, 32.2% of these were inattentive, 40% were hyperactive and 27.8% were combined type. A prevalence of 11.5% was found for ODD. The boy/girl ratio was > 1 for both ADHD and ODD, and 52.2% of those with ADHD were established as having ODD at the same time. Conclusions The prevalence of ADHD and ODD in primary school children was not considered to be small. Studies concerning the distribution of symptoms in different societies, cultures, and viewpoints and identification of children with this type of problem are beneficial for early diagnosis and prophylactic treatment.     

Response perseveration and sensitivity to reward and punishment in boys with oppositional defiant disorder

Abstract Response perseveration is the tendency to continue a response set for reward despite punishment. In the present study, response perseveration and sensitivity to reward and punishment were assessed in boys with oppositional defiant disorder (ODD). The study also examined the relation between punishment sensitivity and autonomic arousal. Nineteen ODD boys (mean age 9.8 years) and 20 normal control boys (NC) (mean age 9.7 years) were administered the door-opening task. In this task, the subject chooses either to open the next door or to stop playing; the opening of doors is initially rewarded and then increasingly punished. ODD boys opened more doors than NC boys. Following punishment, ODD boys took less time than NC boys before opening the next door, but did not differ from NC boys in time after reward. Mean skin conductance level was lower in ODD boys than in NC boys. The correlation coefficient between time after punishment and skin conductance level was moderately positive in the total sample. These results suggest that response perseveration in ODD boys is related to low punishment sensitivity and that skin conductance level is a marker of punishment sensitivity.     

Executive functioning and emotion recognition in youth with oppositional defiant disorder and/or conduct disorder

Abstract

Objectives: Executive functioning and emotion recognition may be impaired in disruptive youth, yet findings in oppositional defiant disorder (ODD) and conduct disorder (CD) are inconsistent. We examined these functions related to ODD and CD, accounting for comorbid attention-deficit/hyperactivity disorder (ADHD) and internalising symptoms.

Methods: We compared executive functioning (visual working memory, visual attention, inhibitory control) and emotion recognition between youth (8–18?years old, 123 boys, 55 girls) with ODD (n?=?44) or CD (with/without ODD, n?=?48), and healthy controls (n?=?86). We also related ODD, CD, and ADHD symptom counts and internalising symptomatology to all outcome measures, as well as executive functioning to emotion recognition.

Results: Visual working memory and inhibitory control were impaired in the ODD and CD groups versus healthy controls. Anger, disgust, fear, happiness, and sadness recognition were impaired in the CD group; only anger recognition was impaired in the ODD group. Deficits were not explained by comorbid ADHD or internalising symptoms. Visual working memory was associated with recognition of all basic emotions.

Conclusions: Our findings challenge the view that neuropsychological impairments in youth with ODD/CD are driven by comorbid ADHD and suggest possible distinct neurocognitive mechanisms in CD versus ODD.     

What single reports from children and parents aggregate to attention deficit-hyperactivity disorder and oppositional defiant disorder diagnoses in epidemiological studies

Objective  To analyze information on attention deficit-hyperactivity disorder (ADHD)–oppositional defiant disorder (ODD) and its consequences, provided separately or in combination by children and their parents in a longitudinal prospective study of 9–15 year-old children from the general population. Method  Cross-sectional and longitudinal epidemiological indexes were compared for single and multiple reports. We evaluated which informant is required for the identification of each DSM-IV criterion. Logistic regressions determined which features were related with the reporting of the “absence” of symptoms. Results  Both informants were required in order to obtain complete psychopathological profiles. Single reports provide infra-estimated prevalences (between 8.8 and 22.9% of ADHD and between 1.7 and 7.6% of ODD), risks (around 3% for ADHD and 2% for ODD) and comorbidities. Psychological and functional measures analyzed in the study were relatively similar for cases presenting ADHD/ODD diagnosis, regardless of the diagnostic algorithm (based on single or combined reports); however, these clinical profiles were different to those obtained for non-diagnosed children. The main predictors of not reporting the presence of psychopathology were: large families (OR between 2 and 2.5), children that are conflictive at school (OR ranging between 1.3 and 4.3) or those with poor mental health (OR between 1.1 and 1.6). Conclusions  These results may provide guidance for obtaining accurate diagnostic information, properly identifying children with mental health needs and planning the required preventive and corrective measures. This work was supported by grants BS02002-3850 and SEJ2005-01786 of the Ministry of Science and Technology, Spain.     

Altered brain morphology in boys with attention deficit hyperactivity disorder with and without comorbid conduct disorder/oppositional defiant disorder

About 50% of attention deficit hyperactivity disorder (ADHD) patients suffer from comorbidity with oppositional defiant disorder/conduct disorder (ODD/CD). Most previous studies on structural morphology did not differentiate between pure (ADHD‐only) and comorbid ADHD (ADHD+ODD/CD). Therefore, we aimed to investigate the structural profile of ADHD‐only versus ADHD+ODD/CD spanning the indices subcortical and cortical volume, cortical thickness, and surface area. We predicted a reduced total gray matter, striatal, and cerebellar volume in both patient groups and a reduced amygdalar and hippocampal volume for ADHD+ODD/CD. We also explored alterations in prefrontal volume, thickness, and surface area. We acquired structural images from an adolescent sample ranging from 11 to 17 years, matched with regard to age, pubertal status, and IQ—including 36 boys with ADHD‐only, 26 boys with ADHD+ODD/CD, and 30 typically developing (TD) boys. We analyzed structural data with FreeSurfer. We found reductions in total gray matter and total surface area for both patient groups. Boys with ADHD+ODD/CD had a thicker cortex than the other groups in a right rostral middle frontal cluster, which was related to stronger ODD/CD symptoms, even when controlling for ADHD symptoms. No group differences in local cortical volume or surface area emerged. We demonstrate the necessity to carefully differentiate between ADHD and ADHD+ODD/CD. The increased rostral middle frontal thickness might hint at a delayed adolescent cortical thinning in ADHD+ODD/CD. Patients with the double burden ADHD and ODD or CD seem to be even more affected than patients with pure ADHD.     

社交焦虑障碍患者家庭环境的分析

目的分析社交焦虑障碍(SAD)与患者家庭环境的关系。方法采用自编社会人口学资料表及家庭环境量表中文版(FES-CV)对42例社交焦虑障碍患者和30例正常对照者进行评估。结果社交焦虑障碍组的亲密度、情感表达、知识性、娱乐性因子分低于正常对照组(P<0.01);矛盾性因子分高于正常对照组(P<0.01)。结论社交焦虑障碍的发生与家庭环境因素有关,不良的家庭环境可能是社交焦虑障碍的发病原因之一。