• Oppositional defiant disorder;
  • attention deficit hyperactivity disorder;
  • conduct disorder;
  • emotional disorders;
  • irritability;
  • comorbidity;
  • depression

Background:  Oppositional defiant disorder (ODD) in youth is a strong predictor of mental illness yet the wide range of associations with psychiatric disorders remains largely unexplained. The aim of this study was to investigate whether the identification of irritable, headstrong and hurtful dimensions within youth oppositionality would clarify the pattern of associations between oppositionality and a wide range of psychopathology in early and adult life.

Methods:  Cross-sectional data from national mental health surveys including 18,415 subjects aged 5–16 in the United Kingdom. The main outcome measures were the associations between a priori hypothesised dimensions of oppositionality with psychiatric disorders and symptoms; parent and teacher-derived information were used in multivariate regression analysis.

Results:  Our three a priori dimensions had very different associations with disorders and symptom scales. Irritability was the only predictor of emotional disorders (parent report: OR = 3.26 [CI 95% 2.79, 3.80]; teacher report: OR = 2.78 [2.39, 3.22]); the hurtful dimension was particularly strongly associated with seeming cold-blooded or callous (parent report: β = .32 [.27, .37]; teacher report: .33 [.30, .36]); and the headstrong dimension was most strongly associated with attention deficit hyperactivity disorder (ADHD; parent report: OR = 3.21 [2.43, 4.23]; teacher report : OR = 7.18 [5.25, 9.82]). All three dimensions were associated with conduct disorder, with the headstrong dimension being the main predictor of non-aggressive symptoms (parent report: β = .31 [.27, .34]; teacher report: .43 [.40, .45]), and with the hurtful dimension being the main predictor of aggressive symptoms (parent report: β = .35 [.32, .39]; teacher report: .40 [.39, .42]).

Conclusions:  The three dimensions of oppositionality have distinctive external correlates, suggesting they may also be differential predictors of aetiology, prognosis and treatment responsiveness.