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OBJECTIVE: Estimates of the stability of a preschooler's diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) into early elementary school vary greatly. Identified factors associated with diagnostic instability provide little guidance about the likelihood a particular child will have ADHD in elementary school. This study examined an approach to predicting age 6 ADHD-any subtype (ADHD-any) from preschoolers' demographics and ADHD symptoms. METHOD: Participants were 796 preschool children (Mage = 4.44; 51% boys; 54% White, non-Hispanic) recruited from primary pediatric care and school settings. Parents completed ADHD Rating Scales at child ages 4 and 5 years, and a structured diagnostic interview (DISC-YC) at ages 4 and 6. Classification tree analyses (CTAs) examined the predictive utility of demographic and symptom variables at ages 4 and 5 years for age 6 ADHD. RESULTS: Over half (52.05%) of preschoolers meeting diagnostic criteria for ADHD-any at age 4 did not meet those criteria at age 6; more than half (52.05%) meeting criteria for ADHD-any at age 6 had not met those criteria at age 4. A CTA conducted at age 4 predicted age 6 ADHD-any diagnosis 65.82% better than chance; an age 5 CTA predicted age 6 ADHD-any 70.60% better than chance. At age 4, likelihood of age 6 ADHD-any diagnosis varied from <5% to >40% across CTA tree branches and from <5% to >78% at age 5. CONCLUSIONS: Parent-reported patterns of preschool-age symptoms may differentially predict ADHD-any at age 6. Psychoeducation regarding these patterns may aid in decision about pursuing multidisciplinary evaluations or initiating treatment.
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Trastorno por Déficit de Atención con Hiperactividad , Preescolar , Masculino , Niño , Humanos , Femenino , Trastorno por Déficit de Atención con Hiperactividad/terapia , Salud Mental , Padres , Escolaridad , Instituciones AcadémicasRESUMEN
Background: Despite the movement toward hospital-based medical centers acquiring pediatric primary care offices, many primary care pediatricians still work in small, independent practices. To expand mental healthcare access, service delivery models must consider primary care practice needs and regionally available resources. Objective: This report describes the implementation and evaluation of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program over a 4 years period. MAACC. MAACC engaged 97 pediatric primary care clinicians across 39 practices in mental health training and supported the treatment of referred patients through a collaborative care model. To support psychosocial treatment needs, we built a child community therapy referral network of 213 licensed psychotherapy providers. Methods: Data were collected on service delivery patterns (e.g., referrals, treatment use, and attrition) and patient outcomes. Measures included parent and children and adolescents PROMIS anxiety and depression short forms and the Parent NICHQ Vanderbilt. Results: Six hundred ninety-six children and adolescents aged 6-18 were evaluated and provided treatment recommendations. Anxiety disorders were the most common diagnosis (45.4%), followed by ADHD (30.7%) and mood disorder (17%). For children and adolescents with an anxiety or mood disorder, significant improvement was observed from baseline to any initial follow-up and from baseline to 6, 12-, and 18 weeks on children and adolescents and parent measures of anxiety and depression. For children and adolescents with ADHD, significant improvement was observed from baseline to any initial follow-up measure and at 6 and 18 weeks on parent-reported inattentive symptoms. Significant differences in treatment outcomes were identified for children and adolescents with anxiety receiving psychotherapy alone and medication management and psychotherapy. Conclusion: MAACC utilization and patient outcomes suggest that real-world collaborative care can effectively provide high-quality care while cultivating increased primary care treatment capacity and building on existing community resources.
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OBJECTIVE: Examine the psychometric properties, validity in relation to a legacy measure, and diagnostic accuracy of the PROMIS Anxiety Short Form 2.0 (PROMIS A-SF) Caregiver and Youth Reports in a clinical sample. METHODS: Participants were 301 youth and caregivers referred to a behavioral health clinic by their pediatrician. Participants and their caregivers completed PROMIS A-SF (youth and caregiver proxy), SCARED (youth and caregiver proxy), and a semi-structured interview. Descriptive, correlational, test-retest reliability, and receiver operating characteristic (ROC) analyses were conducted for both measures. RESULTS: PROMIS A-SF measures were highly correlated with SCARED total scores and the panic subscale. PROMIS A-SF measures had AUCs ranging from .49-.79 for the detection of any of three primary subtypes of anxiety: Generalized Anxiety, Separation Anxiety, and Social Anxiety. IMPLICATIONS: Dimensional anxiety subtypes, such as Social Anxiety may not be well detected on the PROMIS youth measure. Use of the PROMIS A-SF as a part of Evidence Based Assessment process is discussed.
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Ansiedad , Calidad de Vida , Adolescente , Humanos , Niño , Reproducibilidad de los Resultados , Calidad de Vida/psicología , Ansiedad/diagnóstico , Trastornos de Ansiedad/diagnóstico , Miedo , Psicometría , Medición de Resultados Informados por el Paciente , Encuestas y CuestionariosRESUMEN
Unstructured clinical interviews are inaccurate tools for diagnostic decision-making. While structured diagnostic evaluations improve reliability, they are infrequently used in clinical practice. Empirical approaches are a hallmark of evidenced-based assessment and may reduce burdens of structured interviews. We explore two approaches to empirical prediction of diagnosis, the naïve nomogram, and classification tree analysis (CTA). To illustrate the clinical utility of each approach, we compared their use in a sample of 6-year-olds (N = 619) to predict structured-interview diagnoses of oppositional defiant disorder (ODD). Findings indicate the accuracy of both approaches in predicting the absence of a disorder and improved detection of ODD using CTA for subgroups of children. Both empirical prediction techniques have applicability to diagnostic decision-making in psychiatry and pediatrics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.
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Ansiedad de Separación , Responsabilidad Parental , Ansiedad/etiología , Niño , Preescolar , Depresión/diagnóstico , Humanos , Estudios Longitudinales , Factores de RiesgoRESUMEN
This study examined effects of risk factors in multiple domains measured in preschool and kindergarten on age 6 depression symptoms, and on changes in symptom levels between ages 4 and 6. Two models were examined in a large, diverse (N = 796) community sample of children and parents. Risk variables included SES, stress, conflict, parental depression, parental hostility, support, scaffolding, child negative affect (NA), effortful control (EC), sensory regulation (SR), and attachment security. Model 1 included effects of risk factors at ages 4 and 5 on child depression symptoms at age 6. Model 2 also included depression symptoms at all three ages to examine changes in these symptoms. Model 1 revealed that age 4 and 5 parental depression, NA, EC, and SR predicted age 6 child depression levels, Several age 4 variables had indirect pathways to age 6 depression via age 5 EC. Model 2 revealed that preschool depression was the only age 4 variable, and EC and SR were the only age 5 variables that significantly predicted increases in age 6 depression. These findings highlight the role of self-regulation in child depression and suggest that targeting self-regulation may be an effective prevention and intervention strategy.
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Hijo de Padres Discapacitados/psicología , Depresión/diagnóstico , Trastorno Depresivo/diagnóstico , Modelos Psicológicos , Responsabilidad Parental/psicología , Niño , Preescolar , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Padres/psicología , Factores de Riesgo , AutocontrolRESUMEN
OBJECTIVE: To examine the association of psychological factors and pediatric health care utilization. METHOD: Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. RESULTS: There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). CONCLUSIONS: Child and parent MH problems are significantly associated with increased HCU.
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Depresión/psicología , Salud Mental , Aceptación de la Atención de Salud , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Preescolar , Femenino , Humanos , Masculino , PadresRESUMEN
Adolescent depression can be a stressor for parents and families. This study evaluated how treating adolescent depression affects marital and parent-child relationships. We examined whether marital adjustment and parent-child conflict improved over the course of active treatment of depressed adolescents (36-week visit) and long-term follow-up (one year after discontinuation of treatment) in a sample of 322 clinically depressed youth participating in the Treatment for Adolescents with Depression Study (TADS). We also explored the bidirectional influences of adolescent depression and family relationships. Results indicated that marital adjustment was stable during active treatment but declined during long-term follow up. A structural equation model (SEM) examining the bidirectional relation between adolescent depression and marital adjustment indicated that higher adolescent depression at the conclusion of maintenance treatment (24-week visit) predicted a deterioration of marital adjustment at the end of active treatment (36-week visit). Parent-child conflict was unchanged during treatment and follow up. SEM analyses examining the bidirectional relationship between youth depression and parent-child conflict revealed that reduced depressive symptoms at the end of the active treatment period predicted improvement in parent-child conflict at subsequent time points. These findings suggest that youth depression and its treatment may influence long-term family functioning.
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Depresión/terapia , Relaciones Familiares/psicología , Ajuste Social , Esposos/psicología , Adolescente , Adulto , Depresión/fisiopatología , Depresión/psicología , Conflicto Familiar/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Relaciones Padres-HijoRESUMEN
Our ability to predict which children will exhibit oppositional defiant disorder (ODD) at the time of entry into grammar school at age 6 lags behind our understanding of the risk factors for ODD. This study examined how well a set of multidomain risk factors for ODD assessed in 4-year-old children predicted age 6 ODD diagnostic status. Participants were a diverse sample of 796 4-year-old children (391 boys).The sample was 54% White, non-Hispanic; 16.8% African American, 20.4% Hispanic; 2.4% Asian; and 4.4% Other or mixed race. The classification accuracy of two models of multidomain risk factors, using either a measure of overall ODD symptoms or dimensions of ODD obtained at age 4, were compared to one another, to chance, and to a parsimonious model based solely on parent-reported ODD using Automated Classification Tree Analysis. Effect Strength for Sensitivity (ESS), a measure of classification accuracy, indicated a multidomain model including a general measure of ODD symptoms at age 4 yielded a large effect (56.29%), a 13.7% increase over the ESS for the parsimonious model (ESS = 42.9%). The ESS (51.23%) for a model including two ODD dimensions (behavior and negative affect) was smaller than that for the model including a measure of overall ODD symptoms. The Classification Tree Analysis approach showed a small but distinct advantage that would be useful in screening for which children would most likely meet criteria for age 6 ODD.
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Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Relaciones Padres-Hijo , Instituciones Académicas/tendencias , Estudiantes/psicología , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6-7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6-7 while higher age 5 anxiety levels were associated with reductions in age 6-7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child's anxiety symptoms.
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Ansiedad/etiología , Hostilidad , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Autonomía Personal , Apoyo Social , Adulto , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
Interest in providing integrated psychological and medical services in pediatric primary care is growing rapidly. Efforts to incorporate psychological services into primary care settings are leading to new models and innovative approaches to evaluation and treatment in a variety of settings. Presently, there is a need to expand the empirical base for such work and to critically evaluate what is being done. The introduction to this special section discusses some of the background for the development of integrated care, and provides some context for the articles that follow. These articles address issues related to screening in integrated pediatric primary care, the variety of services provided in the context of integrated primary care, and outline the competencies needed for providing high-quality care in such settings. Suggestions for future research directions are provided.
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Servicios de Salud del Niño/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Trastornos Mentales , Atención Primaria de Salud/organización & administración , Psicología Infantil/organización & administración , Niño , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Estados UnidosRESUMEN
OBJECTIVE : To examine the classification accuracy of measures of overall psychopathology recommended for pediatric primary care screening. METHOD : A systematic review identified relevant instruments described in the literature. Subsequent systematic reviews identified studies of sensitivity (SE) and specificity (SP) of each measure for various cutoffs and different criteria for disorder (e.g., caseness determined by structured interview, exceeding a cutoff score, referral for psychiatric evaluation). RESULTS : Measures include the Child Behavior Checklist (CBCL), Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), Brief Infant-Toddler Social Emotional Assessment (BITSEA), and the Ages and Stages Questionnaire: Social-Emotional scale (ASQ:SE). For three measures (CBCL, PSC, and SDQ) studied extensively, achieving relatively high SE and SP values (≥ .70) simultaneously occurred in only 30-55% of the studies reviewed. There are relatively few studies of the ASQ:SE and BITSEA, or of relatively new measures. DISCUSSION : Documented utility of these measures as screening instruments is limited.
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Servicios de Salud del Niño , Servicios Comunitarios de Salud Mental/métodos , Prestación Integrada de Atención de Salud/métodos , Tamizaje Masivo/métodos , Trastornos Mentales/diagnóstico , Atención Primaria de Salud/métodos , Escalas de Valoración Psiquiátrica , Niño , Servicios de Salud del Niño/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Humanos , Atención Primaria de Salud/organización & administración , Psicometría , Sensibilidad y Especificidad , Estados UnidosRESUMEN
OBJECTIVE: The Affordable Care Act has stimulated interest in screening for psychological problems in primary care. Given the scale with which screening might occur, the implications of a problem known as the base rate fallacy need to be considered. METHODS: The concepts of sensitivity and specificity, positive and negative predictive value, and the base rate fallacy are discussed. The possibility that a screening program may not improve upon random selection is reviewed, as is the possibility that sequential screening might be useful. RESULTS AND DISCUSSION: Developing effective screening programs for pediatric mental health problems is highly desirable, and properly addressing the high rate of false positives may improve the likelihood that such programs can be sustained. Consideration needs to be given to the use of sequential screening, which has both advantages and disadvantages, depending upon the type of problem to be screened for and the availability of resources for follow-up evaluations.
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Servicios de Salud del Niño , Servicios Comunitarios de Salud Mental/métodos , Prestación Integrada de Atención de Salud/métodos , Tamizaje Masivo/métodos , Trastornos Mentales/diagnóstico , Atención Primaria de Salud/métodos , Niño , Servicios de Salud del Niño/organización & administración , Servicios Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Humanos , Tamizaje Masivo/organización & administración , Atención Primaria de Salud/organización & administración , Escalas de Valoración Psiquiátrica , Sensibilidad y Especificidad , Estados UnidosRESUMEN
Functional abdominal pain (FAP) occurs frequently in pediatric patients. Lacking clear biomarkers, clinicians and researchers must rely on patient reports of pain intensity. Presently, there are challenges affecting our ability to use existing measures of self-reported pediatric pain intensity. This report discusses those challenges, finding that: (a) inter-rater agreement of children's pain intensity is generally low; (b) typically used approaches to measuring outcomes may yield high levels of unreliable reports of improvement;
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Dolor Abdominal/diagnóstico , Dimensión del Dolor/métodos , Dolor Abdominal/terapia , Niño , Humanos , Reproducibilidad de los Resultados , Autoinforme , Resultado del TratamientoRESUMEN
OBJECTIVE: This report examined limitations in our ability to assess clinically significant change (CSC) in randomized controlled trials of treatments of self-reported pediatric chronic pain intensity. METHODS: The following were reviewed: (a) approaches to assessing CSC; (b) approaches to assessing CSC used in psychological treatment studies of self-reported pediatric chronic pain intensity included in a recent systematic review; (c) the role of test-retest reliability in distribution-based CSC measures; (d) the test-retest reliability of recommended chronic pain measures. RESULTS AND CONCLUSIONS: Existing studies do not assess whether a CSC occurred or use procedures that did not account for measurement error and true score fluctuations unrelated to treatment, possibly resulting in overestimating CSCs. Distribution-based approaches to assessing CSCs that address these problems require knowing test-retest reliability of the chronic pain measure at appropriate intervals. Available information raises concern about our ability to estimate CSC reliably. Recommendations are made for future research.
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Dolor Crónico/diagnóstico , Dimensión del Dolor/métodos , Autoinforme , Niño , Dolor Crónico/terapia , Humanos , Pediatría , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
The present study examined a cascade model of age 4 and 5 contextual, parent, parenting, and child factors on symptoms of oppositional defiant disorder (ODD) at age 6 in a diverse community sample of 796 children. Contextual factors include socioeconomic status, family stress, and conflict; parent factors included parental depression; parenting factors included parental hostility, support, and scaffolding skills; child factors included child effortful control (EC), negative affect (NA), and sensory regulation. Direct effects of age 5 conflict, hostility, scaffolding, EC, and NA were found. Significant indirect, cascading effects on age 6 ODD symptom levels were noted for age 4 socioeconomic status via age 5 conflict and scaffolding skills; age 4 parental depression via age 5 child NA; age 4 parental hostility and support via age 5 EC; age 4 support via age 5 EC; and age 4 attachment via age 5 EC. Parenting contributed to EC, and the age 5 EC effects on subsequent ODD symptom levels were distinct from age 5 parental contributions. Scaffolding and ODD symptoms may have a reciprocal relationship. These results highlight the importance of using a multidomain model to examine factors associated with ODD symptoms early in the child's grammar school years.
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Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Hijo de Padres Discapacitados/psicología , Depresión , Modelos Psicológicos , Responsabilidad Parental/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Niño , Preescolar , Femenino , Hostilidad , Humanos , Masculino , Relaciones Padres-Hijo , Padres/psicología , Factores de Riesgo , Factores SocioeconómicosRESUMEN
Numerous studies indicated that agreement between parent and teacher ratings of symptoms of attention-deficit/hyperactivity disorder in children of all ages is poor, but few studies have examined the factors that may be associated with rater differences. The present study examined the contextual, parent, parenting, and child factors associated with rater differences in a community sample of 4-year-old children. Parents and teachers of 344 4-year-olds recruited from preschools and pediatric practices completed the preschool versions of the Child Symptom Inventory. Measures of socioeconomic status, family stress and conflict, caretaker depression, parental hostility, support-engagement, and scaffolding skills, and child negative affect (NA), sensory regulation (SR), effortful control (EC), inhibitory control, and attachment security were obtained either by parental report or observational measures. χ 2 difference tests indicated that child factors of EC and SR, and contextual factor of stress and conflict, contributed more to parent-ratings of ADHD-I and ADHD-HI than to teacher-ratings of those same types of symptoms. Two factors contributed more to teacher-than to parent-rated ADHD-I, NA and caretaker depression. Results indicate there are differences in factors associated with ADHD symptoms at home and school, and have implications for models of ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Técnicas de Observación Conductual/métodos , Conducta Infantil/psicología , Padres/psicología , Maestros/psicología , Evaluación de Síntomas , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Actitud , Preescolar , Estudios Transversales , Conflicto Familiar/psicología , Femenino , Humanos , Masculino , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Factores Socioeconómicos , Evaluación de Síntomas/métodos , Evaluación de Síntomas/psicología , Estados UnidosRESUMEN
Existing research suggests that parent and teacher reports of children's behavior problems are often discrepant. The current study examined whether contextual (stress and family conflict), parent (depression), parenting (hostility, support, and scaffolding), and child factors (receptive vocabulary; negative affect, NA; effortful control, EC; inhibitory control, IC; attachment; and sensory regulation, SR) are related to parent-teacher reporting discrepancies. Participants included a community sample of 344 4-year-old children. A multi-informant approach was used to assess contextual, parent, parenting, and child factors. Parents and teachers completed the Oppositional Defiant Disorder (ODD) scale of the Child Symptom Inventory. Consistent with previous data, there was poor agreement between parents and teachers (r = .17). After correcting for multiple comparisons, child effortful control, parent hostility, and family conflict were significant predictors of parent-rated symptoms of ODD symptoms but not teacher-rated ODD symptoms. Only family conflict was a significant predictor of discrepancies in parent and teacher ratings.
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Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Docentes , Conflicto Familiar , Hostilidad , Responsabilidad Parental , Padres , Escalas de Valoración Psiquiátrica , Déficit de la Atención y Trastornos de Conducta Disruptiva/fisiopatología , Preescolar , Femenino , Humanos , MasculinoRESUMEN
Identifying the latent structure of Oppositional Defiant Disorder (ODD) may have important clinical and research implications. The present study compared existing dimensional models of ODD for model fit and examined the metric and scalar invariance of the best-fitting model. Study participants were a diverse (38.8% minority, 49.1% boys) community sample of 796 children. Parents completed the Child Symptom Inventory and the DISC-YC ODD scales at child ages of 4, 5 and 6-7 years. When comparing single-factor (DSM-IV model), two-factor (oppositional behavior, negative affect), and three-factor models (one with dimensions of oppositional behavior, negative affect, antagonistic behavior; a second with dimensions of irritable, hurtful, and headstrong), the two-factor model showed the best fit. The two-factor model showed configural, metric and scalar invariance across gender and age. Results suggest that, among existing models, ODD is best characterized as two separate dimensions, one behavioral and one affective, which are comparable for both boys and girls in these age groups.