Oppositional defiant disorder

Last updated
Oppositional defiant disorder
Specialty Paediatrics, Psychology
Symptoms Recurrent patterns of negative, hostile, or defiant behavior towards authority figures
Complications Enforcement action
Usual onsetChildhood or adolescence (can become evident before 8 years of age)
DurationIs diagnosed until 18 years of age
CausesInsufficient care for the affected child during early development
Risk factors ADHD
Differential diagnosis Conduct disorder, disruptive mood dysregulation disorder, attention-deficit hyperactivity disorder, bipolar disorder, autism spectrum disorder, a psychotic disorder, borderline personality disorder, major depressive disorder, antisocial personality disorder
TreatmentMedication, Cognitive behavioral therapy, family therapy, intervention (counseling)
Medication
Prognosis Poor unless professionally treated
Frequency~3%

Oppositional defiant disorder (ODD) [1] is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness". [2] This behavior is usually targeted toward peers, parents, teachers, and other authority figures, including law enforcement officials. [3] Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit. [4] One-half of children with ODD also fulfill the diagnostic criteria for ADHD. [5] [6] [7]

Contents

History

Oppositional defiant disorder was first defined in the DSM-III (1980). Since the introduction of ODD as an independent disorder, the field trials to inform its definition have included predominantly male subjects. [8] Some clinicians have debated whether the diagnostic criteria would be clinically relevant for use with women,[ citation needed ] and furthermore, some have questioned whether gender-specific criteria and thresholds should be included.[ citation needed ] Additionally, some clinicians have questioned the preclusion of ODD when conduct disorder is present. [9] According to Dickstein, the DSM-5 attempts to:

redefine ODD by emphasizing a "persistent pattern of angry and irritable mood along with vindictive behavior," rather than DSM-IV's focus exclusively on "negativistic, hostile, and defiant behavior." Although DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is "angry/irritable mood"—defined as "loses temper, is touchy/easily annoyed by others, and is angry/resentful." This suggests that the process of clinically relevant research driving nosology , and vice versa, has ensured that the future will bring greater understanding of ODD. [10]

Epidemiology

ODD is a pattern of negative, defiant, disobedient, and hostile behavior, and it is one of the most prevalent disorders from preschool age to adulthood. [11] This can include frequent temper tantrums, excessive arguing with adults, refusing to follow rules, purposefully upsetting others, getting easily irked, having an angry attitude, and vindictive acts. [12] Children with ODD usually begin showing symptoms around age 6 to 8, although the disorder can emerge in younger children too. Symptoms can last throughout teenage years. [12] The pooled prevalence is 3.6% up to age 18. [13]

Oppositional defiant disorder has a prevalence of 1–11%. [2] The average prevalence is approximately 3%. [2] Gender and age play an important role in the rate of the disorder. [2] ODD gradually develops and becomes apparent in preschool years, often before the age of eight years old. [2] [14] [15] However, it is very unlikely to emerge following early adolescence. [16]

There is a difference in prevalence between boys and girls, with a ratio of 1.4 to 1 before adolescence. [2] Other research suggests a 2:1 ratio. [17] Prevalence in girls tends to increase after puberty. [14] Researchers have found that the general prevalence of ODD throughout cultures remains constant. However, the gendered disparities in diagnoses is only seen in Western cultures. It is unknown whether this reflects underlying differences in incidence or under-diagnosis of girls. [18] Physical abuse at home is a significant predictor of diagnosis for girls only, and emotional responsiveness of parents is a significant predictor of diagnosis for boys only, which may have implications for how gendered socialization and received gender roles affect ODD symptoms and outcomes. [19]

Children from lower-income backgrounds are more likely to be diagnosed with ODD. [20] [21] The correlative link between low income and ODD diagnosis is direct in boys, but in girls, the link is more complex; the diagnosis is associated with specific parental techniques such as corporal punishment which are in turn linked to lower income households. This disparity may be linked to a more general tendency of boys and men to display more externalized psychiatric symptoms, and girls to display more internalized ones (such as self-harm or anorexia nervosa). [21]

African Americans and Latinos are more likely to receive diagnoses of ODD or other conduct disorders compared to non-Hispanic White youth with the same symptoms, who are more likely to be diagnosed with ADHD. [22] This has wide-ranging implications about the role of racial bias in how certain behaviors are perceived and categorized as either defiant or inattentive/hyperactive.

Prevalence of ODD and conduct disorder are significantly higher among children in foster care. One survey in Norway found that 14 percent met the criteria, and other studies have found a prevalence of up to 17 or even 29 percent. [23] [24] Low parental attachment and parenting style are strong predictors of ODD symptoms.

Earlier conceptions of ODD had higher rates of diagnosis. When the disorder was first included in the DSM-III, the prevalence was 25% higher than when the DSM-IV revised the criteria of diagnosis. [20] The DSM-V made more changes to the criteria, grouping certain characteristics together in order to demonstrate that people with ODD display both emotional and behavioral symptoms. [25] In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviors or other symptoms are directly related to the disorder or simply a phase in a child's life. [25] Consequently, future studies may find that there was also a decline in prevalence between the DSM-IV and the DSM-V.

Signs and symptoms

The fourth revision of the Diagnostic and Statistical Manual ( DSM-IV-TR ) (now replaced by DSM-5) states that a person must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for ODD. [9] These symptoms include:

These behaviors are mostly directed towards an authority figure such as a teacher or a parent. Although these behaviors can be typical among siblings, they must be observed with individuals other than siblings for an ODD diagnosis. [2] Children with ODD can be verbally aggressive. However, they do not display physical aggressiveness, a behavior observed in conduct disorder. [26] Furthermore, they must be perpetuated for longer than six months and must be considered beyond a normal child's age, gender and culture to fit the diagnosis. [27] [2] For children under five years of age, they must occur on most days over a period of six months. For children over five years of age, they must occur at least once a week for at least six months. [2] If symptoms are confined to only one setting, most commonly home, it is considered mild in severity. If it is observed in two settings, it is characterized as moderate, and if the symptoms are observed in three or more settings, it is considered severe. [2]

These patterns of behavior result in impairment at school or other social venues. [27] [2]

Etiology

There is no specific element that has yet been identified as directly causing ODD. Research looking precisely at the etiological factors linked with ODD is limited. The literature often examines common risk factors linked with all disruptive behaviors, rather than ODD specifically. Symptoms of ODD are also often believed to be the same as CD, even though the disorders have their own respective set of symptoms. When looking at disruptive behaviors such as ODD, research has shown that the causes of behaviors are multi-factorial. However, disruptive behaviors have been identified as being mostly due either to biological or environmental factors. [28]

Genetic influences

Research indicates that parents pass on a tendency for externalizing disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems. Research has also shown that there is a genetic overlap between ODD and other externalizing disorders. Heritability can vary by age, age of onset, and other factors. Adoption and twin studies indicate that 50% or more of the variance causing antisocial behavior is attributable to heredity for both males and females. ODD also tends to occur in families with a history of ADHD, substance use disorders, or mood disorders, suggesting that a vulnerability to develop ODD may be inherited. A difficult temperament, impulsivity, and a tendency to seek rewards can also increase the risk of developing ODD. New studies into gene variants have also identified possible gene-environment (G x E) interactions, specifically in the development of conduct problems. A variant of the gene that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behavior following threatening events. Brain imaging studies show patterns of arousal in areas of the brain that are associated with aggression in response to emotion-provoking stimuli. [29]

Prenatal factors and birth complications

Many pregnancy and birth problems are related to the development of conduct problems. Malnutrition, specifically protein deficiency, lead poisoning or exposure to lead, [30] and mother's use of alcohol or other substances during pregnancy may increase the risk of developing ODD. In numerous research, substance use prior to birth has also been associated with developing disruptive behaviors such as ODD. [31] [32] [33] [34] Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.

Neurobiological factors

Deficits and injuries to certain areas of the brain can lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have hypofunction in the part of the brain responsible for reasoning, judgment, and impulse control. [35] Children with ODD are thought to have an overactive behavioral activation system (BAS), and an underactive behavioral inhibition system (BIS). [36] The BAS stimulates behavior in response to signals of reward or non-punishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of non-reward or punishment. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions. [29]

Social-cognitive factors

As many as 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act. [29] Children with ODD have difficulty controlling their emotions or behaviors. In fact, students with ODD have limited social knowledge that is based only on individual experiences, which shapes how they process information and solve problems cognitively. This information can be linked with the social information processing model (SIP) that describes how children process information to respond appropriately or inappropriately in social settings. This model explains that children will go through five stages before displaying behaviors: encoding, mental representations, response accessing, evaluation, and enactment. However, children with ODD have cognitive distortions and impaired cognitive processes. This will therefore directly impact their interactions and relationship negatively. It has been shown that social and cognitive impairments result in negative peer relationships, loss of friendship, and an interruption in socially engaging in activities. Children learn through observational learning and social learning. Therefore, observations of models have a direct impact and greatly influence children's behaviors and decision-making processes. Children often learn through modeling behavior. Modeling can act as a powerful tool to modify children's cognition and behaviors. [28]

Environmental factors

Negative parenting practices and parent–child conflict may lead to antisocial behavior, but they may also be a reaction to the oppositional and aggressive behaviors of children. Factors such as a family history of mental illnesses and/or substance use disorders as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behavior disorders. [37] Parenting practices not providing adequate or appropriate adjustment to situations as well as a high ratio of conflicting events within a family are causal factors of risk for developing ODD. [28]

Insecure parent–child attachments can also contribute to ODD. Often little internalization of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance use. Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated. [29]

School is also a significant environmental context besides family that strongly influences a child's maladaptive behaviors. [38] Studies indicate that child and adolescent externalizing disorders like ODD are strongly linked to peer network and teacher response. [39] [40] Children with ODD present hostile and defiant behavior toward authority including teachers which makes teachers less tolerant toward deviant children. [39] The way in which a teacher handles disruptive behavior has a significant influence on the behavior of children with ODD. [41] Negative relationships from the socializing influences and support network of teachers and peers increases the risk of deviant behavior. This is because the child consequently gets affiliated with deviant peers that reinforce antisocial behavior and delinquency. [42] Due to the significant influence of teachers in managing disruptive behaviors, teacher training is a recommended intervention to change the disruptive behavior of ODD children. [43] [44]

In a number of studies, low socioeconomic status has also been associated with disruptive behaviors such as ODD. [45] [46]

Other social factors such as neglect, abuse, parents that are not involved, and lack of supervision can also contribute to ODD. [1]

Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods. [29] Studies have also found that the state of being exposed to violence was a contribution factor for externalizing behaviors to occur. [45] [46] [47]

Diagnosis

For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Such interference might manifest as challenges in learning at school, making friends, or placing the individual in harmful situations. These behaviors must also persist for at least six months. It is crucial to consider the bio-socio complexity in the expression and management of ODD. Biological factors such as genetics and neurodevelopmental variations interact with social factors like family dynamics, educational practices, and societal norms to influence the manifestation and recognition of ODD symptoms. The effects of ODD can be amplified by other disorders in comorbidity such as ADHD, depression, and substance use disorders. This intricate interplay between biological predispositions and social factors can lead to diverse clinical presentations, affecting the approaches to treatment and support.

Additionally, it has been observed that adults who were diagnosed with ODD as children tend to have a higher chance of being diagnosed with other mental illnesses in their lifetime, as well as being at a higher risk of developing social and emotional problems. This suggests that longitudinal support and intervention, taking into account the individual's biological makeup and social context, are vital for improving long-term outcomes for those with ODD.

Management

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. [48] [49] According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents. [48]

Children with oppositional defiant disorder tend to exhibit problematic behavior that can be very difficult to control. [50] An occupational therapist can recommend family based education referred to as parent management training (PMT) in order to encourage positive parents and child relationships and reduce the child's tantrums and other disruptive behaviors. [51] Since ODD is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy. [52]

Psychopharmacological treatment

Psychopharmacological treatment is the use of prescribed medication in managing oppositional defiant disorder. Prescribed medications to control ODD include mood stabilizers, anti-psychotics, and stimulants. In two controlled randomized trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. However, a third study found the treatment of lithium over a period of two weeks invalid. [53] Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity.

The effectiveness of drug and medication treatment is not well established. Effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. Psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention. [53]

Individual interventions

Individual interventions are focused on child-specific individualized plans. These interventions include anger control/stress inoculation, assertiveness training, a child-focused problem-solving skills training program, and self-monitoring skills. [53]

Anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. They include a process of steps the child may go through.

Assertiveness training educates individuals in keeping a balance between passivity and aggression. It aims to help the child respond in a controlled and fair manner.

A child-focused problem-solving skills training program aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions.

Parent and family treatment

According to randomized trials, evidence shows that parent management training is most effective. [49] It has strong influences over a long period of time and in various environments. [53]

Parent-child interaction training is intended to coach the parents while involving the child. This training has two phases; the first phase is child-directed interaction, where the focus is to teach the child non-directive play skills. The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. The parent-child interaction training is best suited for elementary-aged children. [53]

Parent and family treatment has a low financial cost, which can yield an increase in beneficial results. [53]

Multimodal intervention

Multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighborhood. It is an intervention that concentrates on multiple risk factors. The focus is on parent training, classroom social skills, and playground behavior programs. The intervention is intensive and addresses barriers to individuals' improvement such as parental substance use or parental marital conflict. [53]

An impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or adhered to for adequate periods of time. [53]

Comorbidity

Oppositional defiant disorder can be described as a term or disorder with a variety of pathways in regard to comorbidity. High importance must be given to the representation of ODD as a distinct psychiatric disorder independent of conduct disorder. [54]

In the context of oppositional defiant disorder and comorbidity with other disorders, researchers often conclude that ODD co-occurs with an attention deficit hyperactivity disorder (ADHD), anxiety disorders, emotional disorders as well as mood disorders. [55] Those mood disorders can be linked to major depression or bipolar disorder. Indirect consequences of ODD can also be related or associated with a later mental disorder. For instance, conduct disorder is often studied in connection with ODD. Strong comorbidity can be observed within those two disorders, but an even higher connection with ADHD in relation to ODD can be seen. [55] For instance, children or adolescents who have ODD with coexisting ADHD will usually be more aggressive and have more of the negative behavioral symptoms of ODD, which can inhibit them from having a successful academic life. This will be reflected in their academic path as students. [1]

Other conditions that can be predicted in children or people with ODD are learning disorders in which the person has significant impairments with academics and language disorders, in which problems can be observed related to language production and/or comprehension. [1]

Criticism

Oppositional defiant disorder's validity as a diagnosis has been criticized since its inclusion in the DSM III in 1980. [56] [8] ODD was considered to produce minor impairment insufficient to qualify as a medical diagnosis, and was difficult to separate from conduct disorder, with some estimates that over 50% of those diagnosed with conduct disorder would also meet criteria for ODD. The diagnosis of ODD was also criticized for medicalizing normal developmental behavior. To address these problems, the DSM-III-R dropped the criterion of swearing and changed the cutoff from five of nine criteria, to four of eight. Most evidence indicated a dose–response relationship between the severity of symptoms and level of functional impairment, suggesting that the diagnostic threshold was arbitrary. Early field trials of ODD used subjects who were over 75% male. [8]

Recent criticisms of ODD suggest that the use of ODD as a diagnosis exacerbates the stigma surrounding reactive behavior and frames normal reactions to trauma as personal issues of self-control. [57] Anti-psychiatry scholars have extensively criticized this diagnosis through a Foucauldian framework, characterizing it as a tool of the psy apparatus which pathologizes resistance to injustice. [58] Oppositional defiant disorder has been compared to drapetomania, a now-obsolete disorder proposed by Samuel A. Cartwright which characterized slaves in the Antebellum South who repeatedly tried to escape as being mentally ill. [59] [60]

Race and gender bias in the US

Research has shown that African Americans and Latino Americans are disproportionately likely to be diagnosed with ODD compared to White counterparts displaying the same symptoms, who are more likely to be diagnosed with ADHD. [61] [62] [63] [22] Assessment, diagnosis and treatment of ODD may not account for contextual problems experienced by the patient, and can be influenced by cultural and personal racial bias on the part of counselors and therapists. Many children diagnosed with ODD were, upon reassessment, found to better fit diagnoses of obsessive–compulsive disorder, bipolar disorder, attention deficit hyperactivity disorder, or anxiety disorder. Diagnoses of ODD or conduct disorder are not eligible for disability accommodation at school under the Individuals with Disabilities Education Act. [64] When parents request accommodation for a diagnosed disorder which is eligible, such as ADHD, the request can be denied on the basis that such conditions are co-morbid with ODD. [64] This bias in perception and diagnosis leads to defiant behaviors being medicalized and rehabilitated in White children, but criminalized for Latino and African American ones. [65] Counselors working with children diagnosed with ODD reported that it was common for them to face stigma around the diagnosis in educational and justice systems, and that the diagnosis affected patients' self image. [61] In one study over a quarter of children placed in the foster care system in the United States were found to have been diagnosed with ODD. [24] Over half of children in the juvenile justice system have been diagnosed with ODD. [64]

Latina women may be disproportionately impacted by the diagnosis of ODD because of the difference between Latino and White conceptions of femininity and appropriate feminine behavior. [24]

African American males are known to be more likely to be suspended or expelled from school, receive harsher sentences for the same offenses as defendants of different races, or be searched, assaulted or killed by police officers. [66] [67] [68] The disproportionately high diagnosis of ODD in AA males may be used to rationalize these outcomes. [61] In this manner, ODD diagnoses can serve as a mechanism of the school-to-prison pipeline. From this viewpoint, the ODD diagnosis frames expected reactions to injustice or trauma as defiant or criminal. [61] [24]

See also

Related Research Articles

<span class="mw-page-title-main">Attention deficit hyperactivity disorder</span> Neurodevelopmental disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by executive dysfunction occasioning symptoms of inattention, hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and otherwise age-inappropriate.

<span class="mw-page-title-main">Conduct disorder</span> Developmental disorder

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules, in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors", and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old. Conduct disorder may result from parental rejection and neglect and can be treated with family therapy, as well as behavioral modifications and pharmacotherapy. Conduct disorder is estimated to affect 51.1 million people globally as of 2013.

Antisocial personality disorder is a personality disorder characterized by a limited capacity for empathy and a long-term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity and reckless behavior, a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

Adult Attention Deficit Hyperactivity Disorder is the persistence of attention deficit hyperactivity disorder (ADHD) in adults. It is a neurodevelopmental disorder, meaning symptoms must have been present in childhood except for when ADHD occurs after a traumatic brain injury. Specifically, multiple symptoms must be present before the age of 12, according to DSM-5 diagnostic criteria. The cutoff age of 12 is a change from the previous requirement of symptom onset, which was before the age of 7 in the DSM-IV. This was done to add flexibility in the diagnosis of adults. ADHD was previously thought to be a childhood disorder that improved with age, but recent research has disproved this. Approximately two-thirds of childhood cases of ADHD continue into adulthood, with varying degrees of symptom severity that change over time, and continue to affect individuals with symptoms ranging from minor inconveniences to impairments in daily functioning.

Child psychopathology refers to the scientific study of mental disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and autism spectrum disorder are examples of psychopathology that are typically first diagnosed during childhood. Mental health providers who work with children and adolescents are informed by research in developmental psychology, clinical child psychology, and family systems. Lists of child and adult mental disorders can be found in the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), published by the World Health Organization (WHO) and in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association (APA). In addition, the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood is used in assessing mental health and developmental disorders in children up to age five.

School refusal is a child-motivated refusal to attend school or difficulty remaining in class for the full day. Child-motivated absenteeism occurs autonomously, by the volition of the child. This behavior is differentiated from non-child-motivated absences in which parents withdraw children from school or keep them home for circumstances such as homelessness. School refusal is characterized by avoidance and/or emotional distress at the time of attending school.

Cognitive disengagement syndrome (CDS) is an attention syndrome characterised by prominent dreaminess, mental fogginess, hypoactivity, sluggishness, slow reaction time, staring frequently, inconsistent alertness, and a slow working speed. To scientists in the field, it has reached the threshold of evidence and recognition as a distinct syndrome.

<span class="mw-page-title-main">Attention deficit hyperactivity disorder controversies</span> Controversies surrounding the topic of ADHDs nature, diagnosis, and treatment

Despite the scientifically well-established nature of attention deficit hyperactivity disorder (ADHD), its diagnosis, and its treatment, each of these has been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, stated that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.

Emotional and behavioral disorders refer to a disability classification used in educational settings that allows educational institutions to provide special education and related services to students who have displayed poor social and/or academic progress.

<span class="mw-page-title-main">Bipolar disorder in children</span>

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which people avoid eating certain foods, or restrict their diets to the point it ultimately results in nutritional deficiencies. This can be due to the sensory characteristics of food, such as its appearance, smell, texture, or taste; due to fear of negative consequences such as choking or vomiting; having little interest in eating or food, or a combination of these factors. People with ARFID may also be afraid of trying new foods, a fear known as food neophobia.

Joseph Biederman was Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School. Biederman was board-certified in general and child psychiatry.

<span class="mw-page-title-main">Disruptive mood dysregulation disorder</span> Medical condition

Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a type of depressive disorder diagnosis for youths. The symptoms of DMDD resemble many other disorders, thus a differential includes attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), anxiety disorders, and childhood bipolar disorder, intermittent explosive disorder (IED), major depressive disorder (MDD), and conduct disorder.

The Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP), developed by James Swanson, Edith Nolan and William Pelham, is a 90-question self-report inventory designed to measure attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in children and young adults.

The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.

The Disruptive Behavior Disorders Rating Scale (DBDRS) is a 45-question screening measure, completed by either parents or teachers, designed to identify symptoms of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder in children and adolescents.

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

Externalizing disorders are mental disorders characterized by externalizing behaviors, maladaptive behaviors directed toward an individual's environment, which cause impairment or interference in life functioning. In contrast to individuals with internalizing disorders who internalize their maladaptive emotions and cognitions, such feelings and thoughts are externalized in behavior in individuals with externalizing disorders. Externalizing disorders are often specifically referred to as disruptive behavior disorders or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders. Externalizing psychopathology is associated with antisocial behavior, which is different from and often confused for asociality.

References

  1. 1 2 3 4 eAACAP (2009). "ODD: A guide for Families" (PDF). The American Academy of Child and Adolescent Psychiatry (AACAP). Retrieved February 26, 2018.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 "Diagnostic Criteria 313.81 (F91.3)". Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. 2013. ISBN   978-0-89042-554-1.
  3. ↑ "Oppositional Defiant Disorder (ODD) in Children". www.hopkinsmedicine.org. Retrieved 2021-05-26.
  4. ↑ Nolen-Hoeksema S (2014). Abnormal Psychology. New York, NY: McGraw Hill. p. 323. ISBN   978-0-07-803538-8.
  5. ↑ Golubchik, Pavel, Shalev, Lilach, Tsamir, Dina, Manor, Iris, Weizman, Abraham. High pretreatment cognitive impulsivity predicts response of oppositional symptoms to methylphenidate in patients with attention-deficit hyperactivity disorder/oppositional defiant disorder. International Clinical Psychopharmacology. 2019;34(3):138-142. doi:10.1097/YIC.0000000000000252.
  6. ↑ Harvey EA, Breaux RP, Lugo-Candelas CI (2016). Early development of comorbidity between symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). J Abnorm Psychol125: 154–167.
  7. ↑ Waschbusch DA (2002). A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychol Bull128:118–150.
  8. 1 2 3 Ghosh, Abhishek; Ray, Anirban; Basu, Aniruddha (2017). "Oppositional defiant disorder: current insight". Psychology Research and Behavior Management. 10: 353–367. doi: 10.2147/PRBM.S120582 . ISSN   1179-1578. PMC   5716335 . PMID   29238235.
  9. 1 2 Pardini DA, Frick PJ, Moffitt TE (November 2010). "Building an evidence base for DSM-5 conceptualizations of oppositional defiant disorder and conduct disorder: introduction to the special section". Journal of Abnormal Psychology. 119 (4): 683–8. doi:10.1037/a0021441. PMC   3826598 . PMID   21090874.
  10. ↑ Dickstein DP (May 2010). "Oppositional defiant disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 49 (5): 435–6. doi:10.1097/00004583-201005000-00001. PMID   20431460.
  11. ↑ Crowe SL, Blair RJ (2008). "The development of antisocial behavior: what can we learn from functional neuroimaging studies?". Development and Psychopathology. 20 (4): 1145–59. doi:10.1017/S0954579408000540. PMID   18838035. S2CID   10049329.
  12. 1 2 Ehmke R (2019). "What is Oppositional Defiant Disorder?". Child Mind Institute.
  13. ↑ Ezpeleta, et al. (2019)
  14. 1 2 Fraser A, Wray J (June 2008). "Oppositional defiant disorder". Australian Family Physician. 37 (6): 402–405. PMID   18523691.
  15. ↑ Nock MK, Kazdin AE, Hiripi E, Kessler RC (July 2007). "Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: Results from the National Comorbidity Survey Replication". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 48 (7): 703–713. CiteSeerX   10.1.1.476.4197 . doi:10.1111/j.1469-7610.2007.01733.x. PMID   17593151.
  16. ↑ Rowe R, Costello EJ, Angold A, Copeland WE, Maughan B (November 2010). "Developmental pathways in oppositional defiant disorder and conduct disorder". Journal of Abnormal Psychology. 119 (4): 726–738. doi:10.1037/a0020798. PMC   3057683 . PMID   21090876.
  17. ↑ Demmer DH, Hooley M, Sheen J, McGillivray JA, Lum JA (February 2017). "Sex Differences in the Prevalence of Oppositional Defiant Disorder During Middle Childhood: a Meta-Analysis". Journal of Abnormal Child Psychology. 45 (2): 313–325. doi:10.1007/s10802-016-0170-8. PMID   27282758. S2CID   5457668.
  18. ↑ Demmer, David H.; Hooley, Merrilyn; Sheen, Jade; McGillivray, Jane A.; Lum, Jarrad A. G. (February 2017). "Sex Differences in the Prevalence of Oppositional Defiant Disorder During Middle Childhood: a Meta-Analysis". Journal of Abnormal Child Psychology. 45 (2): 313–325. doi:10.1007/s10802-016-0170-8. ISSN   1573-2835. PMID   27282758. S2CID   5457668.
  19. ↑ Burnette, Mandi L. (August 2013). "Gender and the Development of Oppositional Defiant Disorder: Contributions of Physical Abuse and Early Family Environment". Child Maltreatment. 18 (3): 195–204. doi:10.1177/1077559513478144. ISSN   1077-5595. PMID   23420295. S2CID   46731025.
  20. 1 2 Loeber R, Burke JD, Lahey BB, Winters A, Zera M (December 2000). "Oppositional defiant and conduct disorder: A review of the past 10 years, part I" (PDF). Journal of the American Academy of Child and Adolescent Psychiatry. 39 (12): 1468–1484. doi:10.1097/00004583-200012000-00007. PMID   11128323. S2CID   33898115. Archived from the original (PDF) on 2019-02-22.
  21. 1 2 Granero, Roser; Louwaars, Leonie; Ezpeleta, Lourdes (2015-09-24). "Socioeconomic status and oppositional defiant disorder in preschoolers: parenting practices and executive functioning as mediating variables". Frontiers in Psychology. 6: 1412. doi: 10.3389/fpsyg.2015.01412 . ISSN   1664-1078. PMC   4585310 . PMID   26441784.
  22. 1 2 Fadus, Matthew C.; Ginsburg, Kenneth R.; Sobowale, Kunmi; Halliday-Boykins, Colleen A.; Bryant, Brittany E.; Gray, Kevin M.; Squeglia, Lindsay M. (2020-02-01). "Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth". Academic Psychiatry. 44 (1): 95–102. doi:10.1007/s40596-019-01127-6. ISSN   1545-7230. PMC   7018590 . PMID   31713075.
  23. ↑ Lehmann, Stine; Havik, Odd E.; Havik, Toril; Heiervang, Einar R. (2013-11-21). "Mental disorders in foster children: a study of prevalence, comorbidity and risk factors". Child and Adolescent Psychiatry and Mental Health. 7 (1): 39. doi: 10.1186/1753-2000-7-39 . ISSN   1753-2000. PMC   3922948 . PMID   24256809.
  24. 1 2 3 4 Restrepo, Isabella C. (2019-12-01). "Pathologizing Latinas: Racialized Girlhood, Behavioral Diagnosis, and California's Foster Care System". Girlhood Studies. 12 (3): 1–17. doi:10.3167/ghs.2019.120303. ISSN   1938-8322. S2CID   210478952.
  25. 1 2 "Highlights of Changes from DSM-IV-TR to DSM-5" (PDF). American Psychiatric Association. 2013. pp. 1–19.
  26. 1 2 Craighead WE, Nemeroff CB, eds. (2004). "Oppositional defiant disorder". The concise Corsini encyclopedia of psychology and behavioral science (3rd ed.). Hoboken, NJ: Wiley.
  27. 1 2 Kaneshiro N. "Oppositional Defiant Disorder". A.D.A.M. Medical Encyclopedia. US: National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health . Retrieved 5 November 2011.
  28. 1 2 3 Goldstein S, DeVries M, eds. (September 2017). Handbook of DSM-5 disorders in children and adolescents. Cham: Springer International Publishing. ISBN   978-3-319-57196-6.
  29. 1 2 3 4 5 Mash EJ, Wolfe DA (2013). Abnormal Child Psychology (5th ed.). Belmont, CA: Wadsworth Cengage Learning. pp. 182–191.
  30. ↑ Gump BB, Dykas MJ, MacKenzie JA, Dumas AK, Hruska B, Ewart CK, et al. (October 2017). "Background lead and mercury exposures: Psychological and behavioral problems in children". Environmental Research. 158: 576–582. Bibcode:2017ER....158..576G. doi:10.1016/j.envres.2017.06.033. PMC   5562507 . PMID   28715786.
  31. ↑ Bada HS, Das A, Bauer CR, Shankaran S, Lester B, LaGasse L, et al. (February 2007). "Impact of prenatal cocaine exposure on child behavior problems through school age". Pediatrics. 119 (2): e348-59. doi:10.1542/peds.2006-1404. PMID   17272597. S2CID   24104255.
  32. ↑ Linares TJ, Singer LT, Kirchner HL, Short EJ, Min MO, Hussey P, Minnes S (January 2006). "Mental health outcomes of cocaine-exposed children at 6 years of age". Journal of Pediatric Psychology. 31 (1): 85–97. doi: 10.1093/jpepsy/jsj020 . PMC   2617793 . PMID   15802608.
  33. ↑ Russell AA, Johnson CL, Hammad A, Ristau KI, Zawadzki S, Villar LD, Coker KL (6 February 2015). "Prenatal and Neighborhood Correlates of Oppositional Defiant Disorder (ODD)". Child and Adolescent Social Work Journal. 32 (4): 375–381. doi:10.1007/s10560-015-0379-3. S2CID   145811128.
  34. ↑ Spears GV, Stein JA, Koniak-Griffin D (June 2010). "Latent growth trajectories of substance use among pregnant and parenting adolescents". Psychology of Addictive Behaviors. 24 (2): 322–32. doi:10.1037/a0018518. PMC   3008750 . PMID   20565158.
  35. ↑ Liu J, Zhu Y, Wu YZ (July 2008). "[Features of functional MRI in children with oppositional defiant disorder]". Zhong Nan da Xue Xue Bao. Yi Xue Ban = Journal of Central South University. Medical Sciences. 33 (7): 571–5. PMID   18667767.
  36. ↑ Eskander, Noha (2020). "The Psychosocial Outcome of Conduct and Oppositional Defiant Disorder in Children With Attention Deficit Hyperactivity Disorder". Cureus. 12 (8): e9521. doi: 10.7759/cureus.9521 . ISSN   2168-8184. PMC   7465825 . PMID   32905151.
  37. ↑ Miller G (16 December 2019). "I Thought My Child Was Just Misbehaving But It Was Really Oppositional Defiant Disorder". Parents. Retrieved 2019-12-18.
  38. ↑ Ding, W., Meza, J., Lin, X., He, T., Chen, H., Wang, Y. and Qin, S., 2019. Oppositional Defiant Disorder Symptoms and Children's Feelings of Happiness and Depression: Mediating Roles of Interpersonal Relationships. Child Indicators Research, 13(1), pp.215-235.
  39. 1 2 Samek, D. and Hicks, B., 2014. Externalizing disorders and environmental risk: mechanisms of gene–environment interplay and strategies for intervention. Clinical Practice, 11(5), pp.537-547.
  40. ↑ McDonald, K. and Gibson, C., 2017. Peer Rejection and Disruptive Behavioral Disorders. In: J. Lochman and W. Matthys, ed., The Wiley Handbook of Disruptive and Impulse‐Control Disorders. Wiley online library.
  41. ↑ de Zeeuw, E., van Beijsterveldt, C., Lubke, G., Glasner, T. and Boomsma, D., 2015. Childhood ODD and ADHD Behavior: The Effect of Classroom Sharing, Gender, Teacher Gender and Their Interactions. Behavior Genetics, 45(4), pp.394-408.
  42. ↑ Hawkins, J., Catalano, R. and Miller, J., 1992. Negative relationship from the socialising influences and support network of teachers and peers increases the risk of deviant behaviour. This is because the child gets affiliated with deviant peers that reinforce antisocial behaviour and delinquency. Psychol Bull., 112(1), pp.64-105.
  43. ↑ Ross, K., 2017. School Based Interventions for School-Aged Children with Oppositional Defiant Disorder: A Systematic Review. St. Catherine University.
  44. ↑ Reid, M., Webster-Stratton, C. and Hammond, M., 2003. Follow-up of children who received the incredible years intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34(4), pp.471-491.
  45. 1 2 Eiden RD, Coles CD, Schuetze P, Colder CR (March 2014). "Externalizing behavior problems among polydrug cocaine-exposed children: Indirect pathways via maternal harshness and self-regulation in early childhood". Psychology of Addictive Behaviors. 28 (1): 139–53. doi:10.1037/a0032632. PMC   4174429 . PMID   23647157.
  46. 1 2 Vanfossen B, Brown CH, Kellam S, Sokoloff N, Doering S (March 2010). "Neighborhood context and the development of aggression in boys and girls". Journal of Community Psychology. 38 (3): 329–349. doi:10.1002/jcop.20367. PMC   2915468 . PMID   20689683.
  47. ↑ White R, Renk K (1 February 2011). "Externalizing Behavior Problems During Adolescence: An Ecological Perspective". Journal of Child and Family Studies. 21 (1): 158–171. doi:10.1007/s10826-011-9459-y. S2CID   144507607.
  48. 1 2 "FAQs on Oppositional Defiant Disorder". Manhattan Psychology Group. Retrieved 2015-01-28.
  49. 1 2 Steiner H, Remsing L, et al. (The Work Group on Quality Issues) (January 2007). "Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (1): 126–141. doi:10.1097/01.chi.0000246060.62706.af. PMID   17195736.
  50. ↑ "Oppositional Defiant Disorder (ODD) In Children: Can OT Help Parents With Managing Difficult Behaviors?". Theracare. 19 September 2018. Retrieved 2021-05-03.
  51. ↑ Hood BS, Elrod MG, DeWine DB (2015-06-01). "Treatment of Childhood Oppositional Defiant Disorder". Current Treatment Options in Pediatrics. 1 (2): 155–167. doi: 10.1007/s40746-015-0015-7 . S2CID   145002993.
  52. ↑ Ghosh A, Ray A, Basu A (2017-11-29). "Oppositional defiant disorder: current insight". Psychology Research and Behavior Management. 10: 353–367. doi: 10.2147/prbm.s120582 . PMC   5716335 . PMID   29238235.
  53. 1 2 3 4 5 6 7 8 Burke JD, Loeber R, Birmaher B (November 2002). "Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II" (PDF). Journal of the American Academy of Child and Adolescent Psychiatry. 41 (11): 1275–93. doi:10.1097/00004583-200211000-00009. PMID   12410070. S2CID   6249949. Archived from the original (PDF) on 2019-02-19.
  54. ↑ Nock MK, Kazdin AE, Hiripi E, Kessler RC (July 2007). "Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 48 (7): 703–13. CiteSeerX   10.1.1.476.4197 . doi:10.1111/j.1469-7610.2007.01733.x. PMID   17593151.
  55. 1 2 Maughan B, Rowe R, Messer J, Goodman R, Meltzer H (March 2004). "Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 45 (3): 609–21. doi:10.1111/j.1469-7610.2004.00250.x. PMID   15055379.
  56. ↑ Rutter, M.; Shaffer, D. (1980). "DSM-III. A step forward or back in terms of the classification of child psychiatric disorders?". Journal of the American Academy of Child Psychiatry. 19 (3): 371–394. doi:10.1016/s0002-7138(09)61060-8. ISSN   0002-7138. PMID   7410749.
  57. ↑ Beltrán, Sourik; Sit, Lydia; Ginsburg, Kenneth R. (2021-11-01). "A Call to Revise the Diagnosis of Oppositional Defiant Disorder—Diagnoses Are for Helping, Not Harming". JAMA Psychiatry. 78 (11): 1181–1182. doi:10.1001/jamapsychiatry.2021.2127. ISSN   2168-622X. PMID   34379091. S2CID   236978057.
  58. ↑ Barnhart, Marisa (2018-01-02). "Oppositional Defiant Disorder: The Psy Apparatuses and Youth Resistance". Journal of Progressive Human Services. 29 (1): 6–27. doi:10.1080/10428232.2017.1394788. ISSN   1042-8232. S2CID   148628227.
  59. ↑ Myers, Dr Bob (2014). "Drapetomania": Rebellion, Defiance and Free Black Insanity in the Antebellum United States (Thesis). UCLA.
  60. ↑ Richman, Sheldon (2012-04-21). "The Medicalization of Rebellion". Reason.com. Retrieved 2023-07-17.
  61. 1 2 3 4 "The Process and Implications of Diagnosing Oppositional Defiant Disorder in African American Males - The Professional Counselor". 2016-07-20. Retrieved 2023-07-17.
  62. ↑ "Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Racial Bias". Insights of a Neurodivergent Clinician. Retrieved 2023-07-17.
  63. ↑ Morgan, Paul L.; Staff, Jeremy; Hillemeier, Marianne M.; Farkas, George; Maczuga, Steven (July 2013). "Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade". Pediatrics. 132 (1): 85–93. doi:10.1542/peds.2012-2390. ISSN   1098-4275. PMC   3691530 . PMID   23796743.
  64. 1 2 3 "Breaking the School-to-Prison Pipeline for Students with Disabilities" (PDF). National Council on Disability. June 18, 2015. Retrieved September 19, 2023.
  65. ↑ Ellis, Mary (2017-03-01). "Nancy A. Heitzeg: The School-to-Prison Pipeline: Education, Discipline, and Racialized Double Standards". Adolescent Research Review. 2 (1): 49–54. doi: 10.1007/s40894-016-0033-0 . ISSN   2363-8354.
  66. ↑ "Civil rights data collection: Data snapshot (School discipline)" (PDF). U.S. Department of Education Office for Civil Rights. 2014.
  67. ↑ Ghandnoosh, N (2014). "Race and punishment: Racial perceptions of crime and support for punitive policies" (PDF). The Sentencing Project.
  68. ↑ Gabrielson, Ryan; Sagara, Eric; Jones, Ryann Grochowski (2014-10-10). "Deadly Force, in Black and White". ProPublica.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.