Beyond Symptom Counts for Diagnosing Oppositional Defiant Disorder and Conduct Disorder?

Reciprocal relations between interparental aggression and symptoms of oppositional defiant and conduct disorders: a seven-wave cohort study of within-family effects from preschool to adolescence

BACKGROUND

Interparental aggression is believed to increase the risk of behavioral disorders in offspring, and offspring behavioral problems may forecast interparental aggression. However, these assumptions have yet to be put to a strong test. This study, therefore, examined whether increased interparental aggression predicted increased symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) from preschool to adolescence and vice versa.

METHODS

A sample (n = 1,077; 49.6% girls) from two birth cohorts of children in Trondheim, Norway, was assessed biennially from age 4 to 16. Children's symptoms of ODD and CD were assessed using semi-structured clinical interviews of parents (from age 4) and children (from age 8). One of the parents reported on their own and their partner's verbal and physical aggression. A random intercept cross-lagged model was estimated to test the within-family relations between interparental aggression, CD, and ODD symptoms.

RESULTS

Across development, increased interparental aggression predicted increased CD symptoms 2 years later, whereas an increased number of ODD symptoms forecasted increased interparental aggression.

CONCLUSIONS

The argumentative/defiant, aggressive, and vindictive behaviors seen in ODD are often directed toward parents and may take a toll on their relationship and possibly foster interparental aggression, whereas aggression between parents may promote symptoms of CD in their offspring, which commonly extend beyond the home. Incorporating effective and non-aggressive means to solve interparental conflict into parental management programs may reduce the development of symptoms of CDs in children.

The Interplay between Fear Reactivity and Callous-Unemotional Traits Predicting Reactive and Proactive Aggression

Research has indicated that youths with CU traits are fearless, and this fearlessness plays a bidirectional role in both the development of CU traits and engagement in aggressive behavior. However, research specifically testing the role of fear in the association between CU traits and aggression is scarce. The goal of the current study was to test if fear reactivity, both conscious (self-report) and automatic (skin conductance reactivity; SCR), moderated the association between CU traits and aggression subtypes (reactive and proactive aggression). Participants included 161 adolescents (Mage = 15 years) diagnosed with conduct disorder. CU traits were assessed using the self-report Inventory of Callous-Unemotional Traits. Conscious and automatic fear reactivity were measured during a virtual reality rollercoaster using the Self-Assessment Manikin and skin conductance reactivity (SCR), respectively. Hierarchical regressions found that high fear reactivity on SCR moderated the link between CU traits and reactive aggression, while feeling more excited during fear induction moderated the link between CU traits and proactive aggression. Overall, a possible explanation of our divergent findings between conscious and automatic fear may be the difference between the instinctual biological response to threat versus the cognitive and emotional appraisal and experience of threat. Implications for intervention strategies targeting emotional recognition and regulation in reducing aggression in CD populations are discussed.

Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD

BACKGROUND

Impulsivity is viewed as key to attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item-level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence.

METHODS

Participants were 310 children over-recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes.

RESULTS

Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross-sectional and longitudinal parent-reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher-rated social skills 5 years later compared to total DBD scores.

CONCLUSIONS

Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence.

Latent classes of oppositional defiant disorder in adolescence and prediction to later psychopathology

Current conceptualizations of oppositional defiant disorder (ODD) place the symptoms of this disorder within three separate but related dimensions (i.e., angry/irritable mood, argumentative/defiant behavior, vindictiveness). Variable-centered models of these dimensions have yielded discrepant findings, limiting their clinical utility. The current study utilized person-centered latent class analysis based on self and parent report of ODD symptomatology from a community-based cohort study of 521 adolescents. We tested for sex, race, and age differences in the identified classes and investigated their ability to predict later symptoms of depression and conduct disorder (CD). Diagnostic information regarding ODD, depression, and CD were collected annually from adolescents (grades 6-9; 51.9% male; 48.7% White, 28.2% Black, 18.5% Asian) and a parent. Results provided evidence for three classes of ODD (high, medium, and low endorsement of symptoms), which demonstrated important developmental differences across time. Based on self-report, Black adolescents were more likely to be in the high and medium classes, while according to parent report, White adolescents were more likely to be in the high and medium classes. Membership in the high and medium classes predicted later increases in symptoms of depression and CD, with the high class showing the greatest risk for later psychopathology.

Creating a developmental scale to chart the development of psychopathology with different informants and measures across time

Research Domain Criteria (RDoC) aims to advance a dimensional, multilevel understanding of psychopathology across the life span. Two key challenges exist in applying a developmental perspective to RDoC: First, the most accurate informants for assessing a person's psychopathology often differ across development (e.g., parents and teachers may be better informants of a person's externalizing problems in early childhood, whereas peer- and self-report may also be important to assess in adolescence). Second, many constructs change in their behavioral manifestation across development (i.e., heterotypic continuity). Thus, different informants and measures across time may be necessary to account for the construct's changing manifestation. The challenge of using different informants and measures of a construct across time is ensuring that the same construct is assessed in a comparable way across development. Vertical scaling creates a developmental scale to link scores from changing informants and measures to account for heterotypic continuity and study people's development of psychopathology across the life span. This is the first study that created a developmental scale to assess people's development by putting different informants and measures on the same scale. We examined the development of externalizing problems from ages 2 to 15 years (N = 1,364) using annual ratings by mothers, fathers, teachers, other caregivers, and self-report. The developmental scale linked different informants and measures on the same scale. This allowed us to chart people's growth trajectories and to identify multilevel risk factors, including poor verbal comprehension. Creating a developmental scale may be crucial to advance RDoC's goal of studying the development of psychopathology across the life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders - A Narrative Review

Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct disorders, and first-episodes psychosis frequently appear in early life stages. This review aims to provide a broad overview of transitional-aged youth's most common psychiatric comorbidities with substance use disorders. A literature search was conducted in Embase and Pubmed, and the main findings are described narratively. We present main findings for the following comorbidities: attention-deficit/hyperactivity disorder, conduct disorder, personality disorders, affective disorders, psychotic disorders, and the phenomena of overdose and suicidality. In conclusion, co-occurring mental health disorders are common and appear to facilitate the development of substance use disorders and exacerbate their overall course. Substance use also affects the severity and course of comorbid psychiatric disorders. Overall, data on transition-age youth with substance use disorders are highly inconsistent. Universal screening and treatment guidelines do not yet exist but should be aimed for in the future.

Symptom Profiles of CD and ODD Among Youth With Perinatally Acquired HIV

OBJECTIVE

Youth with perinatally acquired human immunodeficiency virus (PHIV) face increased risk for conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms, and heterogeneous findings indicate that there may be subgroups of youth with PHIV differing in the quality and/or frequency of symptoms. The present study examined symptom profiles of CD and ODD among youth with PHIV and whether profiles differed in terms of parent-child and family correlates.

METHODS

Participants included 314 youth with PHIV, aged 6-17 years (M = 12.88 years, SD = 3.08; 51% male; 85% Black or Latinx), and their caregivers who were recruited from 29 clinics in the US involved in the International Maternal Pediatrics Adolescent AIDS Clinical Trials (IMPAACT) Group's P1055 study. Caregivers reported on youth CD and ODD symptoms, parent-child interactions, and family environment.

RESULTS

Latent class analysis indicated that a four-class model (i.e., moderate CD/high ODD, high ODD, moderate ODD, low CD/ODD) best fit the data. Ancillary analyses to validate these classes revealed differences for family cohesion and conflict; and child-centeredness, detachment, guilt-induced control, and consistency in parent-child interactions. The low CD/ODD class generally differed from other classes with additional differentiation between some higher risk profiles.

CONCLUSIONS

Findings suggest that homogeneous classes of CD/ODD symptoms can be identified among youth with PHIV, and these profiles differ in terms of family processes, consistent with previous work among chronically ill youth.

Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study

BACKGROUND

Children with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down).

METHOD

Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test.

RESULTS

In the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior.

CONCLUSIONS

The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.

Emotion Dysregulation, ODD and Conduct Problems in a Sample of Five and Six-Year-Old Children

Previous studies examining the relationship between emotion dysregulation and externalizing behavior problems have, so far, focused on using general screening questionnaires capturing a wide range of externalizing behaviors and emotion dysregulation has mostly been assessed through direct observation using negative mood induction and behavioral tasks. The purpose of this study was to explore this relationship using a multi-informant rated clinical questionnaires. Parents and teachers of 609 5-6-year-old children (46% girls, 54% boys) completed the ERC, DBRS, and SDQ. ODD symptoms/conduct problems and lability/negativity were more severe among boys but girls had better emotion regulation. The results also showed a significant main effect for emotion dysregulation and ODD symptoms/conduct problems and that gender had no moderating effect on the relationship. These findings show a strong association between emotion dysregulation and concurrent ODD symptoms/conduct problems and suggest that emotional difficulties should be considered when exploring causes of behavior difficulties in daily life.

The validity of conduct disorder symptom profiles in high-risk male youth

Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2-21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5-13.80) and moderate CD (OR 4.18, CI 1.89-9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose-response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism.

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 ODD.

Family Risk Factors Associated With Oppositional Defiant Disorder Symptoms, Depressive Symptoms, and Aggressive Behaviors Among Chinese Children With Oppositional Defiant Disorder

Family factors including parental emotion dysregulation and harsh parenting practices place children at high risk for malfunctioning in emotion regulation, depressive symptoms, and aggressive behaviors. This study investigated the associations among parental emotion dysregulation, harsh parenting practices (i.e., emotional abuse and corporal punishment), and child emotion regulation and child oppositional defiant disorder (ODD) symptoms and co-occurring depressive symptoms and aggressive behaviors. Participants included 239 parent-child dyads from 14 primary schools in Mainland China. All children were diagnosed with ODD. Parental emotion dysregulation, harsh parenting practices, and child emotion regulation were reported by parents; child ODD symptoms were reported by parents and teachers; child depressive symptoms were reported by children; and child aggressive behaviors were reported by teachers. Data indicated that parental emotion dysregulation was related to child ODD symptoms in the home and depressive symptoms indirectly through harsh parenting practices and child emotion regulation. Harsh parenting practices were related to child ODD symptoms in the home directly and indirectly through child emotion regulation. Moreover, emotional abuse was associated with child depressive symptoms directly and indirectly through child emotion regulation. Our findings highlighted the need for prevention and intervention targeting parent emotion dysregulation and harsh parenting practices among children with ODD.

Longitudinal Associations between Oppositional Defiant Symptoms and Interpersonal Relationships among Chinese Children

Children with oppositional defiant disorder (ODD) are at increased risk for developing poor relationships with people around them, but the longitudinal links between ODD symptoms and subsequent interpersonal functioning remain unclear. In the current study, we examined the bidirectional associations between ODD symptoms and children's relationships with parents, peers, and teachers. We included separate analyses for parent vs. teacher reports of ODD symptoms, with regard to subsequent interpersonal relationships. Participants included 256 children with ODD, recruited in China, along with their parents and teachers, assessed at three time points roughly two years apart. Parents and teachers reported child ODD symptoms at each time point, and children reported their perceptions of father- and mother-child attachment, peer relationships, and teacher-student relationships across the three time points. ODD symptoms reported either by parents or teachers predicted impairments in interpersonal functioning. Meanwhile, child interpersonal impairments with peers and teachers predicted subsequent increase in teacher-reported ODD symptoms. These findings highlight the importance of transactional models of influence-and of considering early intervention for ODD in protecting children from developing further deficits and impairments. Additionally, we discuss the perspectives of multiple informants on ODD symptoms, including their different patterns of association with subsequent interpersonal relationships.

Simplifying the implementation of modern scale scoring methods with an automated R package: Automated moderated nonlinear factor analysis (aMNLFA)

When generating scores to represent latent constructs, analysts have a choice between applying psychometric approaches that are principled but that can be complicated and time-intensive versus applying simple and fast, but less precise approaches, such as sum or mean scoring. We explain the reasons for preferring modern psychometric approaches: namely, use of unequal item weights and severity parameters, the ability to account for local dependence and differential item functioning, and the use of covariate information to more efficiently estimate factor scores. We describe moderated nonlinear factor analysis (MNLFA), a relatively new, highly flexible approach that allows analysts to develop precise factor score estimates that address limitations of sum score, mean score, and traditional factor analytic approaches to scoring. We then outline the steps involved in using the MNLFA scoring approach and discuss the circumstances in which this approach is preferred. To overcome the difficulty of implementing MNLFA models in practice, we developed an R package, aMNLFA, that automates much of the rule-based scoring process. We illustrate the use of aMNLFA with an empirical example of scoring alcohol involvement in a longitudinal study of 6998 adolescents and compare performance of MNLFA scores with traditional factor analysis and sum scores based on the same set of 12 items. MNLFA scores retain more meaningful variation than other approaches. We conclude with practical guidelines for scoring.

Testing Cold and Hot Cognitive Control as Moderators of a Network of Comorbid Psychopathology Symptoms in Adolescence

Comorbidity is pervasive across psychopathological symptoms, diagnoses, and domains. Network analysis is a method for investigating symptom-level associations that underlie comorbidity, particularly through bridge symptoms connecting diagnostic syndromes. We applied network analyses of comorbidity to data from a population-based sample of adolescents (n = 849). We implemented a method for assessing nonparametric moderation of psychopathology networks to evaluate differences in network structure across levels of intelligence and emotional control. Symptoms generally clustered by clinical diagnoses, but specific between-cluster bridge connections emerged. Internalizing symptoms demonstrated unique connections with aggression symptoms of interpersonal irritability, whereas externalizing symptoms showed more diffuse interconnections. Aggression symptoms identified as bridge nodes in the cross-sectional network were enriched for longitudinal associations with internalizing symptoms. Cross-domain connections did not significantly vary across intelligence but were weaker at lower emotional control. Our findings highlight transdiagnostic symptom relationships that may underlie co-occurrence of clinical diagnoses or higher-order factors of psychopathology.

Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct as Predictors of Various Antisocial Outcomes During Early Adolescence

The aim of this study was to compare callous-unemotional (CU) traits versus the multidimensional psychopathy construct in their ability to predict future and stable antisocial behavior. At baseline, a community sample of 996 Cypriot 12-year old adolescents (52% girls) completed measures that tap conduct problems (CP) and psychopathic traits, including CU. CP, aggression, and substance use were self-reported at 1–3 year follow-ups. Youths were assigned to six mutually exclusive groups based on their baseline levels of CP and psychopathic traits. Youth with CP scoring high on all three psychopathic traits dimensions (Psychopathic Personality + CP) showed the most robust and highest risk for future and stable CP, aggression, and substance use, followed by youth who were high on all three psychopathic traits dimensions but displayed no concurrent CP (Psychopathic Personality Only) and CP youth with low levels of psychopathic traits (CP Only). Youth with CP who merely manifested callous-unemotional traits (Callous-Unemotional + CP) were only at risk for future CP. The findings suggest that the CU traits-based approach for subtyping children with CP is less informative compared to a subtyping approach using various psychopathic traits dimensions in predicting future and stable forms of various antisocial outcomes. These findings and their consistency with prior work indicate the need for additional research to examine the various psychopathic traits dimensions rather than focusing solely on CU traits, especially for CP subtyping purposes.

Comparing Different Approaches for Subtyping Children with Conduct Problems: Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct

The aim of this study was to compare two youth psychopathy models (i.e., callous-unemotional versus multidimensional model) in their ability to predict future and stable conduct problems (CP). At baseline, mothers and fathers of 321 boys and 369 girls (ages 7-12) completed measures that tap callous-unemotional and other psychopathic traits. Parent-reported CP was collected at baseline and at 6- and 12 month follow-ups. Children were assigned to mutually exclusive groups based on their levels of CP and psychopathic traits. Children with CP who manifested callous-unemotional traits (Callous-Unemotional + CP) were occasionally at risk for future and stable CP. Yet, across gender, children with CP scoring high on all psychopathic trait dimensions (Psychopathic Personality + CP) showed the most robust and highest risk for future and stable CP. Also, Callous-Unemotional + CP children, and children who were only high in CP, often were at similar risk for future CP. The findings suggest that the callous-unemotional model is less sufficient than the multidimensional model in predicting future and stable CP. This can be concluded for both boys and girls and calls for more research reconsidering the multidimensional nature of psychopathy for CP subtyping purposes.

The clinical usefulness of the new LPE specifier for subtyping adolescents with conduct disorder in the DSM 5

In DSM 5, conduct disorder (CD) has been expanded with a new specifier 'with Limited Prosocial Emotions' (LPE) in addition to the age-of-onset (AoO) subtyping, and is thought to identify a severe antisocial subgroup of CD. However, research in clinical practice has been scarce. Therefore, the current study will examine differences in clinical symptoms between subtypes of CD, based on both subtyping schemes. Subsequently, it will investigate whether the LPE specifier explains unique variance in aggression, added to the AoO subtyping. A sample of 145 adolescents with CD (51 % male, mean age 15.0) from a closed treatment institution participated in this study. CD diagnoses and AoO subtype were assessed using a structured diagnostic interview. The LPE specifier was assessed using the callous-unemotional dimension of the Youth Psychopathy Traits Inventory (YPI). Self-reported proactive and reactive aggression, rule-breaking behavior and internalizing problems within the subtypes were compared. Youth with childhood-onset CD and LPE showed significantly more aggression than adolescent-onset CD without LPE (proactive aggression: F = 3.1, p < 0.05, reactive aggression: F = 3.7, p < 0.05). Hierarchical regression revealed that the LPE specifier uniquely explained 7 % of the variance in reactive aggression, additionally to the AoO subtyping. For proactive aggression, the interaction between AoO and the LPE added 4.5 % to the explained variance. Although the LPE specifier may help to identify a more aggressive subtype of CD in adolescents, the incremental utility seems to be limited. Therefore, clinical relevance of the LPE specifier in high-risk adolescent samples still needs to be investigated thoroughly.

Identifying an efficient set of items sensitive to clinical-range externalizing problems in children

The present study applied item response theory to identify an efficient set of items of the Achenbach Externalizing scale from the Child Behavior Checklist (CBCL; 33 items) and Teacher's Report Form (TRF; 35 items) that were sensitive to clinical-range scores. Mothers and teachers rated children's externalizing problems annually from ages 5 to 13 years in 2 independent samples (Ns = 585 and 1,199). Item properties for each rater across ages 5-8 and 9-13 were examined with item response theory. We identified 10 mother- and teacher-reported items from both samples based on the items' measurement precision for subclinical and clinical levels of externalizing problems: externalizing problems that involve meanness to others, destroying others' things, fighting, lying and cheating, attacking people, screaming, swearing/obscene language, temper tantrums, threatening people, and being loud. Scores on the scales using these items had strong reliability and psychometric properties, capturing nearly as much information as the full Externalizing scale for classifying clinical levels of externalizing problems. Scores on the scale with the 10 CBCL items had moderate accuracy, equivalent to the full Externalizing scale, in classifying diagnoses of conduct disorder based on a research diagnostic interview. Of course, comprehensive clinical assessment would consider additional items, dimensions of behavior, and sources of information, too, but it appears that the behaviors tapped by this select set of items may be core to externalizing psychopathology in children. (PsycINFO Database Record