Burke Jeffrey D, Loeber Rolf, Birmaher Boris
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
J Am Acad Child Adolesc Psychiatry. 2002 Nov;41(11):1275-93. doi: 10.1097/00004583-200211000-00009.
To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD).
Selected summaries of the literature over the past decade are presented.
Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains.
Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.
回顾对立违抗性障碍（ODD）和品行障碍（CD）的实证研究结果。
呈现过去十年文献的精选摘要。
过去十年对ODD和CD的研究探讨了识别破坏性行为障碍（DBD）的主要风险因素和发展路径所涉及的复杂性。在某些领域，由于新技术的出现，研究正在进入一个全新阶段。在其他领域，更大的数据集以及更复杂的方法和统计技术正在检验日益复杂的模型。然而，关于最有用的亚型分类系统、最显著风险因素的识别以及多个领域风险因素之间的关系，问题依然存在。
因果联系的确凿证据仍然难以捉摸。研究对CD难以治疗这一观点提出了质疑，尤其是当多个风险和损害领域成为干预目标时。显然不存在单一的致病因素；因此，单一的治疗方式不太可能足以治疗CD。未来的步骤将包括重新构建诊断标准以涵盖适当的亚型和指标，阐明该障碍的神经学基础，以及完善用于解释DBD不同发展路径的模型。
