Stringaris Argyris, Goodman Robert
King's College London Institute of Psychiatry, London, UK.
J Child Psychol Psychiatry. 2009 Mar;50(3):216-23. doi: 10.1111/j.1469-7610.2008.01989.x. Epub 2008 Oct 23.
Oppositional defiant disorder (ODD) in youth is a strong predictor of mental illness yet the wide range of associations with psychiatric disorders remains largely unexplained. The aim of this study was to investigate whether the identification of irritable, headstrong and hurtful dimensions within youth oppositionality would clarify the pattern of associations between oppositionality and a wide range of psychopathology in early and adult life.
Cross-sectional data from national mental health surveys including 18,415 subjects aged 5-16 in the United Kingdom. The main outcome measures were the associations between a priori hypothesised dimensions of oppositionality with psychiatric disorders and symptoms; parent and teacher-derived information were used in multivariate regression analysis.
Our three a priori dimensions had very different associations with disorders and symptom scales. Irritability was the only predictor of emotional disorders (parent report: OR = 3.26 [CI 95% 2.79, 3.80]; teacher report: OR = 2.78 [2.39, 3.22]); the hurtful dimension was particularly strongly associated with seeming cold-blooded or callous (parent report: beta = .32 [.27, .37]; teacher report: .33 [.30, .36]); and the headstrong dimension was most strongly associated with attention deficit hyperactivity disorder (ADHD; parent report: OR = 3.21 [2.43, 4.23]; teacher report : OR = 7.18 [5.25, 9.82]). All three dimensions were associated with conduct disorder, with the headstrong dimension being the main predictor of non-aggressive symptoms (parent report: beta = .31 [.27, .34]; teacher report: .43 [.40, .45]), and with the hurtful dimension being the main predictor of aggressive symptoms (parent report: beta = .35 [.32, .39]; teacher report: .40 [.39, .42]).
The three dimensions of oppositionality have distinctive external correlates, suggesting they may also be differential predictors of aetiology, prognosis and treatment responsiveness.
青少年对立违抗性障碍（ODD）是精神疾病的一个强有力的预测指标，但与精神障碍的广泛关联在很大程度上仍未得到解释。本研究的目的是调查在青少年对立性中识别易怒、任性和伤人维度是否能阐明对立性与早期及成年期广泛精神病理学之间的关联模式。
来自英国全国心理健康调查的横断面数据，包括18415名5至16岁的受试者。主要结局指标是对立性的先验假设维度与精神障碍及症状之间的关联；在多变量回归分析中使用了家长和教师提供的信息。
我们的三个先验维度与障碍及症状量表有非常不同的关联。易怒是情绪障碍的唯一预测因素（家长报告：OR = 3.26 [95%CI 2.79, 3.80]；教师报告：OR = 2.78 [2.39, 3.22]）；伤人维度与看似冷血或无情特别强烈相关（家长报告：β = 0.32 [0.27, 0.37]；教师报告：0.33 [0.30, 0.36]）；任性维度与注意力缺陷多动障碍（ADHD）关联最为强烈（家长报告：OR = 3.21 [2.43, 4.23]；教师报告：OR = 7.18 [5.25, 9.82]）。所有三个维度都与品行障碍相关，任性维度是非攻击症状的主要预测因素（家长报告：β = 0.31 [0.27, 0.34]；教师报告：0.43 [0.40, 0.45]），伤人维度是攻击症状的主要预测因素（家长报告：β = 0.35 [0.32, 0.39]；教师报告：0.40 [0.39, 0.42]）。
对立性的三个维度有独特的外部关联，表明它们也可能是病因、预后和治疗反应性的不同预测因素。
