Single Study on Collaborative and Proactive Solutions

Preschool Oppositional Defiant Disorder: A Disorder of Negative Affect, Surgency, and Disagreeableness

Brittany L. Zastrow, Michelle M. Martel, and Thomas A. Widiger Psychology Department, University of Kentucky

Oppositional defiant disorder (ODD) is conceptualized as a disorder of negative affect and low effortful control. Yet empirical tests of trait associations with ODD remain limited. The current study examined the relationship between temperament and personality traits and Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ODD symptom domains and related impairment in a preschool-age sample. Participants were 109 children ages 3–6 (59% male), overrecruited for ODD from the community, and their primary caregivers (87% mothers). ODD symptoms and impairment were measured using the Kiddie-Disruptive Behavior Disorder Schedule, temperament traits were measured using parent report on the Child Behavior Questionnaire and the Laboratory Temperament Assessment Battery, and personality traits were measured using examiner report on the California Child Q-Sort. Results suggest that high negative affect was associated with all three ODD symptom domains, whereas low agreeableness was specifically associated with the angry/irritable ODD symptom domain, and high surgency was associated with the argumentative/defiant and vindictive ODD symptom domains. Negative affect and surgency interacted with agreeableness to predict impairment, but not symptoms: Low agreeableness was associated with high impairment, regardless of other trait levels, whereas high negative affect and high surgency predicted high impairment in the presence of high agreeableness. Overall, results suggest ODD is a disorder of high negative affect. Furthermore, low agreeableness is differentially associated with affective ODD symptoms, and high surgency is associated with behavioral ODD symptoms. These traits interact in complex ways to predict impairment. Therefore, negative affect, agreeable- ness, and surgency may be useful early markers of ODD symptoms and impairment.

Oppositional defiant disorder (ODD) is a common and impairing behavioral disorder that has a prevalence rate of between 4% and 16% during preschool (Egger & Angold, 2006). ODD is characterized by a pattern of angry, hostile, and/or defiant behaviors and interactions with others and was recently subdivided into three symptom domains: angry/irritable, argumentative/defiant, and vindictive (American Psychiatric Association [APA], 2013), alterna- tively better supported as two domains of affective versus behavioral symptoms by recent work (e.g., angry/irritable and vindictive symptoms combined in an affective symptom domain; Burke et al., 2014; but see Lavigne, Bryant et al., 2015, for other supported two-domain solutions). ODD is associated with a number of negative and costly outcomes,

such as poor family relations and academic problems (Posner et al., 2007; Spira & Fischel, 2005). Notably, spe- cific ODD symptom domains are believed to differentially predict the high levels of comorbidity often seen in the disorder, with the angry/irritable domain related to interna- lizing problems, the argumentative/defiant domain related to attention deficit/hyperactivity disorder (ADHD), and the vindictive domain related to conduct problems (Stringaris & Goodman, 2009). In line with this, ODD is commonly conceptualized as a disorder of negative affect and, secon- darily, low effortful control (Stringaris & Goodman, 2009; Stringaris, Maughan, & Goodman, 2010). Yet, empirical tests of trait associations with early ODD remain in short supply, and this was the goal of the present investigation.

Temperament is commonly conceptualized as indivi- dual differences in self-regulation and reactivity (Rothbart & Derryberry, 1981). Although there are many models of temperament, most recognize at least three

Correspondence should be addressed to Michelle M. Martel, Psychology Department, University of Kentucky, 207C Kastle Hall, Lexington, KY 40506. E-mail: michelle.martel@uky.edu

Journal of Clinical Child & Adolescent Psychology, 47(6), 967–977, 2018 Copyright © Society of Clinical Child & Adolescent Psychology ISSN: 1537-4416 print/1537-4424 online DOI: https://doi.org/10.1080/15374416.2016.1225504

temperament traits that are conceptually similar to the model developed by Rothbart (1989): negative affect, surgency, and effortful control (e.g., Eisenberg et al., 1996). Negative affect includes negative emotions such as anger, fearfulness, discomfort, and sadness. Surgency refers to an individual’s positive emotions, activity level, and impulsivity. Effortful control refers to an individual’s inhibitory control, focus of attention, and sensitivity to perception (Rothbart & Derryberry, 1981). Important to note, individual differences in temperament traits can be reliably measured via questionnaires as early as infancy (Gartstein & Rothbart, 2003).

Similar to temperament, personality refers to an indivi- dual’s unique pattern of thoughts, feelings, and behaviors (McCrae & Costa, 1987; Tackett, 2006). The most well- established model of personality in adulthood is the Five- Factor Model of personality, a model composed of Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness (McCrae & Costa, 1987). Although research on personality traits has histori- cally focused on adults, research suggests that personality traits can also be applied to children (Digman & Inouye, 1986; Shiner, 1998; Tackett, Krueger, Iacono, & McGue, 2008; van Lieshout & Haselager, 1994), even preschoolers (Abe, 2005; De Pauw, Mervielde, & Van Leeuwen, 2009). Further, work suggests that temperament and personality traits may be largely synonymous, with negative affect related to Neuroticism, surgency related to Extraversion, and effortful control related to Conscientiousness (Shiner, 1998; Tackett, 2006). In addition, traits can be well-captured at either a three- (for temperament) or five- (for personality) factor level, depending on the level of analysis; that is, five- factor models can be viewed as a lower level of the trait hierarchy compared to three-factor trait models. For exam- ple, effortful control is a trait that, at a lower level of analysis, can be further subdivided into effortful control and agreeableness (Nigg, 2006; Shiner & DeYoung, 2011).

Temperament and personality traits exhibit robust asso- ciations with psychopathology (Kotov, Gamez, Schmidt, & Watson, 2010; Nigg, 2006), yet the nature of these associa- tions remains debated. Several models have been put for- ward that seek to explain how temperament and personality relate to psychopathology; however, the models most sup- ported by research thus far are the vulnerability model and the spectrum model (reviewed by Tackett, 2006; Watson, Gamez, & Simms, 2005). The vulnerability model suggests that temperament and personality traits are risk factors that may contribute to the development of psychopathology. The spectrum model views psychopathology as the extreme end of the normal range of personality traits, whereby extreme personality traits are conceptualized as synonymous with psychopathology. These models are similar in suggesting the possible utility of early assessment of temperament and personality traits because both models suggest that extreme, maladaptive traits may predict psychopathology. Thus,

extreme traits may be useful early markers of psychopathol- ogy, and tests of the nature of the association between traits and psychopathology are emerging.

As just noted, extant theory (Stringaris & Goodman, 2009) suggests that ODD may be primarily a disorder of negative affect. In line with this idea, prior empirical research indicates that children with disruptive behavior problems exhibit higher negative affect and related traits such as irritability, compared to children without disruptive behavior problems (Deater- Deckard, Dodge, Bates, & Pettit, 1998; Dougherty et al., 2011; Eisenberg et al., 2001; Lahey, Waldman, & McBurnett, 1999; Lavigne, Gouze, Hopkins, Bryant, & LeBailly, 2012; Lavigne, Dahl, et al., 2015; Martel & Nigg, 2006; White, 1999). Further, Stringaris and Goodman’s (2009) theoretical model suggests some specificity of associations between high negative affect and ODD symptom domains such that negative affect may be more strongly associated with the angry/irritable (vs. argumentative/defiant, vindictive) ODD symptom domain, although this idea remains largely untested (but see Ezpeleta, Granero, de la Osa, Penelo, & Domènech, 2012). Stringaris and Goodman’s theoretical model suggests that low effortful control may be more specifically associated with the argumentative/defiant and vindictive (vs. angry/irritable) ODD symptom domains, although little empirical studies have examined this either. Consistent with this idea, work has supported associations between disruptive behavior disorders (DBDs) and low effortful control, or Conscientiousness, and— at a lower level of personality’s hierarchical structure—low Agreeableness (Eisenberg et al., 2001; Gjone & Stevenson, 1997; Hirshfeld-Becker et al., 2007; Kim et al., 2010; Lahey, 2009; Martel, Gremillion, & Roberts, 2012).

Further, child development research suggests complex interactions between traits in prediction of child outcomes. Specifically, negative affect and effortful control—or at lower level of hierarchical analysis, Agreeableness—interact to predict child DBDs, such that low effortful control, or low Agreeableness, is a particularly salient predictor of child DBDs with high negative affect only related to DBD when effortful control, or Agreeableness, is high (Eisenberg et al., 2009; Martel et al., 2012). Recent work suggests similar interactions between positive (vs. negative) affect and effortful control (or Agreeableness, at lower levels of conceptualization). This latter finding is in line with theore- tical work by Carver and Harmon-Jones (2009) that sug- gests that anger may be an approach-related emotion, similar to surgency, suggesting possible associations between positive affect and ODD. Although limited work has validated such ideas in relation to ADHD hyperactivity- impulsivity symptoms (Martel, 2009; Martel & Nigg, 2006), no known work has examined the relationship between positive affect and ODD. However, such relationships might be expected particularly in relation to ODD symp- toms and/or impairment.

To summarize, although ODD is currently conceptualized as a disorder of primarily high negative affect and secondarily

968 ZASTROW, MARTEL, AND WIDIGER

low effortful control, empirical tests of this remain in short supply. Further, the possible role of positive affect in anger as an approach-related emotion remains unexamined. Last, almost no attention has been given to complex interactions between traits related to affect and control as they may relate to early ODD. This study intends to address these gaps in the existing literature by empirically examining associations between traits related to negative affect, surgency, and effort- ful control in relation to ODD symptoms during early child- hood, a period when ODD often first emerges.

The first aim of the study is to evaluate associations of temperament and personality traits with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) ODD symptom domains in young children overrecruited for ODD. Based on Stringaris and Goodman’s (2009) theore- tical model, it is predicted that high negative affect will be more specifically associated with the angry/irritable (vs. argumentative/defiant, vindictive) symptom domain, whereas low effortful control (and low agreeableness) will be more specifically associated with argumentative/defiant and vindictive (vs. angry/irritable) symptom domains. It is also predicted that surgency/positive affect will be asso- ciated with one or more ODD symptom domains, based on prior theoretical and empirical work (Carver & Harmon-Jones, 2009; Martel, 2009; Martel & Nigg, 2006). The second aim of the study is to explore com- plex, potentially interactive associations of effortful con- trol (and Agreeableness), negative affect, and surgency/ positive affect with ODD symptoms and/or impairment. Based on Eisenberg et al. (2009) and Martel, Gremillion, and Roberts’s (2012) work, it is predicted that effortful control (or Agreeableness) and negative affect (or positive affect) will interact to predict ODD symptoms and impair- ment such that low effortful control, or low Agreeableness, will be a particularly salient predictor of child ODD symptoms and impairment with high negative or positive affect only related to ODD when effortful control, or Agreeableness is high.

METHODS

Participants

Overview

Participants were 109 preschoolers between ages 3 and 6 (M = 4.77 years, SD = 1.11) and their primary care- givers (87% mothers). Fifty-nine percent of the sample was male; 33% of the sample was ethnic minority (mostly African American with some Latino, American Indian/ Alaskan Native, and Mixed). Parental educational level ranged from unemployed to highly skilled professionals, with incomes ranging from below $20,000 to above $100,000 annually (0 = annual income less than

$20,000, 1 = between $20,000 and $40,000, 2 = between $40,000 and $60,000, 3 = between $60,000 and $80,000, 4 = between $80,000 and $100,000, and 5 = over $100,000 annually; see Table 1). Based on multistage and comprehensive diagnostic screening procedures, pre- schoolers were recruited into two groups: ODD children (n = 60) and non-ODD children (n = 49). The non-ODD group included preschoolers with subthreshold symptoms to provide a more continuous measure of ODD symp- toms. Symptom counts were the focus of analyses, con- sistent with research suggesting that externalizing behavior may be better captured by continuous dimen- sions than categorical diagnosis (Krueger, Markon, Patrick, & Iacono, 2005; Markon, Chmielewski, & Miller, 2011) and to be sensitive to the young age of the sample.

TABLE 1 Demographics and Descriptive Information

Non-ODDa ODDb

M SD M SD

Demographics Age 4.57 1.08 4.93 1.11 Boys n (%) 27 55.1 37 61.7 Ethnic Minority n (%) 18 36.7 18 30 African American 17 34.7 11 18.3 Latino 1 2 2 3.3 Native Hawaiian/Pacific Islander 0 0 0 0 American Indian/Alaskan Native 0 0 1 1.7 Mixed 0 0 4 6.7 Family Income (Mode) 0,1 0 ODD Symptoms*** 1.78 1.14 5.32 1.26 ODD Impairment*** 6.05 4.05 10.92 3.34

Temperament Traits (CBQ) Negative Affect*** 3.91 0.97 4.56 0.94 Effortful Control* 5.04 0.77 4.68 0.96 Surgency* 4.51 0.95 4.96 0.96

Temperament Traits (LabTAB) Perfect Circle Anger 5.75 6.48 4.98 5.77 Perfect Circle Sadness 1.09 1.42 2.26 3.42 Gift Delay Effortful Control 9.56 2.88 9.33 2.60 Bubbles Positive Affect 21.63 8.68 18.89 8.92

Personality Traits (CCQ) Neuroticism 3.39 1.11 3.68 1.19 Conscientiousness 6.06 1.25 5.55 1.35 Agreeableness** 6.27 1.15 5.46 1.31 Extraversion 6.53 1.39 6.34 1.43

Note: Family income modes: 0 = annual income < $20,000, 1 = between $20,000 and $40,000. Subgroup differences based on independent samples t-tests and chi-squares. ODD = oppositional defiant disorder; CBQ = Child Behavior Questionnaire; LabTAB = Laboratory Temperament Assessment Battery; CCQ = California Child Q-Sort.

an = 49. bn = 60.

*p < .05. **p < .01. ***p < .001.

TRAIT ASSOCIATIONS WITH PRESCHOOL ODD 969

Recruitment and Identification

Participants were recruited from an urban southeastern community through direct mailings, postings, advertise- ments, and flyers designed to overrecruit young children with behavior problems. A telephone screening was con- ducted to rule out children prescribed psychotropic medi- cation (e.g., antidepressants) and children with neurological impairments, intellectual disability, autism spectrum disorders, psychosis, seizure history, head injury with loss of consciousness, or other major medical condi- tions. All families screened into the study attended a cam- pus laboratory visit and completed written and verbal informed consent procedures consistent with the Institutional Review Board, the National Institute of Mental Health, and APA guidelines. Families were paid $50 for study completion.

Measures

Symptom Counts for ODD and Related Impairment

Parent report on ODD symptoms and related impairment was available via the clinician-administered Kiddie- Disruptive Behavior Disorder Schedule (LeBlanc et al., 2008), a semistructured diagnostic interview for ODD and other DBDs, administered by a trained graduate student clinician. The Kiddie-Disruptive Behavior Disorder Schedule demonstrates high test–retest reliability and high interrater reliability in the preschool population (LeBlanc et al., 2008). DSM-IV ODD symptoms were measured using a dichotomous code (0 = absent; 1 = present), and totals of 4 or more resulted in diagnosis, consistent with DSM-IV and DSM-5 criteria for ODD (APA, 2013). Separate sum scores for each symptom domain, as specified in the DSM-5 (given that symptoms are the same as DSM-IV), were utilized. ODD-related impairment (e.g., “How much do the behaviors interfere with the child’s ability to play and get along with other kids?”) was measured on a 1 (not very much) to 3 (a lot) scale of severity. Sum scores for impair- ment were utilized. All scales had acceptable internal con- sistency of .72 or above. Interrater reliability in number of symptoms on a random sample of 10% of the sample was .82 or above based on masked ratings. Higher scores indi- cate more symptoms and impairment.

Temperament Traits

To measure negative affect, effortful control, and sur- gency, parents completed the very short form of the Child Behavior Questionnaire, a reliable and valid measure for use with this age group (Putnam & Rothbart, 2006; Rothbart, Ahadi, Hershey, & Fisher, 2001). Traits were measured using 12-item scales suggested by Rothbart et al. (2001). Composite scale scores were generated by reverse-scoring

selected items and computing the average for negative affect (sample item: gets frustrated when prevented from doing something wanted to do), effortful control (e.g., prepares for trips or outings by planning what needs), and surgency (e.g., likes adventurous activities). The scales had internal consis- tency in the current sample of .76, .67, and .77, respectively.

Select paradigms from the Laboratory Temperament Assessment Battery (Kochanska, Murray, & Harlan, 2000) provided observational ratings of preschool tem- perament traits. Negative affect (sadness and anger; i.e., “perfect circle”), effortful control (i.e., “gift delay”), and positive affect, or exuberance (i.e., “bubbles”) paradigms were used in the present study (see Goldsmith, Reilly, Lemery, Longley, & Prescott, 1999). All examiners were blind to the child’s diagnosis. To assess negative affect (sadness and anger), the child was asked to draw a “per- fect” circle; the child was corrected and asked to redraw their circle for 2 min. During this time, verbal, facial, and behavioral expressions of sadness and anger, as well as intensity of and latency to sadness and anger were coded as present or absent in 5-s increments. Two composite scores were generated by summing all coded behaviors for sadness and for anger across the 2 min. To assess effortful control, children were asked to wait with their back turned while the examiner wrapped a gift; the child was instructed not to touch the gift while the examiner left to room to retrieve a bow for the gift. Extent of peeking for the entire segment was coded on a 5-point scale from 1 (child peeks the entire time) to 5 (child never peeks). To assess positive affect, children played with a bubble gun for 1 min. Presence or absence of positive motor activity (e.g., clapping) and verbal expressions of positive affect (e.g., laughter) were tallied within 10-s increments. To generate composite scores for positive motor activity and verbal expressions of positive affect, a sum of all tally marks across the 1 min was computed. Interrater reliabil- ity was acceptable for each individual coded category within construct (κs > .78). Higher scores denote higher levels of traits.

Personality Traits

To examine personality traits, specifically Neuroticism, Conscientiousness, Agreeableness, and Extraversion, an examiner who was not privy to diagnosis and interacted with the child for at least 3 hr under structured conditions (i.e., during Laboratory Temperament Assessment Battery and questionnaire administration) completed the California Child Q-Sort (CCQ; B. Block, 2008; J. Block & Block, 1980), a developmentally sensitive measure (John, Caspi, Robins, Moffitt, & Stouthamer-Loeber, 1994; Martel & Nigg, 2006). The CCQ is a typical Q-Sort consisting of 100 cards, which must be placed in a forced-choice, nine- category, rectangular distribution. Scales developed by John et al. (1994) for Neuroticism (sample item: fearful or

970 ZASTROW, MARTEL, AND WIDIGER

anxious), Conscientiousness (e.g., resourceful in initiating activities), Agreeableness (e.g., considerate and thoughtful of other children), and Extraversion (e.g., vital, energetic, lively) were used. Composite scale scores were generated by reverse-scoring selected items and computing the average. Internal consistency for these trait scales was .74, .65, .86, and .81, respectively.

Data Analysis

First, temperament and personality traits and ODD symp- toms were examined by two independent raters for item overlap. No items appeared to be overlapping when using a close conceptual overlap criterion (i.e., items had to des- ignate closely related ideas), and agreement between raters was 100%; thus, all items were included in analyses. Next, demographic and diagnostic group differences were exam- ined using t tests, chi-square statistics, and analysis of variance. Then a correlation matrix of all main study vari- ables was conducted.

To evaluate main study aims and hypotheses regarding simple associations between traits and ODD symptoms to reduce utilized trait variables, bivariate correlations were con- ducted followed by path analysis, which allowed for simulta- neous estimation of all paths between traits and ODD symptom domains in order to control for shared covariance among symptom domains and traits. To evaluate main study aims and hypotheses regarding complex, interactive associa- tions between traits and ODD-related impairment, hierarchical regression analysis was conducted with main effects entered as Step 1 and interactions between continuous variables entered at Step 2. In the case of significant interactions, we dichoto- mized variables at 1 standardized deviation below and above the mean in order to graphically depict moderation effects.

Based on a sample size of 109 and an expected medium effect size (r = .3; Martel et al., 2012), power was adequate (.90 for correlations and path analysis and .75 for hierarch- ical regressions).

RESULTS

Demographics and Diagnostic Group Differences

As noted in Table 1, based on t-tests and chi-square statis- tics, there were no demographic differences across diagnos- tic group (ODD vs. non-ODD; all ps ≥ .30), and no significant correlations between demographics and ODD symptoms (r range = –.177 to –.090, all ps ≥ .08) with the exception that univariate analysis of variance revealed sig- nificant mean differences in ODD symptoms based on family income, F(1, 98) = 2.496, p = .04, with lower income levels related to higher ODD symptoms. Mean levels of ODD symptoms and associated impairment, as well as levels of negative affect, surgency, effortful control, and

Agreeableness, were significantly different between the ODD and non-ODD diagnostic groups in the expected direction (all p ≤ .04 to p < .001). All other trait measures exhibited no significant differences between diagnostic groups (all ps ≥ .07). No demographic variables, with the exception of family income, F(1, 98), range = 2.297–2.854, p ≤ .04, exhibited significant associations with the ODD symptom domains; thus the effect of family income on study results was examined in secondary analyses.

Associations Between Traits and ODD Symptom Domains

Bivariate correlations between traits and ODD symptom domains were conducted to determine which traits to focus on in subsequent analyses, shown in Table 2. High negative affect was significantly correlated with all symptom domains (angry/irritable r = .328, argumentative/defiant r = .341, vindictive r = .309; all ps < .001), but neither Neuroticism nor perfect circle anger nor perfect circle sad- ness was significantly associated with any of the symptom domains (r range = –.168 to –.086, all ps ≥ .1). Neither effortful control nor gift delay effortful control exhibited significant associations with any of the symptom domains (r range = –.144 to –.048, all ps ≥ .15), but low Conscientiousness was significantly correlated with the angry/irritable symptom domain (r = –.288, p = .004), but not with the argumentative/defiant or vindictive symptom domains (r range = –.077 to –.015, all ps ≥ .46). Low Agreeableness was significantly associated with the angry/ irritable and argumentative/defiant symptom domains (r = –.504, p < .001; r = –.242, p ≤ .02), but not with the

TABLE 2 Correlations Between Temperament Traits and Personality Traits

and ODD Symptom Domains

Angry/ Irritable

Argumentative/ Defiant Vindictive

CBQ Negative Affect .382*** .341*** .309*** CCQ Neuroticism .168 −.028 −.011 LabTAB Perfect Circle Anger −.078 −.070 −.086 LabTAB Perfect Circle Sadness

.138 −.059 −.088

CBQ Effortful Control −.102 −.141 −.091 CCQ Conscientiousness −.288** −.077 −.015 CCQ Agreeableness −.504*** −.242* −.120 LabTAB Gift Delay Effortful Control

−.110 −.144 .048

CBQ Surgency .204* .217* .206* CCQ Extraversion .059 −.019 −.026 LabTAB Bubbles Positive Affect

−.065 .279* −.138

Note: ODD = oppositional defiant disorder; CBQ = Child Behavior Questionnaire; CCQ = California Child Q-Sort; LabTAB = Laboratory Temperament Assessment Battery.

*p < .05. **p < .01. ***p < .001.

TRAIT ASSOCIATIONS WITH PRESCHOOL ODD 971

vindictive symptom domain (r = –.120, p = .24). Extraversion was not significantly correlated with any of the symptom domains (r range = –.026 to –.059; all ps ≥ .57). High positive affect was significantly correlated with the argumentative/defiant symptom domain (r = .279, p = .02) but not with the angry/irritable or vindictive symp- tom domains (r range = –.138 to –.065, all ps ≥ .2), whereas high surgency was significantly associated with all the symptom domains (r range = .204–.217, all p ≤ .04). Overall, high negative affect, low Conscientiousness, low Agreeableness, and high surgency exhibited the strongest associations within each trait with one or more ODD symp- tom domains. Based on these results, they were chosen as the focus of subsequent analyses.

Specificity of Associations Between Traits and Symptom Domains

Path analysis was conducted in Mplus to examine specificity of associations between traits and ODD symptom domains. All three symptom domains were regressed simultaneously on negative affect, Conscientiousness, Agreeableness, and sur- gency (Akaike’s information criterion = 594.03, Bayesian information criterion = 652.94), and significant difference tests were conducted to examine relative differences in asso- ciations between traits and ODD symptom domains. Results, shown in Figure 1, indicated that high negative affect was significantly associated with the angry/irritable, argumenta- tive/defiant, and vindictive ODD symptom domains (β = .213, p = .03; β = .229, p = .01; β = .275, p < .001). Low Agreeableness was significantly associated with the angry/irritable ODD symptom domain (β = –.429, p < .001), and this association was specific in the sense that it was significantly different than the association between Agreeableness and other ODD symptom domains (t ≥ 2.04,

p ≤ .04). High surgency was significantly associated with the argumentative/defiant and vindictive ODD symptom domains (β = .212, p = .03; β = .210, p = .03), but this association was not specific, as it was not significantly different than the association between surgency and the angry/irritable symptom domain (t ≤ 1.24, p ≥ .22). Conscientiousness was not signifi- cantly associated with any of the ODD symptom domains (β range = .036–.093, all p ≥ .5). Overall, this suggests a more general association between high negative affect and all three ODD symptom domains. However, low Agreeableness appears to be more specifically associated with the angry/ irritable ODD symptom domain.

Traits as Predictors of ODD Symptoms and Impairment

To preliminarily examine associations between traits and ODD impairment, bivariate correlations were conducted between traits and ODD-related impairment. High negative affect (r = .545, p < .001), low Conscientiousness (r = –.313, p = .004), low Agreeableness (r = –.507, p < .001), and high surgency (r = .388, p < .001) were significantly associated with increased ODD-related impairment.

Next, hierarchical regression was utilized to examine whether traits interacted in predicting ODD-related impairment or ODD symptoms with main effects entered as Step 1 and interactions (i.e., Agreeableness x Negative Affect and Agreeableness × Surgency) entered at Step 2. Neither negative affect nor surgency significantly interacted with Conscientiousness to predict ODD-related impairment (ΔR2 = .001, β = .028, SE = .33; p = .78, for negative affect; ΔR2 = .001, β = .024, SE = .46, p = .82, for surgency) or ODD symptoms (ΔR2 = .001, β = .005, SE = .16, p = .96, for negative affect; ΔR2 = .001, β = .023, SE = .21 p = .91, for surgency). Negative affect and surgency significantly inter- acted with Agreeableness to predict ODD-related impairment (ΔR2 = .052, β = .233, SE = .25, p < .05, for negative affect; ΔR2 = .063, β = .253, SE = .27, p < .05, for surgency) but not ODD symptoms (ΔR2 = .002, β = .12, SE = .13 p = .18, for negative affect; ΔR2 = .03, β = .18, SE = .14, p = .06, for surgency). As depicted in Figures 2 and 3 respectively, low Agreeableness was related to increased ODD-related impair- ment, regardless of the level of negative affect or surgency. However, when Agreeableness was high, high negative affect was significantly related to increased ODD-related impairment (t = 4.47, p < .01), but the association between negative affect and impairment was not significantly different from zero when Agreeableness was low (t = –.36, p = .72). A similar pattern was observed for surgency such that, when Agreeableness was high, high surgency was significantly related to increased ODD-related impairment (t = 3.35, p < .01), but the associa- tion between surgency and impairment was not significantly different from zero when Agreeableness was low (t = –1.45, p = .15). Therefore, negative affect and surgency interact with Agreeableness in their prediction of ODD-related impairment but not symptoms.

Negative Affect

Conscientiousness

Agreeableness

Angry/Irritable

Argumentative/ Defiant

Vindictive

Surgency

.213

.229

.275

-.429

.212

.210

.04

.08

.08

-.14

-.003

.03

FIGURE 1 Traits as predictors of oppositional defiant disorder symptom domains. Note: Dotted paths and italicized coefficients were nonsignificant.

972 ZASTROW, MARTEL, AND WIDIGER

Secondary Checks

Income as a Covariate

Because there were significant mean differences in ODD symptoms based on family income, all analyses were con- ducted a second time covarying income. All significant findings just mentioned survived correction for family income, with two exceptions. When family income was entered into the path analysis examining the specificity of associations between traits and ODD symptom domains, the associations between high surgency and the argumentative/ defiant and vindictive ODD symptom domains dropped to nonsignificance (β = .195, p = .07; β = .175, p = .11).

Comparison of DSM-5 Three-Domain Model and Recent Two-Domain Models

We conducted secondary analyses comparing the DSM-5 three-domain ODD model with two recent two-domain ODD models: (a) an affective (i.e., being touchy, angry,

and loses temper) and behavioral (i.e., argues, defies, annoys others, blames others, spiteful/vindictive) model (Burke et al., 2014) and (b) a negative affect (i.e., touchy, angry, spiteful/vindictive) and behavioral (i.e., argues, defies, and loses temper) model (Lavigne, Bryant et al., 2015). We reran the correlation matrix between all traits and these two-factor ODD models with very few substantial differences between the DSM-5 angry/irritable and affective (Burke et al., 2014; or negative affect; Lavigne, Bryant et al., 2015) domains or between the DSM-5 argumenta- tive/defiant and behavioral (Burke et al., 2014; Lavigne, Bryant et al., 2015) domains in the sense that the patterns of significant and nonsignificant findings were almost iden- tical (results available upon request). We also conducted partial correlations among symptom domains and Agreeableness, controlling for the alternative symptom domain in order to examine whether the specific association between Agreeableness and the DSM-5 angry/irritable domain also held for the affective (or negative affect) domain. Significant, specific associations between low

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Im pa

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en t

Low A

High A

FIGURE 2 Interaction between negative affect and Agreeableness predicting oppositional defiant disorder–related impairment. Note: A = Agreeableness.

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Im pa

ir m

en t

Low A

High A

FIGURE 3 Interaction between surgency and Agreeableness predicting oppositional defiant disorder–related impairment. Note: A = Agreeableness.

TRAIT ASSOCIATIONS WITH PRESCHOOL ODD 973

Agreeableness and the affective domain held for the Burke et al. (2014) affective domain (p = .002), but not for the Lavigne, Bryant et al. (2015) negative affect domain (p = .62), based on significant difference tests.

DISCUSSION

The goal of this study was to examine the relationship between traits related to negative affect, effortful control, and surgency and ODD symptoms in young children. Results suggested significant associations between high negative affect and all three ODD symptom domains. However, low Agreeableness was specifically associated with the angry/irritable ODD symptom domain, whereas high surgency was only somewhat specifically associated with the argumentative/defiant and vindictive ODD symp- tom domains. Both negative affect and surgency interacted with Agreeableness to predict more ODD-related impair- ment, but not symptoms, such that when Agreeableness was low, impairment was high regardless of the level of negative affect or surgency, and when Agreeableness was high, high negative affect and high surgency (but not low negative affect or low surgency) were associated with higher impairment. Overall, these results suggest that high negative affect, low Agreeableness, and high surgency are strongly associated with ODD symptoms and related impairment during preschool, with somewhat differential associations with ODD symptom domains, and affect and Agreeableness exhibiting interactive effects in relation to impairment.

Consistent with Stringaris and Goodman’s (2009) con- ceptualization of ODD as a disorder of negative affect, high negative affect was associated with all three ODD symptom domains, not just the angry/irritable ODD symp- tom domain. Thus, ODD may primarily be a disorder of high negative affect. This is in line with work suggesting that children with ODD are at increased risk for comorbid- ity such as depression and anxiety later in life (Lavigne et al., 2001; Stringaris & Goodman, 2009). Yet results of this study do not support associations between low effort- ful control and ODD symptoms, despite diagnostic group differences, and this is somewhat counter to prior work in this area (e.g., Dougherty et al., 2011; Eisenberg et al., 2001; Lavigne et al., 2012). This may be due to the young age of our sample, the primacy of more affectively driven traits in this age range, or impaired parental reporting abilities in the severely stressed urban sample studied. Yet it is also possible that there are diagnostic differences not explained by symptoms or symptom domains, or there was low power to detect symptom-domain-level effects. However, low Agreeableness, related to Conscientiousness and effortful control, but measured at a lower hierarchical level of trait structure, exhibited prominent associations with ODD in this age range, particularly with the angry/

irritable domain. This is in line with recent work by Burke and colleagues (2014) suggesting an irritability dimension within ODD and might be viewed as consistent with recent calls to subdivide ODD into two (vs. three) symptom domains using an affective versus behavioral distinction (Herzhoff & Tackett, 2016; Lavigne, Bryant et al., 2015), as our affective domain, characterized by angry/irritable symptoms, was specifically underpinned by low Agreeableness, and this finding also found in relation in Burke et al.’s (2014) two-domain model (although it should be noted that such specificity was not found in relation to Lavigne, Bryant et al.’s (2015) model).

Important to note, this study was the first to demonstrate that high surgency was associated with ODD, perhaps par- ticularly with the argumentative/defiant and vindictive ODD symptom domains, although this difference in associations was not significant. In line with hypotheses, this finding suggests that high positive affect and high negative affect may be risky, in line with the spectrum conceptualization of trait-psychopathology associations. Associations between high positive affect and ODD are in line with Carver and Harmon-Jones’s (2009) theory of anger as an approach- related emotion, as well as neurobiological findings suggest- ing decreased reward sensitivity in these children, which may lead to higher levels of surgency-related behaviors in order to stimulate positive affect (Matthys, Vanderschuren, & Schutter, 2013). These results are also consistent with prior work finding associations between high positive affect and hyperactive-impulsive ADHD symptoms (Martel, 2009; Martel & Nigg, 2006). We would take such prior work a step further by suggesting that different disorders are described not just by the expression of a single extreme trait but rather by different combinations of extreme traits interacting with one another. In this way, high positive affect may be part of what distinguishes externalizing from inter- nalizing disorders (Kotov et al., 2010).

This study’s findings suggest that negative affect and surgency interact with Agreeableness in relation to ODD- related impairment, consistent with work by Eisenberg et al. (2009) and particularly Martel et al. (2012), which sug- gested that low effortful control is a primary route to ADHD and that negative affect is a secondary pathway. In regard to ODD, current findings suggest that low Agreeableness is a primary pathway to increased ODD- related impairment and high negative affect and high sur- gency are secondary pathways. These findings highlight the importance of Agreeableness for the development of proso- cial behavior and effective management of interpersonal conflict (Eisenberg et al., 1999; Jensen-Campbell, Gleason, Adams, & Malcolm, 2003), often lacking in ODD. In addi- tion, this work suggests that high surgency can be a risk factor for psychopathology in the right circumstances and when manifest with particular combinations of other traits.

The study had a number of strengths, including a well- characterized sample of children overrecruited for ODD and

974 ZASTROW, MARTEL, AND WIDIGER

multiple measures of traits and clinical symptoms, but it also had limitations. There is the possibility of results being due to a Type I error, given that multiple analyses were conducted. There may be shared source variance between temperament traits and ODD symptoms, given that the same informant completed both measures in some cases. Although overlapping items between traits and ODD symp- toms were screened, conceptual overlap between psycho- pathology and traits may still be an issue. In addition, we did not obtain interrater reliability on the CCQ, and this measure is not independent of other study measures; these are study limitations. Of importance, because this sample was a community-recruited sample, overrecruited for ODD symptoms in an urban setting, the results may not generalize to other populations; these results should be replicated using other samples. Further, this study is cross-sectional in nat- ure, and longitudinal extension of the current work will be important. Although the current study shows that there are distinct associations between temperament and personality traits and ODD symptoms and impairment, conclusions cannot be drawn regarding the longitudinal relationship between these traits and the disorder.

Study results may have clinical utility. For example, study results suggest that it may be useful for clinicians to conduct early assessment of maladaptive variants of nega- tive affect, Agreeableness, and surgency in young children at risk for ODD. Because these traits can be reliably identi- fied earlier than ODD itself (Gartstein & Rothbart, 2003), identification of children with extreme traits may be able to lead to earlier identification of children at risk for a disorder with severe public health outcomes, including poor family relations, academic problems, and high comorbidity with other disruptive behavior problems (Posner et al., 2007; Spira & Fischel, 2005). Further, study results suggest that high negative affect, high surgency, and low Agreeableness may be useful for understanding the level of impairment the child is likely to experience, which has real-world implica- tions for the quality of the child’s social relationships (Eisenberg et al., 1999; Jensen-Campbell et al., 2003). In sum, early assessment of these traits could be helpful for determining which children are most in need of early inter- vention for ODD.

Overall, this study addressed the relationship between temperament traits, personality traits, and ODD symptoms in young children. Study results partially support Stringaris and Goodman’s (2009) theory of ODD, suggesting that it is a disorder of high negative affect. Results also advance work in this area by highlighting the important roles of low Agreeableness and high surgency. Although high negative affect appears to be more generally associated with ODD symptoms, low Agreeableness appears particularly asso- ciated with angry/irritable ODD symptoms and high sur- gency might be somewhat more related to argumentative/ defiant and vindictive ODD symptoms. Further, negative affect and surgency appear to interact with Agreeableness to

predict ODD-related impairment. Collectively, this suggests the importance of the early assessment of these traits in young children in order to help identify children at high risk for ODD symptoms and impairment and to guide targeted early intervention.

ACKNOWLEDGMENTS

All families screened into the study completed written and verbal informed consent procedures consistent with the Institutional Review Board, the National Institute of Mental Health, and APA guidelines. We are indebted to the families who made this study possible.

FUNDING

This research was supported by National Institute of Child Health and Human Development Grant 5R03 HD062599- 02 to M. Martel.

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