Sex differences in oppositional defiant disorder

The goal was to analyze the sex differences in symptoms, comorbidity and functional impairment in outpatient children with Oppositional Defiant Disorder (ODD). A sample of 343 children, aged 8 to 17 years and diagnosed with ODD, were assessed with a semi-structured diagnostic interview and dimensional measures of psychopathology and functional impairment. Boys with ODD more frequently displayed the symptoms «deliberately annoys» and «blames others», presented comorbid ADHD, and had greater functional impairment in school and community contexts; girls presented higher comorbidity with internalizing symptomatology (anxiety, depression and somatic complaints). Given that some clinical differences are apparent in ODD between boys and girls, it is necessary to consider the sex of the patient in order to identify and treat this disorder efficiently and effectively in boys and in girlsEl objetivo es analizar las diferencias de sexo en la prevalencia, sintomatología, comorbilidad y deterioro funcional en pacientes externos con Trastorno Negativista Desafiante (TND). Una muestra de 343 niños y adolescentes de entre 8 y 17 años diagnosticados de TND fueron evaluados con una entrevista diagnóstica semiestructurada y otras medidas dimensionales de psicopatología y deterioro funcional. Los niños con TND mostraron con mayor frecuencia los síntomas «molestar deliberadamente» y «acusar a otros», mayor comorbilidad con trastorno por déficit de atención con hiperactividad y mayor deterioro funcional en el colegio y en la comunidad; las niñas presentaron mayor comorbilidad con sintomatología interiorizada (ansiedad, depresión y quejas somáticas). Niños y niñas presentan un cuadro clínico de TND con algunas diferencias. Es necesario adoptar una perspectiva de sexo para identificar y tratar el TND de manera eficaz y eficiente en niños y en niña

Parenting practices as mediating variables between parents' psychopathology and oppositional defiant disorder in preschoolers

Background: Oppositional defiant disorder (ODD) is very frequent in preschoolers. The severity and the long-term negative outcomes make the understanding of this disorder a priority. The goal in this study was to assess the mediating role of parenting practices in the relationship between parents' psychopathology and ODD in preschoolers. Method: A community sample of 622 children was assessed longitudinally at age 3 and age 5. Parents reported on children's psychopathology through a diagnostic interview, and on their own psychological state and parenting style through questionnaires. Results: At ages 3 and 5, corporal punishment mediated the relationships between mothers' anxiety-depression and ODD (in girls), between mothers' aggressive behavior and ODD (in boys), and between parents' rule-breaking and ODD both in boys and girls. For both sexes, there was a direct association between mothers' aggressive behavior score and ODD. The association between fathers' psychopathology and ODD was not mediated by the fathers' parenting practices. Fathers' anxiety-depression and aggressive behavior scores were directly associated with ODD. Conclusions: Parents' psychopathology must be explored and, in families where such psychopathology is a relevant variable, parenting practices must be addressed with a view to the prevention and treatment of children's ODD in the preschool yearsAntecedentes: la frecuencia del trastorno negativista desafiante (TND) y las consecuencias negativas a largo plazo hacen que la comprensión de este trastorno sea una prioridad. El objetivo de este estudio fue evaluar el papel mediador de determinadas prácticas educativas en la relación entre la psicopatología de los padres y el TND de los hijos. Método: una muestra comunitaria de 622 niños se evaluó longitudinalmente a los 3 y 5 años. Resultados: a los 3 y 5 años el castigo corporal medió la relación entre la ansiedad - depresión de la madre y TND (en las niñas), entre el comportamiento agresivo de la madre y TND (en los niños) y entre la ruptura de normas de las madres y TND en ambos sexos. Existe una asociación directa entre la puntuación de la conducta agresiva de la madre y el TND. El estilo educativo del padre no medió la asociación entre la psicopatología del padre y TND. Ansiedad - depresión y comportamiento agresivo del padre se asoció directamente con TND. Conclusiones: se debe explorar la psicopatología parental en familias de niños con TND y considerar las prácticas educativas como variables relevantes para la prevención y el tratamiento del TN

Prevalence, comorbidity, functioning and long-term effects of subthreshold oppositional defiant disorder in a community sample of preschoolers

To study the prevalence of subthreshold oppositional defiant disorder (ST ODD)-less than 4 symptoms, but nonetheless an impairing form of oppositional defiant disorder (ODD)-its coexistence with other homotypic externalizing and heterotypical internalizing problems in children and associated impairment, as well as the long-term effect of this condition. A population-based sample of 622 preschoolers (5.0% boys) was followed up from preschool to preadolescence. Parents were interviewed when the children were 3, 6 and 9 years old with the Diagnostic Interview for Preschoolers/Children and Adolescents versions following DSM-5 and the children's functioning was assessed by trained clinicians. ST ODD diagnosis is highly prevalent (19.4-25.5%), highly comorbid [homo- (1.9-18.4%) and heterotypical (5.8-23.7%)], resulting in functional impairment across child development in a similar way for both genders. ST is also a risk factor condition that predicts the presence of psychological problems and impairment in childhood and preadolescence from preschool age. A broader clinical assessment and intervention similar to that provided full syndrome cases is needed for children presenting subthreshold forms of OD

Transdiagnostic trajectories of irritability and oppositional, depression and anxiety problems from preschool to early adolescence

Irritability is a transdiagnostic symptom in oppositional defiant disorder, depression, and anxiety, all highly comorbid disorders but with unknown simultaneous evolution. The aim was to obtain the developmental trajectories of simultaneous irritability and oppositional, depression, and anxiety problems from preschool age to early adolescence. A sample of 493 community children was followed up annually from ages 3-11 years and assessed using categorical and dimensional measures answered by parents and teachers. Latent Class Growth Analysis for four parallel processes was used to identify distinct groups of individual trajectories for irritability and oppositional, depression, and anxiety problems. Outcomes at ages 11 and 12 were compared among trajectories using regression models and multiple comparisons. A 3-class model showed the highest entropy (0.961) and adequate posterior probabilities of class membership (≥0.969). Class 1 (n = 331, 67.1%) was made up of children with stable low scores in all the variables; class 2 (n = 55, 11.2%) of children with high depression, anxiety, and irritability and above the mean stable profiles for oppositional problems; and class 3 (n = 107, 21.7%) of children with medium-high increasing irritability and oppositional problems and on the mean depression and anxiety. The classes with symptomatology and irritability (2 and 3) clearly differed from class 1 (low) at baseline and in outcomes. The course of irritability and oppositional, depression, and anxiety problems from ages 3-11 years differed qualitatively and quantitatively across subgroups of children. The 3 classes identified may help to guide clinicians' decision-making regarding treating irritability and its comorbid disorders

Life conditions during COVID-19 lockdown and mental health in Spanish adolescents

Spanish children were locked down for 72 days due to COVID-19, causing severe disruption to their normal life. The threat posed by COVID-19 continues and clinicians, administrators, and families need to know the life conditions associated with more psychological problems to modify them and minimize their effect on mental health. The goal was to study the life conditions of adolescents during lockdown and their association with psychological problems. A total of 226 parents of 117 girls and 109 boys (mean age: 13.9; Standard deviation: 0.28) from the community that were participants in a longitudinal study answered an online questionnaire about life conditions during lockdown and the Strengths and Difficulties Questionnaire (SDQ). Stepwise regression analyses controlling by previous reports of SDQ were performed. Conduct, peer, prosocial, and total problems scores increased after lockdown. After adjusting for previous measures of psychopathology, worse adolescents' mental health during COVID-19 lockdown was associated with unhealthy activities, worsening of the relationships with others, and dysfunctional parenting style. It seems important to mitigate psychological stress in a situation of isolation due to a state of emergency by keeping the adolescent active and maintaining their daily habits and routines in a non-conflictive atmosphere and give support to parent

How the Affective Reactivity Index (ARI) works for teachers as informants

Background: The Affective Reactivity Index (ARI) is a brief instrument originally designed as a self- and parent report. However, the view of teachers, who can observe social situations that may give rise to irritability, is relevant. The goal is to provide the measurement qualities of the ARI score as reported by teachers. Method: Children formed part of a longitudinal study on behavior problems in Barcelona (Spain) and they were assessed when they were 7 (N=471) and 11 years old (N=454) with questionnaires about psychopathology, anger and aggressive behavior, and a diagnostic interview answered by the parents, youths and teachers. Confirmatory factor analysis, measurement invariance, reliability and validity were studied for the ARI answered by teachers. Results: The 6-item, 1-factor model fitted well. Almost full metric invariance and partial scalar invariance was obtained across sex and over age. The ARI scores largely converged with other teacher-reported measures of anger and irritability, and with other measures of psychopathology, aggressive behavior, and callousunemotional traits at a medium level. The associations with parent's measures were medium to low, and very low for child self-reported measures. The ARI scores significantly differentiated children with and without psychopathology and functional impairment, both cross-sectionally and longitudinally. Limitations: Only one child self-report measure of irritability included. Limited internal consistency of some scale scores. Findings are mostly generalizable to Spanish children. Conclusions: ARI could be a suitable instrument for measuring irritability as reported by teachers. The teacher's view can be useful when planning treatment by helping to identify treatment target

The MABIC project: An effectiveness trial for reducing risk factors for eating disorders

Challenges in the prevention of disordered eating field include moving from efficacy to effectiveness and developing an integrated approach to the prevention of eating and weight-related problems. A previous efficacy trial indicated that a universal disordered eating prevention program, based on the social cognitive model, media literacy educational approach and cognitive dissonance theory, reduced risk factors for disordered eating, but it is unclear whether this program has effects under more real-world conditions. This effectiveness trial tested whether this program has effects when previously trained community providers in an integrated approach to prevention implement the intervention. The research design involved a multi-center non-randomized controlled trial with baseline, post-test and 1-year follow-up measures. The sample included girls in the 8th grade from six schools (n = 152 girls) in a city near Barcelona (intervention group), and from eleven schools (n = 413 girls) in four neighboring towns (control group). The MABIC risk factors of disordered eating were assessed as main outcomes. Girls in the intervention group showed significantly greater reductions in beauty ideal internalization, disordered eating attitudes and weight-related teasing from pretest to 1-year follow-up compared to girls in the control group, suggesting that this program is effective under real-world conditions

Trajectories of oppositional defiant disorder irritability symptoms in preschool children

This study traces the developmental course of irritability symptoms in oppositional defiant disorder (ODD) from ages 3-5 and examines the psychopathological outcomes of the different trajectories at age 6. METHOD: A sample of 622 3-year-old preschoolers (311 were boys), followed up until age 6, was assessed yearly with a semi-structured diagnostic interview with parents and at age 6 with questionnaires answered by parents, teachers and children. RESULTS: Growth-Mixture-Modeling yielded five trajectories of irritability levels for the whole sample (high-persistent 3.5 %, decreasing 3.8 %, increasing 2.6 %, low-persistent 44.1 % and null 46.0 %). Among the children who presented with ODD during preschool age, three trajectories of irritability symptoms resulted (high-persistent 31.9 %, decreasing 34.9 % and increasing 33.2 %). Null, low-persistent and decreasing irritability courses in the sample as a whole gave very similar discriminative capacity for children's psychopathological state at age 6, while the increasing and high-persistent categories involved poorer clinical outcomes than the null course. For ODD children, the high-persistent and increasing trajectories of irritability predicted disruptive behavior disorders, comorbidity, high level of functional impairment, internalizing and externalizing problems and low anger control at age 6. CONCLUSIONS: Irritability identifies a subset of ODD children at high risk of poorer longitudinal psychopathological and functional outcomes. It might be clinically relevant to identify this subset of ODD children with a high number of irritability symptoms throughout development with a view to preventing comorbid and future adverse longitudinal outcome

The discriminative capacity of CBCL/1½-5 -DSM5 scales to identify disruptive and internalizing disorders in preschool children

This paper studies the discriminative capacity of CBCL/1½-5 (Manual for the ASEBA Preschool-Age Forms & Profiles, University of Vermont, Research Center for Children, Youth, & Families, Burlington, 2000) DSM5 scales attention deficit and hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety and depressive problems for detecting the presence of DSM5 (DSM5 diagnostic and statistical manual of mental disorders, APA, Arlington, 2013) disorders, ADHD, ODD, Anxiety and Mood disorders, assessed through diagnostic interview, in children aged 3-5. Additionally, we compare the clinical utility of the CBCL/1½-5-DSM5 scales with respect to analogous CBCL/1½-5 syndrome scales. A large community sample of 616 preschool children was longitudinally assessed for the stated age group. Statistical analysis was based on ROC procedures and binary logistic regressions. ADHD and ODD CBCL/1½-5-DSM5 scales achieved good discriminative ability to identify ADHD and ODD interview's diagnoses, at any age. CBCL/1½-5-DSM5 Anxiety scale discriminative capacity was fair for unspecific anxiety disorders in all age groups. CBCL/1½-5-DSM5 depressive problems' scale showed the poorest discriminative capacity for mood disorders (including depressive episode with insufficient symptoms), oscillating into the poor-to-fair range. As a whole, DSM5-oriented scales generally did not provide evidence better for discriminative capacity than syndrome scales in identifying DSM5 diagnoses. CBCL/1½-5-DSM5 scales discriminate externalizing disorders better than internalizing disorders for ages 3-5. Scores on the ADHD and ODD CBCL/1½-5-DSM5 scales can be used to screen for DSM5 ADHD and ODD disorders in general populations of preschool childre

L'atenció primària davant les drogues de síntesi

Recomanacions; Professionals d'atenció primària; Drogues de síntesi;Recomendaciones; Profesionales de atención primaria; Drogas de síntesisRecommendations; Primary Health Care; Synthesis drugDocumento que ofrece información sobre las drogas de síntesis; epidemiología, características, clasificación, efectos adversos de su consumo y recomendaciones sobre la conducta de los profesionales de atención primaria ante situaciones relacionadas con las drogas.Document que ofereix informació sobre les drogues de síntesi; epidemiologia, característiques, classificació, efectes adversos del seu consum i recomanacions sobre la conducta dels professionals d'atenció primària davant de situacions relacionades amb les drogues