Thien-An Le Oppositional Defiant Disorder Intermittent Explosive Disorder Antisocial Personality Disorder Pyromania Kleptomania Other Specified Disruptive, Impulse-Control, and Conduct Disorder Unspecified Disruptive, Impulse-Control, and Conduct Disorder Four+ symptoms for at least 6 months: Pattern of angry/irritable mood, includes: ◦ Often loses temper, ◦ Often touchy or easily annoyed, ◦ Often angry and resentful. Argumentative/defiant behavior, includes: ◦ Argues w/authority figures or adults, ◦ Actively defies or refuses to comply w/requests from authority figures or w/rules, ◦ Deliberately annoys others, ◦ Often blames others for his/her mistakes or misbehavior. Vindictiveness, includes: ◦ Spiteful or vindictive at least twice within the past six months. For children < 5 years, the behavior should occur on most days for a period of at least 6 months. ◦ 5 + y/o, the behavior should occur at least once per week for at least 6 months. Frequency and intensity of the behaviors are outside normative range ◦ Including: developmental level, gender, and culture. Behavior associated with distress: ◦ individual or others in his or her immediate social context or, ◦ impacts negatively on social, educational, occupational, or other important areas of functioning. Do not occur exclusively during the course of a psychotic disorder, substance use, depressive, or bipolar disorder and criteria are not met for disruptive mood dysregulation disorder. Mild, Moderate and Severe Specifications ODD- Dr. Phil Angry/irritable ◦ Temper, ◦ Easily annoyed, ◦ Resentful. Argumentative/defiant behavior ◦ ◦ ◦ ◦ ◦ ◦ Argues w/mom Defying mom Refusing to comply w/requests from mom Refuses to comply with mom Deliberately annoyed mom elbowing her on plane Blames mom for misbehaviors “you jabbed me first” Vindictiveness ◦ Spiteful or vindictive ODD is associated with increased risk of other mental disorders during childhood AND adulthood beyond the effects of CD (Burke et al., 2005). ◦ Approximately 1/3 children CD (Hamilton & Armando, 2008) ◦ Approximately 40% Anti-Personality Disorder (Hamilton & Armando, 2008) Associated suicide attempts Increased risk for adjustment as adults ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Academic failure, Antisocial behavior, Rejection by peers, Low self-esteem, Impulse-control problems, Substance abuse, Anxiety, and Depression. Impairments in emotional, social, academic, and occupational adjustment. ◦ Parents, teachers, supervisors, peers, and romantic partners. Prevalence: 1-11%, avg. of 3.3%. More prevalent in families in which child care is disrupted by a succession of different caregivers or families in which harsh, inconsistent, or neglectful child-rearing practices are common. Rate depends on age and gender of child. Somewhat more prevalent in males prior to adolescence. First symptoms usually appear during preschool and behaviors are frequent during preschool and adolescence. ◦ Important to evaluate intensity and frequency vs. normative levels. ODD often precedes development of CD. ◦ Childhood-onset type of conduct disorder. ◦ Many children and adol. w/ODD do not subsequently develop CD. Course: 3 years Manifestations of ODD across development are consistent. Temperamental: problems in emotional regulation predictive of ODD. ◦ i.e.: High levels of emotional reactivity, poor frustration tolerance angry/irritable moods. ◦ Related to abnormality of the amygdala and prefrontal cortex (PFC). Neurobiological markers: ◦ Lower heart rate and skin conductance reactivity, reduced basal cortisol reactivity, abnormalities in the PFC and amygdala. Reduced basal cortisol reactivity associated with higher rates of aggression and with poor social relationships (Booth, Granger, & Shirtcliff, 2008). PFC regulation of behavior, cognition, and attention (Arsten, 2006). Amygdala emotion regulation. May not be specific to oppositional defiant disorder, also similar in conduct disorder. Disrupted by a succession of different caregivers or families in which harsh, inconsistent, or neglectful child-rearing practices are common. Associated w/distress in the individual or others in his/her immediate social context. o Could impact negatively on social, educational, occupational, or other areas of functioning. Often justify their behaviors as a response to unreasonable demands/circumstances. ◦ Do not consider themselves as being angry, oppositional, or defiant difficult to disentangle relative contribution of the individual with the disorder to problematic interactions ◦ i.e.: Hostile parenting ODD? or ODD Hostile parenting? Higher rate of substance use disorders. ODD higher in samples of children, adolescents, and adults with ADHD. ◦ Independent? ◦ Shared temperamental risk factors. Risk for development of anxiety disorders and major depressive disorder. ◦ Defiant, vindictive, & argumentative symptoms carry most risk CD ◦ Angry-irritable mood symptoms emotional disorders. Symptoms are relatively the same. DSM-V: ◦ DSM-V categorizes the symptom groups. ◦ DSM-V more specific: spiteful or vindictive at least twice within the past 6 months. ◦ Includes consideration of environmental factors in Criteria. ◦ Includes caveat for substance use, depressive, or bipolar disorder in Criteria. ◦ Distinguishes the age-specific behavioral criteria. Before and after 5 years of age criteria. DSM-IV-TR: Classified in different categories. ◦ Criteria D: Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder Recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient and hostile behavior toward authority figures. ◦ Including actively defying or refusing to comply with adult rules and requests, frequent temper outbursts, and excessive arguing ◦ (Anderson et al., 1986; Dumas and LaFrenier, 1993; Dumas et al., 1995; Lytton, 1990; Rey et al., 1988; Schacher and Wachsmuth, 1990; Stormchack et al., 1997) Arguing with adults, losing one’s temper, and angry or intentionally annoying behavior (Dick et al., 2005). Early childhood (Dick et al., 2005) Children with ODD often are diagnosed with CD when they reach adolescence (Dick et al., 2005) ◦ Not all individuals with CD have had a previous diagnosis of ODD. ◦ 3x as likely to develop CD (Lahey, McBurnett, & Loeber, 2000). ◦ Lahey-Loeber Model of comorbity: Only children with ADHD who also exhibit comorbid ODD will develop CD. Then later develop APD (Loeber et al., 2000). Temperament: ◦ Predictive of externalizing behavior problems by late childhood (Sanson and Prior,1999). ◦ Temperamental difficulties due to psychosocial early life risk factors Low income Maternal depression, social stress, and support and home environment (Shaw et al., 2001). Attachment? ◦ (Burke et al., 2002) Coercive parenting behaviors et al., 2000) (Patterson, 1984; Eddy et al., 2001; Stormshak Low parental warmth and involvement Oppositional child behavior (Stormashak et al., 2000) Child abuse (Dodge et al.,1995) ◦ Demonstrated social processing deficit conduct problems Association with deviant peers 1995; Simons et al., 1996) : (Elliott and Menard, 1996; Keenan et al., ◦ Initiation of delinquent behavior in boys ◦ For girls, more common with an early onset of pubertal maturation (Stattin and Magnusson, 1990) Peer Rejection conduct problems and aggressive responding ◦ Peer rejection Conduct problems ◦ (Coie and Dodge, 1998; Coie and Lenox, 1994; Dodge et al., 1990; Bolger and Patterson, 2001). Community Factors: ◦ Community disorganization, drug availability, presence of neighborhood adults involved in crime (Herrenkohl et al., 2000) ◦ Exposure to violence and exposure to racial prejudice (Hawkins et al., 1998) Unemployment (Fergusson et al.,1997), Neighborhood violence (Guerra et al.,1995) Family poverty and children’s aggression (among white children alone) (Guerra et al.,1995) Low income (Shaw et al., 2001) and Duration of poverty (McLoyd,1998) Prenatal smoking (Landgren et al., 1998; Hill et al., 2000) Prenatal maternal alcohol use (Hill et al., 2000) Maternal viral illness (Mellins et al., 2006) Parental separation (Fergusson et al., 1994; Sullivan et al., 1995) Early deprivation (Zeanah et al., 2005) Adoption (Sullivan et al., 1995) Based on the Coercion theory. Patterson hypothesized that aggressive behavior develops in families when parents use coercion as the primary mode for controlling their children. A child who has received abundant negative reinforcement for aversive behaviors and little positive reinforcement for appropriate behaviors ◦ Likely to encounter major difficulties in academic and peer settings middle childhood. Parental failure to discipline, which is thought to be a major determinant for increases in antisocial child behavior. Behavioral event is initiated by the child Caregiver terminates aversive state by “caving in” to the demands of the child ◦ Arguing, crying, etc… ◦ Highly aversive to the caregiver ◦ Negative reinforcement conditioning mechanism ◦ Escape behavior Strengthens the child's behavior of exhibiting ODD Strengthening the caregiver's inappropriate behavior. Intra-Individual level of analysis: Two conditionals for a contingency model. Infant irritable cries / Infant is hungry Mother attends and terminates aversive state Mother attends / All other infant behavior Infant irritable crying is reinforced Mother reinforces infant prosocial behavior Child irritable, active, has difficult temperament Mother Depressed Antisocial Pregnancy and birth Complications Hyporesponsive Divorce Parenting Discipline Tracking Teaching Involved Relative rate reinforce coercive behavior Relative rate reinforce prosocial behavior Genetic influences on behavior (twin studies): ◦ Delinquent set of behaviors: Rule-breaking behaviors: 30-79% (Bartels et al., 2003). Girls: 56%-72% of variance in Rule-breaking accounted by genetic factors. When assessed by both parents: 80% covariance for rule-breaking due to genetics. Aggression: 51%-72% (Bartels et al., 2003). ◦ Familial negativity and adolescent antisocial behavior 51%-60% (Pike et al., 1996). ◦ Functioning of PFC Composite genotypes (Nigg et al., 2007). Genetic correlation between CD and ODD. ◦ Joint Construct (Eaves et al., 2000; Nadder, Rutter, Silberg, Maes, & Eaves, 2002). Genetic influences contributes to covariation between ADHD and ODD (Dick et al., 2005) CD, ADHD, and ODD are largely explained by shared genetic influences (Dick et al., 2005). PFC ◦ ◦ (Baving et al., 2000): Atypical EEG in frontal lobe activation patterns. Brain asymmetry in oppositionally defiant girls and boys ((F1,33=4.45, p <.05) and (F1,24=4.75, p <.05) respectively) (van Goozen et al., 1998).: Lower levels of baseline heart rate Experimentally induced HIGHER heart rate. Left orbitofrontal cortex. Less white matter ◦ Pathways to serious conduct and delinquent problem behavior. Less gray matter (Fahim et al., 2012): ◦ (Burke et al., 2002): Autonomic Nervous System ◦ ◦ May be involved in overcoming psychosocial adversity. Dopamine Frontal Lobe ◦ ◦ : Developmental pathways ◦ (Nigg et al., 2007). (Fahim et al., 2012): Left Superior frontal area. Increase in left temporal area ◦ (Fahim et al., 2012): Associated with aggressive, impulsive, and antisocial personality. Low salivary cortisol level (van Goozen et al., 1998). Dopamine transporter, dopamine D4 receptor, noradrenergic alpha-2 receptor (Nigg et al., 2007). Testosterone and aggression Serotonin and aggression et al., 1992). (Pliszka, 1999). (Clarke et al., 1999; Kruesi ◦ Regulation of mood and impulsive behavior (Davidson et al., 2000). Early physical maturation: ◦ Increased problem behaviors in girls (Graber et al., 1997; Laitinen- Krispijn et al., 1999; Stattin and Magnusson, 1990), ◦ but not in boys (Graber et al., 1997). “Off-time” in pubertal development: ◦ associated with deviant social status and thus contributes to antisocial behavior (Williams and Dunlop,1999). ◦ Delayed pubertal onset Estrogen and testosterone administration increased aggression (Finkelstein et al., 1997). Developmental Pathway (Loeber and Stouthamer-Loeber, 1998): Pathways to serious conduct and delinquent problem behavior: ◦ Behavioral development of a group of individuals that is different from the behavioral development of another group or other groups of individuals. ◦ Overt Pathway: Minor aggression to physical fighting and then violence ◦ Covert Pathway: Before age 15 Minor covert behaviors to property damage (fire setting or vandalism), and then Moderate to serious forms of delinquency ◦ Authority Conflict Pathway: Before age 12 From stubborn behavior to defiance Authority avoidance Latimer et al., 2012: ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Prenatal cigarette smoking and alcohol use, Prenatal viral illness, Maternal stress and anxiety, Low birthweight, Peripartum and early neonatal complications, Parental stress and parenting styles in infancy, Early deprivation, Adoption and Separation. Prevention ◦ ◦ ◦ ◦ ◦ (Burke et al., 2002; Coie and Jacobs, 1993; Loeber and Farrington, 1998): Parent-directed component Social-cognitive skills training Academic skills training Proactive classroom management Teacher training Interventions on parenting factors: ◦ Focus is on multiple domains and needs (Catalano et al., 1998) Individual Intervention (Brestan and Eyberg, 1998): ◦ Anger control/stress inoculation ◦ Assertiveness training ◦ Rational-emotional therapy ◦ Problem-solving skills training (Kazdin, 1996; Webster-Stratton and Hammond, 1997) ◦ Moral development interventions (Arbuthnot, 1992) Parent and Family Treatment: Integration of universal, targeted, and clinical intervention strategies Multisystemic Therapy (MST) ◦ Parent management training (Brestan and Eyberg, 1998) ◦ Parent child interaction training (Schuhmann et al., 1998) 1998) (Offord et al., In order to best deal with a youth in trouble, treatment must target the many "systems" that impact the youth: • • • • Family, School environment, Friendships and, Peer pressures. Works closely with the parents and child for 3-5 months in their home and community. ◦ Emphasizes recognized risk factors associated with antisocial behavior. ◦ Goal-oriented and focuses on helping the caregivers manage and nurture their challenging children more effectively. Project LIFT (Reid et al, 1999) Parent training + classroom social skills + playground behavior + systematic communication Psychopharmacological Treatment ◦ ◦ ◦ ◦ Mood stabilizers, Antipsychotics, Clonidine, Stimulants (Burke, 2002) Anderson, K.E., Lytton, H., Romney, D.M.: Mothers’ interactions with normal and conduct-disordered boys: who affects whom? Developmental Psychology 1986; 22:604–609. Arbuthnot, J. (1992), Sociomoral reasoning in behavior-disordered adolescents: cognitive and behavioral change. In : Preventing Antisocial Behavior: Interventions From Birth Through Adolescence, McCord J, Tremblay RE, eds. New York: Guilford, pp 283–310. Arsten, A. F. ( 2006). Fundamentals of attention-deficit/hyperactivity disorder: Circuits and pathways. Journal of Clinical Psychiatry, 67 ( Suppl. 8), 7– 12. Bartels, M., Hudziak, J.J., van den Oord, E.J., van Beijsterveldt, C.E., Rietveld, M.J., Boomsma, D.I. (2003), Co-occurrence of aggressive behavior and rule breaking behavior at age 12: multi-rater analyses. Behavioral Genetics 33:607–621. Baving, L., Laucht, M., Schmidt, M.H. (2000), Oppositional children differ from healthy children in frontal brain activation . Journal of Abnormal Child Psychology 28:267–275. Booth, A., Granger, D. A., & Shirtcliff, E. A. (2008). Gender‐and Age‐Related Differences in the Association Between Social Relationship Quality and Trait Levels of Salivary Cortisol. Journal of Research on Adolescence, 18(2), 239-260. Brestan, E.V., Eyberg, S.M. (1998), Effective psychosocial treatments of conduct- disordered children and adolescents: 29 years, 82 studies, and 5272 kids. Journal of Clinical Child Psychology 27:180–189. Burke, J.D., Loeber, R., Lahey, B.B., & Rathouz, P.J (2005). Development al transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46, 1200-1210. Burt, S.A., Krueger, R.F., McGue, M., Iacono, W.G.(2001), Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant dis- order, and conduct disorder: the importance of shared environment. Journal of Abnormal Psychology 110:516– 525. Catalano, R.F., Arthur, M.W., Hawkins, J.D., Berglund, L., Olson, J.J. (1998), Comprehensive community- and school-based interventions to prevent antisocial behavior. In: Serious and Violent Juvenile Offenders: Risk Factors and Successful Intervention , Loeber R, Farrington DP, eds. Thousands Oaks, CA: Sage, pp 248–283. Coie, J.D., Jacobs, M.R. (1993) The role of social context in the prevention of conduct disorder. Developmental Psychopathology 5:263– 275. Dick, D.M., Viken, R.J., Kaprio, J., Pulkkinen, L., Rose, R.J. (2005), Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder, Attention Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder Symptoms. Journal of Abnormal Child Psychology 33: 219-228. Dumas, J.E., LaFreniere, P.J.: Mother-child relationships as sources of support or stress: a comparison of competent, average, aggressive, and anxious dyads. Child Development 1993; 64:1732–1754. Dumas, J.E., LaFreniere, P.J., Serketich, W.J.: “Balance of power”: a transactional analysis of control in mother-child dyads involving socially competent, aggressive, and anxious children. Journal of Abnormal Psychology 1995; 104:104–113. Eaves ,L., Rutter, M., Silberg, J.L., Shillady, L., Maes, H., Pickles, A. (2000), Genetic and environmental causes of covariation in interview assessments of disruptive behavior in child and adolescent twins. Behavioral Genetics 30:321–334. Deater-Deckard, K. (2000), Parenting and child behavioral adjustment in early childhood: a quantitative genetic approach to studying family processes. Child Dev 71:468–484. Eddy, J.M., Leve, L.D., Fagot, B.I. (2001), Coercive family processes: a replication and extension of Patterson’s coercion model. Aggressive Behavior 27:14–25. Elliott, D.S., Menard, S. (1996), Delinquent friends and delinquent behavior: temporal and developmental patterns. In: Delinquency and Crime: Current Theories, Hawkins JD, ed. New York: Cambridge University Press, pp 28–67. Farrington, D.P., Jolliffe, D., Loeber, R., Stouthamer-Loeber, M., Kalb, L.M. (2001), The concentration of offenders in families, and family criminality in the prediction of boys’ delinquency. Journal of Adolescents 24:579–596. Fergusson, D. M., Horwood, L. J. & Lynskey,M. T. (1994) Parental separation, adolescent psychopathology, and problem behaviors. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 1122–1131. Fergusson, D.M., Lynskey, M.T., Horwood, L.J. (1997), The effects of unemployment on juvenile offending. Criminal Behavior and Mental Health 7:49–68. Finkelstein, J.W., Susman, E.J., Chinchilli, V.M. al. (1997), Estrogen or testosterone increases self-reported aggressive behaviors in hypogonadal adolescents. Journal of Clinical Endocrinology and Metabolism 82:2433-2438. Graber, J.A., Lewinsohn, P.M., Seeley, J.R., Brooks-Gunn, J. (1997), Is psychopathology associated with the timing of pubertal development? Journal of American Academic Child Adolescent Psychiatry 36:1768–1776. Guerra, N.G., Huesmann, L.R., Tolan, P.H., Van Acker, R., Eron, L.D. (1995), Stressful events and individual beliefs as correlates of economic disadvantage and aggression among urban children. Journal of Consultation Clinical Psychology 63:518–528. Hamilton, S.S., & Armando, J. (2008). Oppositional Defiant Disorder. American Family Physician,78., 861-866. Hawkins, J.D., Herrenkohl, T., Farrington, D.P., Brewer, D., Catalano, R.F., Harachi, T.W. (1998), A review of predictors of youth violence. In: Serious and Violent Juvenile Offenders: Risk Factors and Successful Intervention , Loeber R, Farrington DP, eds. Thousands Oaks, CA: Sage, pp 107–146. Herrenkohl, T.I., Maguin, E., Hill, K.G., Hawkins, J.D., Abbott, R.D., Catalano, R.F. (2000), Developmental risk factors for youth violence. Journal of Adolescent Health 26:176–186. Hill, S. Y., Lowers, L., Locke-Wellman, J. & Shen, S. A. (2000) Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. Journal of Studies on Alcohol, 61, 661–668. Kazdin, A.E. (1996), Problem solving and parent management in treating aggressive and antisocial behavior. In: Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice,Hibbs ED, Jensen PS, eds. Washington, DC: American Psychological Association, pp 377–408. Lahey, B.B., Loeber, R., Quay, H.C., Applegate, B., Shaffer, D., Waldman, I., Hart, E.L., McBurnet, K., Frick, P.J., Jensen, P.S., Dulcan, M.K., Canino, G., Bird, HR. (1998), Validity of DSM-IV subtypes of conduct disorder based on age of onset. Journal of the American Academy of Child and Adolescent Psychiatry 37:435–442. Lahey, B.B., Loeber, R., Quay, H.C., Frick, P.J., Grimm, J. (1997), Oppositional defiant disorder and conduct disorder. In DSMIV Sourcebook, Vol 3, Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Davis W, eds. Washington DC: American Psychiatric Association, pp 189–209. Landgren, M., Kjellman, B. & Gillberg, C. (1998) Attention deficit disorder with developmental coordination disorders. Archives of Disease in Childhood, 79, 207–212. Loeber, R., Stouthamer-Loeber, M. (1998), The development of juvenile aggression and violence: some common misconceptions and controversies. American Psychology 53:242–259. Lytton, H.: Child and parent effects on boys’ conduct disorder: a reinterpretation. Developmental Psychology 1990; 26:683– 697. McLoyd, V.C. (1998), Socioeconomic disadvantage and child development. American Psychology 53:185–204. Mellins, C. A., Brackis-Cott, E., Dolezal, C. & Abrams, E. J. (2006) Psychiatric disorders in youth with perinatally acquired human immunodeficiency virus infection. Pediatric Infectious Disease Journal, 25, 432–437. Nigg, J., Nikolas, M., Friderici, K., Park, L., Zucker, R.A. (2007) Genotype and Neuropsychological response inhibition as resilience promoters for attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder under conditions of psychosocial adversity. Development and Psychopathology 19: 767-786. Offord, D.R., Kraemer, H.C., Kazdin, A.E., Jensen, P.S., Harrington, R. (1998), Lowering the burden of suffering from child psychiatric disorder: trade- offs among clinical, targeted and universal interventions. Journal of American Academic Child Adolescent Psychiatry 37:686–694. Rey, J.M., Bashir, M.R., Schwarz, M., Richards, I.N., Plapp, J.M., Stewart, G.W.: Oppositional disorder: fact or fiction? Journal of American Academic Child Adolescent Psychiatry 1988; 27:157–162. Sanson, A., Prior, M. (1999), Temperament and behavioral precursors to oppositional defiant disorder and conduct disorder. In: Handbook of Disruptive Behavior Disorders, Quay HC, Hogan AE, eds. New York: Kluwer Academic/Plenum, pp 397–417. Schachar, R,J., Wachsmuth, R.: Oppositional disorder in children: a validation study comparing conduct disorder, oppositional disorder and normal control children. Journal of Child Psychological Psychiatry 1990; 31:1089–1102. Schuhmann, E.M., Foote, R.C., Eyberg, S.M., Boggs, S.R., Algina, J. (1998), Efficacy of parent–child interaction therapy: interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology 27:34-45 Shaw, D. S., Owens, E. B., Giovannelli, J. &Winslow, E. B. (2001) Infant and toddler pathways leading to early externalizing disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 36–43. Snyder, J.J., Patterson, G.R. (1995), Individual differences in social aggression: a test of a reinforcement model of socialization in the natural environment. Behavioral Therapy 26:371–391. Sonuga-Barke, E. J. S. & Rubia, K. (2008) Inattentive/overactive children with histories of profound institutional deprivation compared with standard ADHD cases: a brief report. Child: Care, Health and Development, 34, 596–602. Stattin, H., Magnusson, D. (1990), Pubertal Maturation in Female Development. Hillsdale, NJ: Erlbaum. Stevens, S. E., Sonuga-Barke, E. J. S., Kreppner, J. M., Groothues, C., Hawkins, A. & Rutter, M. (2008) Inattention/overactivity following early severe institutional deprivation: presentation and associations in early adolescence. Journal of Abnormal Child Psychology, 36, 385–398. Stormshak, E.A., Biederman, K.L., McMahon, R.J., Lengua, L.J. (2000), Parenting practices and child disruptive behavior problems in early elementary school. Journal of Clinical Child Psychology 29:17–29. Stormschak, E., Speltz, M., DeKlyen, M., Greenberg, M. (1995) Family inter- actions during clinical intake: a comparison of families of nor- mal or disruptive boys. Journal of Abnormal Child Psychology 25:345– 357. Sullivan, P. F.,Wells, J. E. & Bushnell, J. A. (1995) Adoption as a risk factor for mental disorders. Acta Psychiatrica Scandinavica, 92, 119–124. van Goozen S.H.M., Matthys W., Cohen-Kettenis P.T., Gispen-de Wied C., Wiegant V.M., Engeland, H.V. (1998), Salivary cortisol and cardiovascular activity during stress in oppositional-defiant disorder boys and normal controls. Biological Psychiatry 43:531– 539. Wasserman, G.A., Seracini, A.M. (2001), Family risk factors and interventions. In: Child Delinquents, Loeber R, Farrington DP, eds. Thousands Oaks, CA: Sage, pp 165–189. Zeanah, C. H., Smyke, A. T., Koga, S. F. & Carlson, E. (2005) Attachment in institutionalized and community children in Romania. Child Development, 76, 1015– 1028.