Oppositional Defiant Disorder: Meta-Analysis, Predictive Validity, and Mediation of Psychopathology Outcomes

Background: Oppositional defiant disorder (ODD) is a youth disorder characterized by developmentally atypical defiance, hostility, disobedience, and angry/irritable mood. ODD predicts diverse negative outcomes such as psychopathology, antisocial behavior (ASB), and impairment. This dissertation included three studies unified around testing youth ODD’s prediction of future psychopathology and impairment, and identifying potential mechanisms underlying the development from ODD dimensions to ASB.Study I: The aim of Study I was to estimate the prevalence of psychopathology outcomes among youth with prior ODD. Meta-analyses included 1137 participants across 17 studies. Among youth with ODD, 13% developed a subsequent anxiety disorder, 5% a depressive disorder, and 21% conduct disorder (CD)/antisocial personality disorder. Meta-regression identified that older youth at baseline had a higher prevalence of later depression. More prevalent psychotropic medication use at baseline was associated with elevated rates of later depression and CD/antisocial personality disorder.Study II: The aim of Study II was to test the predictive validity of irritable and oppositional ODD dimensions with respect to multiple psychopathology outcomes (i.e., anxiety, depression, CD), ASB, psychopathic traits, substance use, and functional impairment, with control of baseline negative emotionality, attention-deficit/hyperactivity disorder (ADHD), and psychopathology/impairment in each model by employing generalized linear models. Oppositional ODD inversely predicted parent-rated Total Anxiety and Depression, several parent-rated anxiety subscales, and youth-rated Total Anxiety and Depression. Irritable ODD positively predicted parent-rated obsessions and compulsions. Negative emotionality did not significantly predict any outcomes. Notably, baseline measures of ADHD and psychopathology/impairment predicted the majority of outcomes. Study III: The aim of Study III was to test reactive and proactive aggression as simultaneous, temporally-ordered mediators of predictions of multi-informant rated ASB from irritable and oppositional ODD symptoms in a prospective sample. Individual differences in Wave 2 reactive aggression significantly mediated the prediction of Wave 3 youth-rated ASB from baseline irritable ODD. Wave 1 irritable ODD positively predicted Wave 2 reactive aggression in all prediction models.Conclusion: The theoretical and clinical implications of the results from Studies I – III were discussed, as well as future directions for research.Keywords: Oppositional defiant disorder (ODD); Meta-analysis; Prospective psychopathology; Irritability; Oppositionality; Predictive validity; Multiple mediatio