Theory and Research

Cognitive behavioral therapy (CBT) was created by two central figures, Albert Ellis and Aaron T. Beck, both of whom contributed uniquely to its contemporary formulation. Since its inception, CBT’s research and clinical applications have spanned thousands of scientific papers and assisted many more children, adolescents, and families. This chapter discusses CBT’s theoretical development and the differing and converging views of its central theorists and describes three major theoretical conceptualizations: rational-emotive behavior therapy, cognitive therapy, and a general model. This chapter then reviews CBT’s research effectiveness for a wide range of internalizing and externalizing disorders, including anxiety, depression, autism, oppositional defiant disorder, and attention-deficit/hyperactivity disorder. It concludes with a case study delineating the two major theoretical approaches.

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Emotion Dysregulation and Externalizing Spectrum Disorders

The Oxford Handbook of Emotion Dysregulation ◽

10.1093/oxfordhb/9780190689285.013.17 ◽

2019 ◽

pp. 236-247

Author(s):

Tiffany M. Shader ◽

Theodore P. Beauchaine

Keyword(s):

Emotion Dysregulation ◽

Externalizing Disorders ◽

Developmental Model ◽

Peer Influences ◽

Neighborhood Violence ◽

Number Of Children ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Trait Impulsivity ◽

And Function

As described in the literature for many years, a sizable number of children with hyperactive-impulsive and combined subtypes/presentations of attention-deficit/hyperactivity disorder (ADHD)—especially males—progress to more serious externalizing syndromes across development. Such outcomes include oppositional defiant disorder, conduct problems, delinquency, substance use disorders, and in some cases antisocial personality disorder, incarceration, and recidivism. This chapter summarizes a developmental model that emphasizes different contributions of trait impulsivity, a highly heritable, subcortically mediated vulnerability, versus emotion dysregulation, a highly socialized, cortically mediated vulnerability, to externalizing progression. According to this perspective, trait impulsivity confers vulnerability to all externalizing disorders, but this vulnerability is unlikely to progress beyond ADHD in protective environments. In contrast, for children who are reared under conditions of adversity—including poverty, family violence, deviant peer influences, and neighborhood violence/criminality—neurodevelopment of prefrontal cortex structure and function is compromised, resulting in failures to achieve age-expected gains in emotion regulation and other forms of executive control. For these children, subcortical vulnerabilities to trait impulsivity are amplified by deficient cortical modulation, which facilitates progression along the externalizing spectrum.

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ADHD, ODD, and CD: Do They Belong to a Common Psychopathological Spectrum? A Case Series

Case Reports in Psychiatry ◽

10.1155/2012/520689 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Sayanti Ghosh ◽

Mausumi Sinha

Keyword(s):

Conduct Disorder ◽

Past History ◽

Case Series ◽

Externalizing Disorders ◽

Developmental Pathways ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Symptom Profile ◽

History Of ◽

Shared Risk

Purpose of Research. Numerous studies have reported comorbidities, overlapping symptoms, and shared risk factors among cases of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD). We present three adolescent males aged 13–16 years with conduct disorder having past history of ADHD and ODD.Principal Result. The symptom profile especially in domains of aggression, hostility, and emotionality as well as the manner of progression from ADHD to ODD and CD in the above cases shows a similar pattern.Conclusion. These common developmental pathways and overlapping symptoms suggest the possibility of a common psychopathological spectrum encompassing the three externalizing disorders.

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Reward-Related Dysfunctions in Children Developing Attention Deficit Hyperactivity Disorder—Roles of Oppositional and Callous-Unemotional Symptoms

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.738368 ◽

2021 ◽

Vol 12 ◽

Author(s):

Susan Schloß ◽

Friederike Derz ◽

Pia Schurek ◽

Alisa Susann Cosan ◽

Katja Becker ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Electrodermal Activity ◽

Externalizing Disorders ◽

Approach Motivation ◽

Autonomic Reactivity ◽

Hyperactivity Disorder ◽

Cu Traits ◽

Callous Unemotional ◽

Oppositional Defiant

Objectives: Neurocognitive functions might indicate specific pathways in developing attention deficit hyperactivity disorder (ADHD). We focus on reward-related dysfunctions and analyze whether reward-related inhibitory control (RRIC), approach motivation, and autonomic reactivity to reward-related stimuli are linked to developing ADHD, while accounting for comorbid symptoms of oppositional defiant disorder (ODD), and callous-unemotional (CU) traits.Methods: A sample of 198 preschool children (115 boys; age: m = 58, s = 6 months) was re-assessed at age 8 years (m = 101.4, s = 3.6 months). ADHD diagnosis was made by clinical interviews. We measured ODD symptoms and CU traits using a multi-informant approach, RRIC (Snack-Delay task, Gift-Bag task) and approach tendency using neuropsychological tasks, and autonomic reactivity via indices of electrodermal activity (EDA).Results: Low RRIC and low autonomic reactivity were uniquely associated with ADHD, while longitudinal and cross-sectional links between approach motivation and ADHD were completely explained by comorbid ODD and CU symptoms.Conclusion: High approach motivation indicated developing ADHD with ODD and CU problems, while low RRIC and low reward-related autonomic reactivity were linked to developing pure ADHD. The results are in line with models on neurocognitive subtypes in externalizing disorders.

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Child and Adolescent Psychiatry

10.1093/med/9780199326075.003.0015 ◽

2014 ◽

Cited By ~ 1

Author(s):

Daniel T. Chrzanowski ◽

Elisabeth B. Guthrie ◽

Matthew B. Perkins ◽

Moira A. Rynn

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Children And Adolescents ◽

Attention Deficit ◽

Neurodevelopmental Disorders ◽

Externalizing Disorders ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Multiple Informants ◽

Hyperactivity Disorder ◽

Oppositional Defiant

Common disorders of children and adolescents include neurodevelopmental disorders (e.g., intellectual disability, autistic spectrum disorder, and learning disorders), internalizing disorders (e.g., mood and anxiety disorders), and externalizing disorders (e.g., oppositional defiant disorder and conduct disorder). The assessment of a child or adolescent patient always includes multiple informants, the context in which the child’s difficulties occur, and a functional behavioral assessment. Patients with autism spectrum disorder tend to have persistent deficits in social communication and social interaction, a restricted repertoire of behaviors and interests, and abnormal cognitive functioning. Children with disruptive mood dysregulation disorder experience chronic and severe irritability and frequent temper outbursts. Attention deficit hyperactivity disorder is characterized by hyperactivity, impulsivity, and inattention before 12 years of age. Behavior therapy has been effectively used to treat children and adolescents with neurodevelopmental disorders, attention deficit hyperactivity disorder, tic disorders, feeding and elimination disorders, and externalizing disorders. Fluoxetine is approved for treatment of depression in children and escitalopram, for adolescents. Methylphenidate and amphetamine preparations are first-line treatment for children with attention deficit hyperactivity disorder.

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Severity of symptomatology and subtypes in ADHD children with comorbid oppositional defiant and conduct disorders

International Journal on Disability and Human Development ◽

10.1515/ijdhd-2012-0106 ◽

2013 ◽

Vol 12 (3) ◽

Author(s):

Michela Di Trani ◽

Francesca Di Roma ◽

Maria Cristina Scatena ◽

Renato Donfrancesco

Keyword(s):

Sources of covariation among the child-externalizing disorders: informant effects and the shared environment

Psychological Medicine ◽

10.1017/s0033291705004770 ◽

2005 ◽

Vol 35 (8) ◽

pp. 1133-1144 ◽

Cited By ~ 54

Author(s):

S. ALEXANDRA BURT ◽

MATT McGUE ◽

ROBERT F. KRUEGER ◽

WILLIAM G. IACONO

Keyword(s):

Environmental Factors ◽

Genetic Factors ◽

Family Members ◽

Relative Weight ◽

Externalizing Disorders ◽

Shared Environment ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Co Morbidity ◽

Informant Effects

Background. Research has documented high levels of co-morbidity among childhood externalizing disorders, but its etiology remains in dispute. Specifically, although all behavior genetic studies of the etiology of the co-occurrence of attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) agree that genetic factors are important, differences exist across studies in the relative weight assigned to genetic, shared environmental factors (i.e. factors that increase similarity among family members), and non-shared environmental factors (i.e. factors that decrease similarity among family members). Because heritability estimates can vary across informants, we used a biometric informant-effects model to determine whether these discrepancies were a function of systematic differences in maternal and child informant reports of ADHD, CD, and ODD.Method. We studied 1782 11-year-old twins from the Minnesota Twin Family Study. Symptom counts for each disorder were obtained from interviews administered to twins and their mothers. We fit a model that allowed us to examine, both across and within informants, the genetic and environmental contributions to the co-occurrence among ADHD, CD, and ODD.Results. The results revealed that the co-occurrence among the disorders common to maternal and child informant reports was influenced largely by shared environmental forces. Genetic factors also contributed, though their impact was only marginally significant. In contrast, the co-occurrence unique to each informant was influenced exclusively by either genetic or non-shared environmental factors.Conclusions. Such findings offer additional evidence that shared environmental factors are important to the co-morbidity among ADHD, CD, and ODD, and highlight the necessity of considering informant effects when drawing conclusions about the origins of co-morbidity from analyses of genetically informative data.

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Effectiveness of Psychoanalytic Psychotherapy and Behavioral Therapy Treatment in Children with Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder

Journal of Infant Child and Adolescent Psychotherapy ◽

10.1080/15289168.2015.1014991 ◽

2015 ◽

Vol 14 (2) ◽

pp. 111-128 ◽

Cited By ~ 7

Author(s):

Katrin Luise Laezer

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Oppositional Defiant Disorder ◽

Attention Deficit ◽

Behavioral Therapy ◽

Psychoanalytic Psychotherapy ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Therapy Treatment

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Autism and Migraine: An Unexplored Association?

Brain Sciences ◽

10.3390/brainsci10090615 ◽

2020 ◽

Vol 10 (9) ◽

pp. 615 ◽

Cited By ~ 2

Author(s):

Luigi Vetri

Keyword(s):

Psychotic Disorders ◽

Autism Spectrum ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Genetic Abnormalities ◽

Gastrointestinal Problems ◽

The Common ◽

Anxiety Depression

Autism spectrum disorder is characterized by neurological, psychiatric and medical comorbidities—some conditions co-occur so frequently that comorbidity in autism is the rule rather than the exception. The most common autism co-occurring conditions are intellectual disability, language disorders, attention-deficit hyperactivity disorder, epilepsy, gastrointestinal problems, sleep disorders, anxiety, depression, obsessive-compulsive disorder, psychotic disorders, oppositional defiant disorder, and eating disorders. They are well known and studied. Migraine is the most common brain disease in the world, but surprisingly only a few studies investigate the comorbidity between autism and migraine. The aim of this narrative review is to explore the literature reports about the comorbidity between autism and migraine and to investigate the common neurotransmitter, immune, anatomical and genetic abnormalities at the base of these two conditions.

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Characterizing Underlying Cognitive Components of ADHD Presentations and Co-morbid Diagnoses: A Diffusion Decision Model Analysis

Journal of Attention Disorders ◽

10.1177/10870547211020087 ◽

2021 ◽

pp. 108705472110200

Author(s):

Nadja R. Ging-Jehli ◽

L. Eugene Arnold ◽

Michelle E. Roley-Roberts ◽

Roger deBeus

Keyword(s):

Information Integration ◽

Performance Test ◽

Behavioral Therapy ◽

Continuous Performance Test ◽

Presentation Modality ◽

Children With Adhd ◽

Hyperactivity Disorder ◽

Cognitive Components ◽

Oppositional Defiant ◽

Response Biases

Objective: To Explore whether subtypes and comorbidities of attention-deficit hyperactivity disorder (ADHD) induce distinct biases in cognitive components involved in information processing. Method: Performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared between 150 children (aged 7 to 10) with ADHD, grouped by DSM-5 presentation (ADHD-C, ADHD-I) or co-morbid diagnoses (anxiety, oppositional defiant disorder [ODD], both, neither), and 60 children without ADHD. Diffusion decision modeling decomposed performance into cognitive components. Results: Children with ADHD had poorer information integration than controls. Children with ADHD-C were more sensitive to changes in presentation modality (auditory/visual) than those with ADHD-I and controls. Above and beyond these results, children with ADHD+anxiety+ODD had larger increases in response biases when targets became frequent than children with ADHD-only or with ADHD and one comorbidity. Conclusion: ADHD presentations and comorbidities have distinct cognitive characteristics quantifiable using DDM and IVA-CPT. We discuss implications for tailored cognitive-behavioral therapy.

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Attention Deficit and Disruptive Behavior Disorder Symptoms

European Journal of Psychological Assessment ◽

10.1027//1015-5759.17.1.25 ◽

2001 ◽

Vol 17 (1) ◽

pp. 25-35 ◽

Cited By ~ 8

Author(s):

G. Leonard Burns ◽

James A. Walsh ◽

David R. Patterson ◽

Carol S. Holte ◽

Rita Sommers-Flanagan ◽

...

Keyword(s):

Attention Deficit ◽

Rating Scales ◽

Behavior Disorder ◽

Disruptive Behavior Disorder ◽

Subjective Rating ◽

Time Interval ◽

Assessment Procedure ◽

Frequency Count ◽

Hyperactivity Disorder ◽

Oppositional Defiant

Summary: Rating scales are commonly used to measure the symptoms of attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). While these scales have positive psychometric properties, the scales share a potential weakness - the use of vague or subjective rating procedures to measure symptom occurrence (e. g., never, occasionally, often, and very often). Rating procedures based on frequency counts for a specific time interval (e. g., never, once, twice, once per month, once per week, once per day, more than once per day) are less subjective and provide a conceptually better assessment procedure for these symptoms. Such a frequency count procedure was used to obtain parent ratings on the ADHD, ODD, and CD symptoms in a normative (nonclinical) sample of 3,500 children and adolescents. Although the current study does not provide a direct comparison of the two types of rating procedures, the results suggest that the frequency count procedure provides a potentially more useful way to measure these symptoms. The implications of the results are noted for the construction of rating scales to measure the ADHD, ODD, and CD symptoms.

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