Greene Ross W, Biederman Joseph, Zerwas Stephanie, Monuteaux Michael C, Goring Jennifer C, Faraone Stephen V
Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, ACC-725, Boston, MA 02114, USA.
Am J Psychiatry. 2002 Jul;159(7):1214-24. doi: 10.1176/appi.ajp.159.7.1214.
The authors sought to achieve an improved understanding of the diagnosis of oppositional defiant disorder independent of its association with conduct disorder.
Family interactions, social functioning, and psychiatric comorbidity were compared in clinically referred male and female subjects with oppositional defiant disorder alone (N=643) or with comorbid conduct disorder (N=262) and a psychiatric comparison group with neither oppositional defiant disorder nor conduct disorder (N=695).
Oppositional defiant disorder youth with or without conduct disorder were found to have significantly higher rates of comorbid psychiatric disorders and significantly greater family and social dysfunction relative to psychiatric comparison subjects. Differences between subjects with oppositional defiant disorder alone and those with comorbid conduct disorder were seen primarily in rates of mood disorders and social impairment. Oppositional defiant disorder was a significant correlate of adverse family and social outcomes when comorbid disorders (including conduct disorder) were controlled.
These results support the validity of the oppositional defiant disorder diagnosis as a meaningful clinical entity independent of conduct disorder and highlight the extremely detrimental effects of oppositional defiant disorder on multiple domains of functioning in children and adolescents.
作者试图在不考虑对立违抗障碍与品行障碍关联的情况下，更好地理解对立违抗障碍的诊断。
对临床转介的仅患有对立违抗障碍（N = 643）或同时患有共病品行障碍（N = 262）的男性和女性受试者，以及既无对立违抗障碍也无品行障碍的精神科对照组（N = 695）的家庭互动、社会功能和精神科共病情况进行比较。
发现无论有无品行障碍，对立违抗障碍青少年的共病精神障碍发生率显著更高，且相对于精神科对照受试者，其家庭和社会功能障碍显著更大。仅患有对立违抗障碍的受试者与患有共病品行障碍的受试者之间的差异主要体现在情绪障碍发生率和社会损害方面。当控制共病障碍（包括品行障碍）时，对立违抗障碍与不良家庭和社会结局显著相关。
这些结果支持将对立违抗障碍诊断作为一个独立于品行障碍的有意义临床实体的有效性，并强调对立违抗障碍对儿童和青少年多个功能领域具有极其有害的影响。
