Longitudinal Outcome of Youth Oppositionality: Irritable, Headstrong, and Hurtful Behaviors Have Distinctive Predictions

Objective: Oppositional behavior in youths is one of the strongest predictors of a wide range of psychiatric disorders. We test the hypothesis that oppositionality encompasses an Irritable, a Headstrong, and a Hurtful dimension, each with distinct predictions. Method: Longitudinal design combining data from two British national surveys and their respective 3-year follow-ups (N = 7,912). The Developmental and Well-Being Assessment was used to generate DSM-IV diagnoses. Results: The Irritable dimension was the sole predictor of emotional disorders at follow-up and was particularly associated with distress disorders (depression and anxiety) rather than fear disorders (phobias, separation anxiety, and panic disorder), both before and after adjustment for baseline psychopathology. The Headstrong dimension was the only predictor of attention-deficit/hyperactivity disorder at follow-up. Both Headstrong and Hurtful predicted conduct disorder, although only the Headstrong dimension did so after adjustment for baseline psychopathology. The Hurtful dimension was the strongest predictor of aggressive conduct disorder symptoms. Conclusions: Our data suggest a developmental model of mental disorder whereby oppositionality is an interim shared manifestation of different dimensions of psychopathology with distinct outcomes. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(4):404-412.