Abstract
This study investigated whether oppositional defiant disorder (ODD) with the DSM-5 limited prosocial emotions (LPE) specifier marks a more severe clinical presentation than ODD alone. Mothers, fathers, and teachers of 2,142 Spanish children (49.49% girls; ages 8 to 13 years) completed measures of ODD, LPE, ADHD-hyperactivity/impulsivity (HI), ADHD-inattention (IN), cognitive disengagement syndrome (CDS), anxiety, depression, social impairment, academic impairment, and peer rejection (teacher only measure). Scores greater or less than 1.50 SDs above the ODD and LPE means were used to create ODD-only (5.89–7.22% of the sample, depending on informant), LPE-only (7.61–8.25%), ODD + LPE (1.69–2.20%), and comparison groups (82.96–84.68%) for each source. For all three sources, the LPE-only group scored higher than the comparison group on social impairment, peer rejection, and academic impairment but did not differ significantly on anxiety. Although the ODD-only and ODD + LPE groups scored higher than the LPE-only group on all symptom and most impairment dimensions, the ODD + LPE group did not show a consistent pattern of higher scores than the ODD-only group. There were no differences on mother ratings, and higher scores for the ODD + LPE group emerged on only three of seven father-report measures (depression, CDS, and ADHD-IN) and three of eight teacher-report measures (peer rejection, social impairment, and academic impairment). Limited differences between the ODD + LPE and ODD-only groups raise questions about the usefulness of LPE as a severity specifier for ODD among children. Future studies need to address this issue with adolescents and clinical samples.
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Data Availability
The study was not preregistered. The output files for the analyses are available from the second author. Data are available from the second author upon a reasonable request and the execution of a data use agreement.
Notes
With our sample of mother (N = 1,645), father (N = 1,356), and teacher (N = 1,773) ratings of the eight ODD symptoms, exploratory factor analysis was used to evaluate one, two, and three-factor models (cross-loadings allowed in the two- and three-factor models). A one-factor model yielded substantial loadings (> 0.76) for the three sources. The two-factor model did not provide strong support for two distinct ODD subfactors for any source (Factor 1 had only two symptoms with strong convergent and discriminant validity, whereas Factor 2 had only three symptoms with strong convergent and discriminant validity). In addition, Factor 1 with Factor 2 correlation indicated weak discriminant validity (mothers: 0.79, fathers: 0.75, and teachers: 0.88). These results lead to our decision to focus on a single ODD symptom dimension. Supplemental Table S1 shows the results from these factor analyses.
Although a possible floor effect on our measure of anxiety might not allow the LPE-only group to score significantly lower than the comparison group on anxiety (see Colins et al., 2021 results for their measure of fearlessness as an alternative measure of anxiety), the LPE-only group was expected to score significantly lower on anxiety than the ODD-only and ODD + LPE groups with the ODD + LPE group being significantly lower on anxiety than the ODD-only group.
Forming LPE-only, ODD-only, and ODD + LPE groups allowed for the possibility that the LPE-only and comparison groups could either differ or not differ on ODD. The LPE-only and comparison groups might not differ on ODD, especially for mother and father ratings, given low correlations between the LPE and ODD measures (0.19 to 0.34 for mother/father ratings and 0.33 to 0.54 for teacher ratings; see Burns et al. (2021b)).
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Funding
This research was supported by two grants from the Ministry of Economy and Competitiveness of Spanish Government under award numbers PSI2014-52605-R and PSI2017-82550-R (AEI/FEDER, UE), and a predoctoral fellowship co-financed by MINECO (Spanish Government) and the European Social Fund (BES-2015-075142). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Spanish Government. We thank Cristina Trias for assistance with the study.
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The research protocol was approved by the Research Ethics Committee (Institutional Review Board) of the University of the Balearic Islands.
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Chrysosferidis, J.R., Burns, G.L., Becker, S.P. et al. Oppositional Defiant Disorder in the DSM-5: Does the Limited Prosocial Emotions Specifier Portend a More Severe Clinical Presentation?. Res Child Adolesc Psychopathol 51, 1037–1050 (2023). https://doi.org/10.1007/s10802-023-01052-1
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DOI: https://doi.org/10.1007/s10802-023-01052-1