Journal of Youth and Adolescence (2022) 51:1089–1105 https://doi.org/10.1007/s10964-021-01528-7 EMPIRICAL RESEARCH Irritability, Defiant and Obsessive-Compulsive Problems Development from Childhood to Adolescence Lourdes Ezpeleta1,2 Eva Penelo1,3 J. Blas Navarro1,3 Núria de la Osa1,2 Esther Trepat1,2 ● ● ● ● Received: 29 July 2021 / Accepted: 16 September 2021 / Published online: 2 November 2021 © The Author(s) 2021 Abstract Little is known about the coexistence of oppositionality and obsessive-compulsive problems (OCP) in community children and how it affects their development until adolescence to prevent possible dysfunctions. The co-development of oppositional defiant dimensions and OCP is studied in 563 children (49.7% female) from ages 6 to 13 years, assessed yearly with measures answered by parents and teachers. A 4-class model based on Latent Class Growth Analysis for three parallel processes (irritability, defiant, and OCP) was selected, which showed adequate fitting indexes. Class 1 (n = 349, 62.0%) children scored low on all the measures. Class 2 (n = 53, 9.4%) contained children with high OCP and low irritability and 1234567890();,: 1234567890();,: defiant. Class 3 (n = 108, 19.2%) clustered children with high irritability and defiant and low OCP. Class 4 (n = 53, 9.4%) clustered comorbid irritability, defiant, and OCP characteristics. The classes showed different clinical characteristics through development. The developmental co-occurrence of irritability and defiant plus obsessive-compulsive behaviors is frequent and adds severity through development regarding comorbidity, peer problems, executive functioning difficulties, and daily functioning. The identification of different classes when combining oppositional problems and OCP may be informative to prevent developmental dysfunctions and to promote good adjustment through development. Keywords Defiant/Headstrong; developmental trajectories; Irritability; Obsessive-compulsive; Oppositional defiant. Abbreviations typically comorbid. All the available information on their OCD Obsessive-compulsive disorder association comes from cross-sectional studies with clinical OCP Obsessive-compulsive problems samples of children with OCD who also show behavior pro- ODD Oppositional defiant disorder blems. It is well known that clinical samples are not repre- ODP Oppositional defiant problems sentative of the general population as they include individuals with severe symptomatology and a high prevalence of comorbidity. Consequently, there is a gap in the knowledge on Introduction the joint manifestation of oppositionality and obsessive- compulsive problems in children from the general popula- Oppositional defiant disorder (ODD) and obsessive- tion, how these symptoms manifest longitudinally from compulsive disorder (OCD) both have their roots in child- childhood to adolescence, and which developmental char- hood. ODD and OCD may coexist although they are not acteristics occur together. This information is essential for prevention purposes and services provision for children from the community. This research aims to fill this gap, obtaining classes of children from the general population that present * Lourdes Ezpeleta different degrees of oppositional and obsessive-compulsive lourdes.ezpeleta@uab.cat symptoms from early childhood to adolescence, and studying 1 relevant developmental characteristics through the 8-year fol- Unitat d’Epidemiologia i de Diagnòstic en Psicopatologia del Desenvolupament, Universitat Autònoma de Barcelona, low-up period. The objectives are framed in the developmental Barcelona, Spain psychopathology paradigm, which promotes the study of the 2 Departament de Psicologia Clínica i de la Salut, Universitat course of the disorders from early life to understand how Autònoma de Barcelona, Barcelona, Spain multiple features of adaptation and maladaptation lead to 3 Departament de Psicobiologia i de Metodologia de les Ciències de disorders (Rutter & Sroufe, 2000). The results may help to la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain understand the comorbidity and developmental characteristics 1090 Journal of Youth and Adolescence (2022) 51:1089–1105 of oppositionality and obsessive-compulsive problems when However, there is no information about the co- they present together and to identify preventive targets to development of ODD and OCD from early ages and in promote better adjustment in children from the general community samples. The few available studies on the population. association of these symptoms have mostly focused on ODD is characterized by angry mood, disobedience, children with OCD and investigate its comorbidity with negativistic and hostile behavior towards authority figures, and disruptive behavior disorders. Comorbidity with ODD in vindictiveness. ODD has been conceptualized as a multi- children with OCD ranges from 8 to 51% (Peris et al., dimensional disorder with two factors (irritable and defiant) 2017). In cross-sectional studies, children with OCD and (Burke et al., 2014) or, less frequently, three factors (irritable, disruptive behavior/externalizing disorders have shown defiant, and hurtful) (Wesselhoeft et al., 2019). The irritable greater OCD symptomatology (Langley et al., 2010), higher dimension includes loses temper, angry, and touchy symp- functional impairment (Langley et al., 2010), worse quality toms; the defiant dimension includes argues, defies, annoys, of life (Storch et al., 2018), greater family accommodation and blames symptoms (and spitefulness- vindictiveness in the (Storch et al., 2010), and higher anxiety and internalizing 2-factor solution); and the hurtful dimension includes spite- problems (Peris et al., 2017) than those without comorbid fulness and vindictiveness symptoms. The differentiation of conditions. There is controversy as to whether this comor- these dimensions has proven to be extremely useful in the bidity is more frequent in younger (Tanidir et al., 2015) or clinical setting as they associate with specific disorders, pos- older children (Peris et al., 2017). These studies suggest that sibly explaining, at least partially, the comorbidities of ODD, the lives of children with both OCD and externalizing which is potentially useful for preventive efforts (Lavigne problems are severely affected. et al., 2014). For its part, obsessive-compulsive disorder Although ODD and OCD may appear to be very different (OCD) refers to the presence of unwanted, nonsensical, disorders, the reality is that they can coexist, as has been recurrent thoughts, urges, or images (obsessions), and/or shown in studies on the comorbidity of ODD in samples with unnecessary repetitive behaviors or mental acts performed in OCD. The stubbornness of the oppositional child who wants response to obsession (compulsions) (American Psychiatric to do their will and the rituals of the obsessive child who needs Association, 2013). OCD is associated with serious distress to do things in a certain way, the low anger threshold in and impairment in the daily life of the child and the family oppositionism and the anger attacks of the obsessive child (Monzani et al., 2020). when prevented from doing their rituals, the argumentative- ODD is one of the most prevalent disorders from pre- ness in both cases to be able to do what they want, annoying school age, with figures in different countries ranging from others for fun or because they need to participate in the ritual, 0.4 to 13.4% (Vasileva et al., 2021) and a lifetime pre- and defying rules may make the two disorders coexist. For valence of 10.2% (Nock et al., 2007). ODD shows a example, temper outbursts are common in children with OCD, moderate continuity through childhood (Husby & Wich- with about one third of the children diagnosed presenting this strom, 2017), adolescence (Whelan et al., 2013), and symptom (Krebs et al., 2013). Furthermore, youth with OCD adulthood (Johnston et al., 2018), and is accompanied by and rage attacks presented a higher incidence of disruptive severe consequences in academic achievement and social behavior disorders (Storch et al., 2012). The notion of multi- relationships until adulthood (Leadbeater & Ames, 2017). finality in developmental psychopathology, which states that ODD irritability dimension is most often comorbid with common risk factors may lead to different outcomes (Cicchetti anxiety (Martín et al., 2014) and depressive disorders & Rogosch, 1996), may explain how different individual and (Burke & Loeber, 2010), and the defiant dimension with contextual traits may facilitate the co-existence of both attention-deficit/hyperactivity disorder (ADHD) (Harvey symptoms. Executive functioning (McKenzie et al., 2020; et al., 2016) and conduct disorder (Nock et al., 2006). In the Qian et al., 2010), irritability (Stringaris & Goodman, 2009; case of OCD, in about half of cases the disorder starts in Theriault et al., 2018), other common comorbidities such as childhood, with prevalence until adolescence ranging from ADHD (Farrell et al., 2020; Harvey et al., 2016) and anxiety 0.1 to 4% (Heyman et al., 2001), and persistence rates of (Martín et al., 2014; Storch et al., 2008), and family dys- 40% (Liu et al., 2021). About 80% of children with OCD function (Greene et al., 2002) may be some of the character- meet diagnostic criteria for other psychological disorders istics that foster overlapping contemporary symptoms of ODD (Langley et al., 2010). OCD is most often comorbid with and OCD. depressive and anxiety disorder (Peris et al., 2017), tic disorders (Storch et al., 2008), ADHD (Cabarkapa et al., 2019) and, to a lesser extent, externalizing disorders Current Study (Guzick et al., 2019). DSM-5 indicates that OCD is also associated “with disorders characterized by impulsivity, Despite the points made above, little is known about how such as oppositional defiant disorder” (p.242). the coexistence of ODD and OCD may impact the Journal of Youth and Adolescence (2022) 51:1089–1105 1091 development of affected children and families in the general Table 1 Description of the Sample population. For instance, the natural simultaneous evolution At age 6 (N = 563) of both symptomatologies in children in the general popu- Age (years); M (SD) 6.6 (0.36) lation, how many of them in the general population suffer from oppositional problems and obsessive-compulsive pro- Sex; % Female 49.7 blems (OCP), and the characteristics that may be more SES; % High 33.8 associated with a certain developmental trajectory are Medium-High/Medium 46.8 unknown. The goal was to study the co-development of Medium-low/Low 19.4 oppositional problems and OCP from ages 6 to 13 years in Born in Spain; % Yes 97.1 children from the general population and to describe the Ethnicity; % Caucasian 92.3 clinical characteristics of the obtained trajectories. Given that Latino 4.2 ODD is characterized by two different dimensions the goal Other 3.5 was to describe how the dimensions of ODD, irritability, and defiant co-develop with obsessive-compulsive symptoms to find out if a certain dimension or the two dimensions The sample used for this study consisted of 563 children develop simultaneously with obsessive-compulsive pro- (32.9% screen positive) (Table 1). Because of the age of blems, and if there should therefore be a specific focus of application of the assessment instruments, data from ages 6 prevention or treatment. The following research questions to 13 years (8 assessment points) were used to estimate are raised. First, how do ODD dimensions (irritability and classes. To this effect, the retention rates in the successive defiant) and OCP co-develop longitudinally in a general follow-ups with respect to the 563 participants were 85.1%, population of children aged 6 to 13 years? And second, what 83.3%, 76.0%, 78.7%, 75.8%, 79.8%, 64.7%, and 56.7%. are the clinical characteristics through development asso- No differences were found in sex between the sample at age ciated with the different developmental trajectories obtained. 6 and the children remaining at age 13 (p = 0.903). With The identification of different classes when combining respect to socioeconomic status at age 6, the available oppositional problems and OCP may be informative not sample at age 13 had a higher percentage of high SES only for the forecast of future comorbidities, but also for the children (p < 0.001). prevention, assessment, and tailoring of treatment options. Measures Methods Developmental trajectories Participants Dimensions of oppositional problems: Irritability and defiant The dimension scores of ODD were obtained The sample is part of a longitudinal study of behavioral pro- following Rowe’s (Rowe et al., 2010) 2-factor model. The blems starting at age 3 years described in Ezpeleta et al. irritability dimension included three items, ‘touchy-easily (2014). The children (N = 2,283) were randomly selected from annoyed’, ‘angry and resentful’, and ‘loses temper’, and the early childhood schools in Barcelona (Spain). A two-phase median (Mdn) of the ordinal alpha in the sample through design was employed. A total of 1341 families (58.7%) agreed follow-ups was 0.92. The defiant dimension included five to participate (33.6% high socioeconomic status (SES), 43.1% items (‘argues with adults’, ‘defies rules’, ‘deliberately middle, and 23.3% low; 50.9% boys) in the first phase of annoys’, ‘blames others’, ‘spiteful’) (Mdn of ordinal alpha sampling. To ensure the participation of children with possible = 0.90). These symptoms come from the Strengths and behavioral problems, the parent-rated Strengths and Difficul- Difficulties Questionnaire (SDQ) (Goodman, 1997) conduct ties Questionnaire (SDQ) conduct problems scale (Goodman, problem scale (loses temper, defies rules, argues, spiteful) 1997) plus four ODD DSM-IV-TR symptoms (deliberately plus four questions based on symptoms of DSM-IV ODD annoys, blames others, touchy, angry-resentful), not included not covered by the SDQ and added for the study (deliber- in the SDQ questions, were used for screening. Two groups ately annoys, blames others, touchy, angry-resentful) (0: not were considered: the screen-positive group, which included all true; 1: somewhat true; 2: certainly true). Direct scores for the children with SDQ scores ≥ 4, in percentile 90, or with a the dimensions were obtained as the sum of the ratings of positive response (certainly true) to any of the eight DSM-IV the corresponding items. Higher scores indicated greater ODD symptoms (N = 417; 49.0% boys); and a random draw irritability and defiant problems (possible theoretical range of children screened negative (n = 205; 51.2% boys) (total of 0–6 and 0–10, respectively). A total score of 2 for both sample of 622 children aged 3–13 years for the follow-up, irritability and defiant corresponded to percentile 75 in the mean age = 3.77 years; SD = 0.33; 96.9%, born in Spain). sample (equivalent to a total score obtained from the 1092 Journal of Youth and Adolescence (2022) 51:1089–1105 average of the responses to the items of 0.67 and 0.40, follow-ups was equal to or above 0.75 for 9 of the 11 scale respectively; scale: 0–2). For the purposes of this study, scores analyzed). Items 31.Fear, 32.Perfectionism, 52. scores equal to or higher than percentile 75 in the sample Guilty and 112. Worries on the anxious/depressed and were considered as “high”. Teachers answered the ques- internalizing scales were eliminated to calculate the scores tionnaire every year from when the children were aged 6 to because these items were also included in the OCP 2007- 13 years. scale. Response categories 1 and 2 (sometimes and often) to items 46 (tics), 58 (picks skin), and 83 (stores up), chosen to Obsessive-compulsive problems (OCP) The OCP 2007- indicate OCD-related problems, were grouped to calculate scale of the Child Behavior Checklist (Achenbach & the percentage of presence of these problems. Rescorla, 2007) contains eight items (9. Obsessions; 31. Fear doing/thinking something bad; 32. Perfectionism; 52. Functional impairment The Children’s Global Assessment Feels too guilty; 66. Compulsions; 84. Strange behavior; 85. Scale (CGAS) (Shaffer et al., 1983) is a global measure of Strange ideas; 112. Worries) (0: not true; 1: sometimes true; functional impairment rated by the interviewer based on 2: often true) that have proven to identify children with information from the diagnostic interview with the parents clinical problems related to OCD. Parents answered the at each follow-up. questionnaire every year from when the child was aged 6 to 13 years (Mdn of ordinal alpha = 0.82). The OCP direct Peer relationship problems The Strengths and Difficulties score was obtained as the sum of the ratings of the eight Questionnaire (SDQ) (Goodman, 1997) assesses children’s items. Higher scores indicated greater problems (theoretical mental health with 25 items (0: not true; 1: somewhat true; 2: possible range of 0–16). A total score of 1 corresponded to certainly true) on five scales. The teachers reported on the peer percentile 75 of the sample (equivalent to a total score relationship problems scale (Mdn of ordinal alpha = 0.82). obtained from the average of the responses to the items of 0.13; scale 0–2). For the purposes of this study, scores equal Temperament The Children’s Behavior Questionnaire-Very to or higher than percentile 75 were considered as “high”. Short Form (CBQ-VSF) (age 7) (Putnam & Rothbart, 2006) and the Early Adolescent Temperament Questionnaire Revised Variables through development (EATQR) (age 10) (Ellis & Rothbart, 2001) measure reactive and self-regulative temperament, with 36 items and 62 items If not otherwise specified, all the measures were obtained (extremely untrue to extremely true), respectively, on a 7-point yearly. and 5-Likert-type scale. It was answered by the parents. The dimensions surgency, negative affect, and effortful control DSM-5 diagnoses The Diagnostic Interview for Children were analyzed (Mdns of Cronbach’s alpha were 0.74, 0.81, and Adolescents for Parents of Preschool and Young and 0.79, respectively). Children (DICA-PPYC) (Ezpeleta et al., 2011) is a semi- structured diagnostic interview for assessing DSM-5 psy- Irritability The Affective Reactivity Index (ARI) (Stringaris chological disorders. It was answered by the parents at each et al., 2012) contains 6 items about feelings and behaviors follow-up. The main diagnoses analyzed were disruptive related to irritability (0: not true; 1: somewhat true; 2: behavior disorders (ADHD, ODD, and conduct disorder) certainly true) plus one item assessing impairment due to and anxiety disorders (separation and generalized anxiety, irritability during the last 6 months. The children’s teachers, specific, and social phobia). Comorbidity was defined as the who had known them for a mean of 10.2 months, answered presence of more than one disorder among those evaluated the ARI questionnaire when the children were 7 and 11 in the interview. The presence of any diagnosis, seeking years old, and the child answered the questionnaire at ages help, and treatment received for any of the diagnoses 12 and 13 years (Mdn of ordinal alpha = 0.85 for teachers’ assessed in the interview were also registered. ratings and 0.95 for the children’s). Dimensional psychopathology The Child Behavior Executive functioning The Behavior Rating Inventory of Checklist (CBCL/6-18) (Achenbach & Rescorla, 2001) Executive Function (BRIEF2) (Gioia et al., 2015) evaluates measures behavioral and emotional problems as reported behaviors showing different domains of executive func- annually by parents through 112 items with 3 response tioning in daily life. BRIEF2 was used as an outcome options (0: not true; 1: sometimes true; 2: often true). measure at the last follow-up to indicate global difficulties Empirical scales plus the dysregulation profile (sum of the in carrying out actions, meeting long-term goals, organizing items of anxious-depressed, attention problems, and materials, setting schedules, controlling emotions or aggressive behavior scales) (Rescorla et al., 2019) were impulses, and analyzing or processing information (Gioia used for the analyses (Mdn of ordinal alpha over the eight et al., 2015). It contains 63 items (0: never, 1: sometimes; 2: Journal of Youth and Adolescence (2022) 51:1089–1105 1093 often) about behaviors in the last 6 months that reflect how accurate classification by average posterior probabilities, often these behaviors are a problem. It was answered by tea- entropy values equal to or greater than 0.70, and more than 5% chers when the children were 13 years old. The three indexes: (n > 28) of participants in a class/trajectory. Pairwise mean the behavior regulation index (inhibit, self-monitor), the differences of growth parameter estimates (intercept, slope, emotional regulation index (shift, emotional control), the and quadratic term) among classes for the selected LCGA cognitive regulation index (initiate, working memory, plan/ model were tested using one-way ANOVA and the Games- organize, task-monitor, organization of materials), plus the Howell correction for post-hoc comparisons, in addition to global executive composite (GEC) were used (ordinal alpha effect sizes for each comparison (Cohen’s d). values: 0.97, 0.95, 0.99, and 0.99 respectively). Different demographic and clinical characteristics were compared between classes using multiple post-hoc compar- Procedure isons. To synthesize the information from the follow-ups, a variable was considered as a present for the binary measures if The families were recruited at the schools and gave written it was present at least one of the follow-ups, while the average consent for the assessment. All the families of the 3-year-old of the follow-ups was calculated for the quantitative measures. children from participating schools were invited to answer the These summary measures (outcomes) were compared between screening questionnaire. The families who agreed and met the classes using linear models for the continuous measures, screening criteria were contacted by telephone and interviewed logistic models for the binary ones, and multinomial logistic at the school for each annual assessment. The interviewer team models for the polytomous measures. The risk of type I error was specifically trained, and all the interviewers were blind to was corrected using Tukey (1949) when comparing the the screening group. The teachers answered the questionnaires quantitative measures and Bonferroni-Holm’s (Holm, 1979) after permission from the families was obtained. when comparing the categorical ones. Internal consistency reliability was calculated using Statistical Analysis Cronbach’s alpha for questionnaires containing items with 5 or more response options and with ordinal alpha (Elosua & The statistical analysis was carried out using MPlus 8.6 and Zumbo, 2008) for items with less than 5 response options. SPSS 24. Given the multistage sampling procedure used, the analyses were weighted by the inverse probability of selection in the second phase of sampling. Results Latent Class Growth Analysis (LCGA) for three parallel processes was used to identify distinct groups of individual Table 2 presents the bivariate correlations between observed trajectories considering the direct scores for irritability, defiant, scores over waves. Bivariate correlations within each pro- and OCP. As a person-centered approach, LCGA allows cess ranged from 0.22 to 0.63, (irritability: 0.23–0.57; individuals with similar patterns to be grouped, focusing on defiant: 0.34–0.63; OCP: 0.22–0.63) and between two class membership according to time-varying attributes, by processes from −0.07 to 0.82 (irritability-defiant: obtaining growth parameters such as the intensity of severity 0.21–0.82; irritability-OCP: −0.01–0.20; defiant-OCP: (i.e., the initial level) and the amount of growth or decline (i.e., −0.07–0.16). Correlation values between observed scores the rate of change or slope) in attributes over time. The Robust involving two processes cross-sectionally ranged from Maximum Likelihood (MLR) method of estimation was −0.02 to 0.82 (irritability-defiant: 0.67–0.82; irritability- employed, which enables the inclusion of non-normal and OCP: 0.00–0.15; defiant-OCP: −0.02–0.15). incomplete data, using the expectation-maximization algo- rithm for missing data with robust standard errors (i.e., full Trajectories of Irritability, Defiant, and OCP information method). The growth models considered intercept (I), slope (S; i.e., linear trend), and quadratic trend over the Table 3 shows the goodness-of-fit indices for the LCGA eight annual assessments from ages 6 to 13 years, with equal models from one to six classes. Based on the aforementioned spacing between measurement occasions. The time was criteria, the 4-class model, which showed high entropy (0.892) rescaled from 6–13 years to 0–7 years, so the first-year and very high on-diagonal posterior probabilities of class assessment (at age 6) represented the intercept. membership values ( ≥ 0.920), was selected. After checking for possible overlap between measures with Table 4 presents the parameter estimates for the selected bivariate Pearson’s correlations, models with one to six latent 4-class model, the profiles of which, based on sum-item classes of growth patterns were obtained. In addition to best scores, are shown in Figure 1. Figure 2 represents the three clinical interpretability, the following criteria were used to processes jointly for each of the four resultant classes, based determine the model selected: larger decrement in AIC and on average-item scores (same 0–2 scale for all three pro- sample-size adjusted BIC (aBIC), greater power and more cesses at Y-axis, also including each corresponding 75th Table 2 Means, Standard Deviations and Bivariate Pearson’s Correlations between Observed Scores 1094 M SD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1. Irritability at age 6 1.07 1.38 1 2. Irritability at age 7 1.20 1.38 0.57** 1 3. Irritability at age 8 1.18 1.46 0.43** 0.43** 1 4. Irritability at age 9 1.24 1.43 0.39** 0.42** 0.55** 1 5. Irritability at age 10 1.10 1.40 0.43** 0.43** 0.49** 0.49** 1 6. Irritability at age 11 1.08 1.38 0.36** 0.35** 0.38** 0.49** 0.53** 1 7. Irritability at age 12 1.03 1.45 0.35** 0.37** 0.36** 0.48** 0.43** 0.49** 1 8. Irritability at age 13 0.99 1.44 0.23** 0.24** 0.27** 0.29** 0.30** 0.30** 0.44** 1 9. Defiant at age 6 1.39 1.84 0.74** 0.49** 0.46** 0.40** 0.40** 0.38** 0.34** 0.26** 1 10. Defiant at age 7 1.45 1.89 0.52** 0.67** 0.44** 0.36** 0.41** 0.34** 0.41** 0.31** 0.63** 1 11. Defiant at age 8 1.48 2.09 0.45** 0.38** 0.82** 0.45** 0.47** 0.40** 0.37** 0.22** 0.54** 0.49** 1 12. Defiant at age 9 1.59 1.93 0.41** 0.41** 0.54** 0.70** 0.44** 0.46** 0.45** 0.30** 0.49** 0.45** 0.56** 1 13. Defiant at age 10 1.63 2.10 0.43** 0.40** 0.46** 0.46** 0.70** 0.50** 0.48** 0.30** 0.48** 0.44** 0.58** 0.55** 1 14. Defiant at age 11 1.50 2.05 0.37** 0.28** 0.34** 0.47** 0.37** 0.73** 0.46** 0.37** 0.41** 0.38** 0.47** 0.55** 0.59** 1 15. Defiant at age 12 1.48 2.04 0.34** 0.34** 0.33** 0.44** 0.35** 0.37** 0.72** 0.36** 0.39** 0.41** 0.47** 0.45** 0.57** 0.51** 1 16. Defiant at age 13 1.55 2.09 0.26** 0.21** 0.28** 0.22** 0.28** 0.30** 0.38** 0.71** 0.38** 0.38** 0.34** 0.36** 0.40** 0.42** 0.45** 1 17. OCP at age 6 0.84 1.34 0.14** 0.09 0.09 0.06 −0.01 0.08 0.00 0.02 0.08 0.03 0.07 0.08 0.02 0.09 0.08 0.04 1 18. OCP at age 7 0.84 1.28 0.17** 0.09 0.11* 0.09 0.07 0.06 0.04 0.07 0.11* 0.04 0.07 0.09 0.03 0.02 0.03 0.02 0.50** 1 19. OCP at age 8 0.88 1.31 0.16** 0.13** 0.15** 0.09 0.08 0.15** 0.10 0.07 0.12* 0.09 0.15** 0.09 0.07 0.11* 0.12* 0.08 0.47** 0.52** 1 20. OCP at age 9 0.86 1.44 0.18** 0.18** 0.11* 0.09 0.06 0.20** 0.11 0.09 0.12* 0.05 0.09 0.07 0.08 0.11 0.16** 0.03 0.49** 0.44** 0.48** 1 21. OCP at age 10 0.76 1.24 0.20** 0.19** 0.18** 0.09 0.11* 0.12 0.11 0.07 0.16** 0.12* 0.14** 0.10 0.06 0.04 0.13* 0.01 0.43** 0.46** 0.49** 0.63** 1 22. OCP at age 11 0.76 1.29 0.13* 0.13* 0.05 0.01 0.06 0.11* 0.04 0.00 0.08 0.08 0.01 0.01 −0.04 −0.02 0.00 −0.07 0.22** 0.37** 0.34** 0.52** 0.59** 1 23. OCP at age 12 0.57 1.07 0.04 0.09 0.08 0.04 0.00 0.12* 0.00 0.08 0.04 0.05 0.08 0.01 0.00 0.06 −0.02 0.04 0.25** 0.31** 0.35** 0.46** 0.40** 0.55** 1 24. OCP at age 13 0.59 1.02 0.11 0.16* 0.10 0.06 0.08 0.01 0.03 0.07 0.12 0.03 0.05 0.06 0.02 0.00 0.06 0.04 0.28** 0.30** 0.47** 0.39** 0.46** 0.58** 0.63** 1 *p < 0.05; **p < 0.01; OCP Obsessive-Compulsive Problems Journal of Youth and Adolescence (2022) 51:1089–1105 Journal of Youth and Adolescence (2022) 51:1089–1105 1095 Table 3 Fitting Indices for 1- to 6- LCGAs Classes for 3 Processes Clinical Characteristics through Development and N. classes AIC aBIC Class: N Class: Entropy Comparisons among the Trajectories (weighted) probability* Tables 5 and 6 show the demographic and clinical (categorical 1 36874.1 36912.4 1: 563 – – and dimensional) characteristics of the four classes obtained 2 34553.8 34603.7 1: 431 1: 0.981 0.921 through ages 6–13 years and the comparison among classes. 2: 132 2: 0.970 The clinical characteristics of each class are briefly summar- 3 33926.1 33987.5 1: 51 1: 0.955 0.918 ized as follows. Class 1 (all low) clustered children with the 2: 116 2: 0.965 lowest scores in all the variables, the least adverse outcomes, 3: 396 3: 0.966 and better functioning in comparison with the other classes. 4 33368.1 33441.1 1: 349 1: 0.942 0.892 Children in class 2 (high OCP with low irritability and 2: 53 2: 0.941 defiant) showed a severe developmental trajectory, with a 3:108 3: 0.920 high percentage of DSM-5 diagnoses (92.3%), especially in 4: 53 4: 0.960 the any anxiety category (60.4%) and, to a lesser extent, in 5 33125.6 33210.1 1:49 1: 0.972 0.906 the any disruptive disorder category (47.2%), high comor- 2: 345 2: 0.945 bidity (43.4%), high scores (above percentile 90) in the 3: 107 3: 0.924 dimensional measures of OCP (measure included in the 4: 35 4: 0.931 trajectory), internalizing problems (anxious/depressed, 5: 27 5: 0.933 withdrawn/depressed, somatic problems), and negative 6 32905.4 33001.5 1: 298 1: 0.935 0.884 affect, but low scores in surgency. Parents reported a high 2: 36 2: 0.911 frequency (sometimes or often) of tics and storing up. 3: 39 3: 0.918 Class 3 (irritability and defiant) was a class that included 4: 125 4: 0.865 mostly boys who, by early adolescence, self-reported high 5: 27 5: 0.907 levels of irritability-anger and difficulties in cognitive reg- 6: 38 6: 0.968 ulation (BRIEF2 index). The most frequent diagnoses in this class were disruptive behavior disorders (41.7%) (ODD aBIC Sample-Size Adjusted BIC. and ADHD). *On-diagonal values for the posterior probability of class membership. Class 4 (irritability-defiant and OCP) was the most In bold: selected solution of LCGA severe developmental trajectory regarding the different clinical characteristics observed. The most frequent diag- percentile score as threshold). The profile represented in the noses in this class were disruptive behavior disorders figures shows that class 1 (n = 349, 62.0%) included chil- (59.6%) (ADHD, ODD and conduct disorder). It was made dren with low scores in irritability, defiant, and OCP; class 2 up of mostly boys (65.4%). ODD in this class was mod- (n = 53, 9.4%) included children with high OCP increasing erate-severe, required consultation, psychological treatment, until age 10 years and then decreasing (quadratic trend p = and started at an early age. Children in this class also 0.020) while maintaining a high score, and low irritability obtained the highest scores in irritability and defiant (mea- and defiant scores; class 3 (n = 108, 19.2%) included chil- sures included in the trajectory), externalizing symptoms dren with high irritability scores from age 9 to 12 years (rule-breaking, aggressive behavior), peer problems, (linear trend p = 0.002; quadratic trend p = 0.015) and high irritability-anger reported by the teacher, and all the scores defiant (linear trend p = 0.001; quadratic trend p = 0.003), of executive functioning, and the lowest scores in effortful but low OCP scores (defiant plus irritability); and class 4 control. This class presented the worst functioning. (n = 53, 9.4%) included children with high scores in irrit- Classes 2, 3, and 4, with high scores in all the processes ability and defiant from 6 to 13 years, and high OCP until evaluated, were similar in terms of the percentage of ODD age 11, and was labeled as the comorbid class. Both inter- diagnoses (clinical and subthreshold), the associated family cept and slope estimates for the three processes involved burden, the need to seek treatment for the problems, and the differed among the four classes (p ≤ 0.001; d ≥ 0.51). The scores in attention problems. They all differed from class 1 same was observed for the quadratic trend, except that this (all low). Classes 3 (irritability and defiant) and 4 (irrit- parameter for OCP did not differ between classes 1 and 4 ability-defiant and OCP) were similar in terms of the per- (p = 0.128). However, the effect size was small but not null centage of boys and in the difficulties in executive functions (d = 0.32 in absolute value) and, as mentioned, both the of cognitive regulation. Classes 2 (OCP) and 4 (irritability- intercept and the slope did differ. Taken together, we con- defiant and OCP) were similar in the percentage of DSM-5 sider there is support for four distinguishable classes diagnoses and comorbidity, and in the scores for social and (detailed statistics in Appendix). total problems on CBCL. 1096 Journal of Youth and Adolescence (2022) 51:1089–1105 Table 4 Parameter Estimates for Class Processes Parameter estimate (p) the Selected 4-Class Model Intercept (basal) Linear trend (slope) Quadratic trend 1 Irritability 0.64 (<0.001) −0.01 (0.712) −0.00 (0.796) All low Defiant 0.72 (<0.001) −0.07 (0.172) 0.01 (0.076) Obsessive-compulsive 0.66 (<0.001) −0.09 (0.008) 0.01 (0.148) 2 Irritability 1.13 (<0.001) −0.07 (0.495) 0.00 (0.889) OCP Defiant 1.33 (<0.001) −0.15 (0.354) 0.02 (0.465) Obsessive-compulsive 1.91 (<0.001) 0.62 (0.016) −0.08 (0.020) 3 Irritability 1.18 (<0.001) 0.48 (0.002) −0.06 (0.015) Irrit- Defiant Defiant 1.71 (<0.001) 0.71 (0.001) −0.09 (0.003) Obsessive-compulsive 0.73 (<0.001) 0.00 (0.998) −0.01 (0.454) 4 Irritability 3.89 (<0.001) −0.17 (0.420) −0.00 (0.932) Irrit-Defiant- Defiant 5.06 (<0.001) 0.10 (0.702) −0.03 (0.384) OCP Obsessive-compulsive 1.31 (0.001) 0.16 (0.278) −0.04 (0.067) OCP Obsessive-compulsive problems Fig. 1 Trajectories for Irritability, Defiant, and Obsessive-Compulsive horizontal dotted line shows the 75th percentile. Class 1: All low; Problems (OCP) by Processes. Note. Each panel shows the four Class 2: High OCP with low irritability-defiant; Class 3: High classes simultaneously for each of the 3 processes over time. The Irritability-Defiant with low OCP; Class 4: High Irritability-Defiant- Y-axis corresponds to direct scores based on the sum of item ratings OCP (the title of each figure indicates its theoretical possible scale); the grey Journal of Youth and Adolescence (2022) 51:1089–1105 1097 Fig. 2 Trajectories for Irritability, Defiant, and Obsessive-compulsive percentile of the measure with the same line pattern. Class 1: All low; problems (OCP) by Classes. Note. Each panel shows the three pro- Class 2: High OCP with low irritability-defiant; Class 3: High cesses simultaneously for each of the 4 classes. The Y-axis corre- Irritability-Defiant with low OCP; Class 4: High Irritability-Defiant- sponds to the direct scores based on the average of item ratings (0- OCP 2 scale for all three processes); the grey horizontal lines show the 75th The association between classes and different psycholo- severe clinical picture. However, little is known about how gical characteristics were also analyzed through the first these symptoms coexist and co-develop from childhood to order scales of executive functioning (BRIEF2 ques- adolescence in community samples. Knowing their devel- tionnaire) and other aggressive behavior scales. This opmental paths would be helpful not only to understand the information was discarded due to redundancy. developmental course of boths symptomatologies but also for preventive interventions in the general population. The Sensitivity Analysis present study fills this gap through a longitudinal design in which community children were assessed yearly from 6 to As a sensitivity analysis, LCGA modelling was replicated 13 years. LGCA with parallel processes identified different using only data corresponding to children with responses classes based on ODD dimensions (irritability and defiant) for at least 4 of the 8 follow-ups (50%). Global fit indexes and OCP scores. A model of four classes fitted the data and suggested that the 4-class solution was optimal, with very clinical interpretability well and showed how irritability, similar growth patterns to those observed when analyzing defiant, and obsessive compulsive behaviors co-develop the information using FIML (all children). from childhood to adolescence. The four classes represented the individual disorders under study (OCP and oppositional defiant problem dimensions, classes 2 and 3, respectively), Discussion and included a comorbid class in which there were high levels of OCP and ODP dimensions (class 4) and a class Oppositional-defiant and obsessive-compulsive symptoms with low levels of all the characteristics (class 1). The have proved comorbid in clinical samples in cross-sectional classes showed different clinical characteristics through studies, and this coexistence is associated with a more development. As expected, the comorbid class (class 4) 1098 Journal of Youth and Adolescence (2022) 51:1089–1105 Table 5 Comparisons of Class 1 Class 2 Class 3 Class 4 Significant Demographic Characteristics All low OCP Irritability- Irritability- contrasts and DSM-5 Diagnoses in n = 349 n = 53 Defiant Defiant-OCP each Class n = 108 n = 53 Demographics at baseline Sex (% boys) 45.3 48.1 59.8 65.4 (3 = 4)>1 Socioeconomic status % n.s. High 38.0 34.6 31.8 34.0 Medium/Medium-High 46.4 44.2 44.9 47.2 Low/Medium-Low 15.6 21.2 23.4 18.9 DSM-5 Diagnoses ODD (%) 13.8 37.7 29.6 41.5 (2 = 3 = 4)>1 Subthreshold (%) 46.7 65.4 65.7 67.9 (2 = 3 = 4)>1 Consultation (% Yes) 20.4 33.3 46.2 63.0 4 > (2 = 3)>1 Severity (% Moderate- 18.6 37.7 47.2 69.8 4 > (2 = 3)>1 high)* Family burden (%)* 55.2 73.5 74.7 78.3 (2 = 3 = 4)>1 Treatment (%)* 61.2 81.3 76.2 79.3 n.s. Age at onset – M (SD) 4.3 (2.6) 3.8 (1.9) 4.0 (2.3) 3.3 (1.4) n.s ADHD (%) 12.0 28.8 19.4 42.3 4 > 3 > 1; 2 > 1 Age at onset – M (SD) 3.3 (1.1) 3.2 (0.9) 3.2 (1.1) 3.4 (1.5) n.s. Conduct disorder (%) 0.0 1.9 0.0 7.5 n.s. Age at onset – M (SD) 6.5 (3.3) 5.4 (3.1) 5.3 (2.8) 4.8 (2.5) n.s. Any disruptive 18.0 47.2 41.7 59.6 (2 = 3 = 4)>1 disorder (%) Any anxiety (%) 22.6 60.4 23.1 30.2 2 > (1 = 3 = 4) Any DSM-5 diag. (%) 60.0 92.3 72.9 82.7 (2 = 4)>1; 2 > 3>1 Comorbidity DSM-5 (%) 8.6 43.4 15.7 28.3 (2 = 4)>1; 2 > 3>1 Consultation any 77.6 86.5 85.2 86.5 n.s. disorder (%) Treatment by any 46.2 69.2 63.9 78.8 (2 = 3 = 4)>1 disorder. (%) Psychological 21.8 40.4 45.8 65.4 4 > (2 = 3)>1 treatment (%) Linear models for continuous measures; logistic models for binary measures; multinomial logistic models for polytomous measures. Risk of type I error corrected by Bonferroni-Holm’s (Holm, 1979). ODD Oppositional defiant disorder; ADHD Attention deficit/Hyperactivity disorder; any anxiety, including separation anxiety, generalized anxiety, specific phobia and social phobia; any disruptive disorder, including ODD, ADHD, CD; comorbidity: presence of more than one DSM-5 diagnosis in the Diagnostic Interview for Children and Adolescents. *Values calculated among those children with any ODD symptom. N.s non-significant presented a more severe clinical picture where the most in community samples. The identification of these classes marked dimension was irritability, while the pure opposi- and their clinical traits may help to better meet the needs of tional problems class (irritability and defiant; class 3) the children in each class. showed stronger externalizing comorbidity and the pure In about 9.4% of the children in a general population obsessive-compulsive class (class 2) showed stronger sample oppositional characteristics (irritability and defiant) and internalizing comorbidity plus tics and other obsessive- obsessive-compulsive behaviors co-develop from ages 6 to 13 compulsive related characteristics. These results point to the years. Most of the previous literature has focused in children need for early assessment and follow-up of OCP in children with OCD and has warned of a high proportion of comorbidity with ODP and the assessment of ODP in children with OCP with ODD (8-51%) and of the need for careful assessment of Journal of Youth and Adolescence (2022) 51:1089–1105 1099 Table 6 Comparisons of Dimensional Characteristics, Percentage of Affirmative Response to Items in each Class (mean through follow-ups) and Reliability of the Measures α (Mdn) Class 1 Class 2 Class 3 Class 4 Significant contrasts All low OCP Irritability- Defiant Irritability- Defiant- n = 349 n = 53 n = 108 OCP n = 53 Trajectories variables - M (SD) Irritability-Teachers 0.92 0.6 (0.5) 0.9 (0.8) 1.9 (0.6) 3.4 (1.0) 4>3>2>1 Defiant-Teachers 0.90 0.7 (0.6) 1.0 (0.9) 2.8 (0.8) 5.0 (1.6) 4 > 3 > (1 = 2) CBC OCP-Parents 0.82 0.5 (0.5) 2.8 (1.0) 0.6 (0.6) 1.3 (1.3) 2 > 4 > (1 = 3) Psychopathology - M (SD) CBCL 6–18 (T scores)-Parents Anxious/depressed1 0.75 47.9 (6.5) 59.2 (10.5) 50.7 (6.5) 54.5 (10.3) 2 > 4 > (1 = 3) Withdrawn/depressed 0.86 48.7 (7.1) 58.2 (10.6) 49.9 (7.3) 51.9 (10.1) 2 > (1 = 3 = 4) Somatic complaints 0.74 48.9 (6.5) 58.0 (10.7) 50.9 (8.5) 50.7 (7.3) 2 > (1 = 3 = 4) Social problems 0.77 47.8 (5.9) 58.7 (10.0) 51.4 (8.0) 55.8 (11.9) (2 = 4)>3 > 1 Attention problems 0.92 48.2 (8.0) 54.9 (10.3) 53.0 (9.0) 54.6 (9.8) (2 = 3 = 4)>1 Rule breaking behavior 0.57 48.1 (6.1) 54.2 (10.2) 53.5 (8.8) 57.9 (13.6) 4 > (2 = 3)>1 Aggressive behavior 0.87 47.7 (6.3) 55.4 (11.0) 53.3 (8.4) 58.1 (13.4) 4 > 3 > 1; 2 > 1 Internalizing problems1 0.81 48.1 (6.7) 60.8 (10.1) 50.7 (7.4) 53.3 (10.1) 2 > 4 > 1;2 > 3 Externalizing problems 0.88 47.7 (6.3) 55.4 (10.8) 53.6 (8.6) 58.5 (13.5) 4>3>; 2>1 Total problems 0.93 47.4 (6.6) 59.8 (10.2) 52.6 (7.9) 57.1 (12.6) (2 = 4)>3 > 1 Dysregulation-2007 0.89 47.3 (6.4) 58.8 (10.5) 52.6 (7.6) 57.6 (12.7) (2 = 4)>3 > 1 CBCL Items (% of 1–2 response options) 46 Tics NA 26.0 51.9 34.6 42.0 2>1 58 Pick skin NA 25.4 32.1 37.4 32.7 n.s. 83 Stores up NA 30.5 56.6 39.3 52.0 (2 = 4)>1 CGAS Functional Impairment- M NA 75.6 (7.0) 67.2 (7.9) 70.1 (7.8) 64.3 (9.9) 1 > (2 = 3); 1 > 4; 3 > (SD) 4 SDQ-Teachers - M (SD) Peer problems 0.82 0.9 (0.9) 1.2 (1.0) 1.7 (1.4) 2.5 (1.5) 4 > 3 > (1 = 2) Temperament- - M (SD) CBQ VSF- EATQ (T scores) - Ages 7, 10 – Parents Surgency 0.74 49.8 (8.7) 45.2 (10.4) 51.6 (7.8) 52.5 (8.9) (1 = 3 = 4)>2 Negative affect 0.81 47.9 (7.7) 57.5 (9.6) 51.9 (8.7) 54.4 (9.9) 2 > 3 > 1; 4 > 1 Effortful control 0.79 51.3 (7.7) 48.6 (9.3) 47.2 (9.5) 45.7 (10.1) 1>3>4 ARI-Child - Ages 12–13 - M (SD) 0.85 1.6 (1.5) 2.1 (1.6) 2.8 (2.2) 2.1 (1.6) 3>1 ARI-Teacher- Ages 7–11 - M (SD) 0.95 0.6 (1.0) 1.1 (1.7) 2.4 (1.6) 4.7 (2.7) 4 > 3 > (1 = 2) BRIEF2 (Age 13) - M (SD) Behavior regulation index 0.97 16.4 (4.5) 15.9 (4.2) 21.2 (6.8) 26.9 (5.8) 4 > 3 > (1 = 2) Emotional regulation index 0.95 20.0 (4.2) 20.8 (4.9) 23.9 (6.4) 28.0 (6.7) 4 > 3 > (1 = 2) Cognitive regulation index 0.99 42.5 (13.9) 42.5 (14.4) 50.5 (16.4) 57.2 (12.9) (3 = 4)>(1 = 2) Global executive composite 0.99 78.9 (20.2) 79.2 (21.5) 95.6 (25.7) 112.1 (20.1) 4 > 3 > (1 = 2) Linear models for continuous measures. Risk of type I error corrected by Tukey’s correction (Tukey, 1949) for dimensional comparison and by Bonferroni-Holm’s (Holm, 1979) for percentages comparison. Unless specified table contents direct scores. N.s. Non-significant contrast 1 Items 31.Fear, 32.Perfectionism, 52.Guilty and 112.Worries were not included in the score of anxious/depressed and internalizing scales because were shared with OCP. ARI Affective Reactivity Index, BRIEF2 Behavior Rating Inventory of Executive Functions, CBCL Child Behavior Checklist, CBQ-VSF Children’s Behavior Questionnaire Short Form, CGAS Children’s Global Assessment Scale, EATQR Early Adolescent Temperament Questionnaire-Revised, SDQ Strengths and Difficulties Questionnaire. 1100 Journal of Youth and Adolescence (2022) 51:1089–1105 both conditions (Peris et al., 2017). This study adds to pre- include “cool” executive functions, which are those related to vious data indicating that children in the general population tasks requiring cognitive, critical, or logic analysis without the with high scores in oppositionality dimensions may also have intervention of emotions. Accordingly, difficulties in cognitive high scores in OCP from childhood to early adolescence, also reappraisal, rumination, expressive suppression, emotion dys- needing careful assessment. In this class, irritability and defiant regulation, planning (Jiang et al., 2016), inhibitory control scores were above percentile 75 in each follow-up, whereas (Deters et al., 2020), working memory and sustained attention this was the case for OCP from ages 6 to 10, indicating that (Schoorl et al., 2018), emotion processing, error monitoring, middle childhood is the developmental period when the co- problem solving, and self-control (Noordermeer et al., 2016) development of these behaviors is more frequently observed. have been reported in children with ODD. The results of this Irritability tended to diminish with age (although the negative study indicate that executive functions difficulties are not linear trend was not significant) and defiant behavior remained characteristic of OCP, since executive functioning is similar in fairly stable through development. Visual inspection of the OCP and in the all-low classes (classes 2 and 1), while the four shape of trajectories in this class shows that the defiant global indexes of executive functioning are significantly dimension and OCP evolve in parallel, meaning that higher when there is a confluence of oppositional dimensions obsessive-compulsive behaviors (i.e., repeating acts, being at a high level and OCP (class 4). In short, comorbidity perfectionistic, intrusive thoughts, etc.) and defiance (arguing, exacerbates executive functioning difficulties, suggesting the blaming others, annoying, disobeying) follow the same need to intervene in the improvement of global executive developmental pattern. While mean scores of OCP in this functions in children with oppositional and obsessive char- community sample were generally low, as would be expected, acteristics. In the same line, effortful control, or the ability to the class that grouped together higher scores in the three self-regulate behaviors, cognitions, and emotions, has been processes (irritability, defiant, and OCP) (class 4) showed the proposed as another transdiagnostic dimension for internaliz- worst outcomes through development. In brief, high scores in ing problems, as would be the case of the comorbidity of irritability and defiant (above percentile 75) through develop- OCD, and externalizing problems, as would be the case of ment may be accompanied by high scores in OCP (above ODD and its comorbidity (Santens et al., 2020). In the present percentile 75) (or the reverse), and this co-occurrence is study, effortful control was lower in the classes with psycho- associated with externalizing symptoms, functional impair- logical problems than in the all-low trajectory (class 1) (though ment, peer problems, difficulties in effortful control through the class 2 comparison was not significant), and it had the development and, by age 13 years, worse general executive lowest score in the comorbid class (4), indicating difficulties in functioning. These difficulties were not observed when only self-regulation across problems, which is more accentuated irritability and defiant were at high levels and OCP was low when oppositional dimensions and OCP coexist. (class 3), suggesting a synergistic effect among the three Irritability was the dimension that started with the highest processes when they occur together, which associates with a values in comorbid class 4. Irritability in this class decreased more difficult development. The results are relevant since it through development (the linear trend was not significant) but has been reported that the co-occurrence of ODD and OCD in remained high. Some previous studies have shown the asso- childhood predicts persistence of OCD in early adults (Bloch ciation between anger and OCD. For instance, rage attacks et al., 2009). (explosive anger outbursts) were present in 53% of children The results on the clinical associations with trajectories with OCD and were associated with parental limit setting, point to the role of several possible transdiagnostic variables. need to be perfect, changes in routines and other OCD situa- According to the Research Domain Criteria approach (Insel tions, facilitating reducing irritability and return to calmness et al., 2010), which aims to identify transdiagnostic factors (Storch et al., 2012). Anger attacks in Storch’s study were across psychological clinical problems to guide research and associated with more symptom interference and functional clinical practice, deficits in executive functioning seem to be impairment. Similarly, irritability in childhood was associated transdiagnostic (East-Richard et al., 2020). However, there is with OCP and was a strong predictor of obsessive-compulsive controversy about the implication of executive functions in behavior in adulthood (Theriault et al., 2018; Theriault et al., pediatric OCD and in ODD. While some studies have reported 2014). The present and other results in clinical samples point the non-implication of executive functioning in children and to the need to tackle irritability in cases of oppositional and adolescents with OCD (Abramovitch et al., 2015), others point obsessive-compulsive behaviors. to difficulties in action monitoring, decision-making, planning, The classes found represent the problems observed in working memory (Marzuki et al., 2020), organizational skills clinical settings and this gives validity to the classification (Vandborg et al., 2014), and shifting (Lewin et al., 2014). obtained. For instance, class 2 clustered children with pro- Regarding ODD, while executive function difficulties focus blems on the obsessive-compulsive spectrum who, in mainly on “hot” executive functions, which are the functions addition to OCP scores in the fourth quartile through related to emotional involvement (Rubia, 2011), they also development, also showed comorbidity with anxiety and Journal of Youth and Adolescence (2022) 51:1089–1105 1101 depression disorders/symptoms, negative affect, tics and remained in the study so the results should be generalized storing up. Children in this class had notable clinical char- with caution. Future research should report on mediational acteristics and functional impairment. In this class OCP differential paths from trajectories to clinical outcomes that increased significantly from ages 6 to 10, and then may help to refine preventive interventions to optimize the decreased. This developmental shape may agree with the development of children in the different classes. bimodal distribution of incidence of OCD observed in The results have preventive implications from a devel- childhood and adulthood (Boileau, 2011). Class 3, which opmental perspective. Middle childhood (6–10 years) is the showed almost parallel trajectories for irritability and defi- period of highest irritability, defiant and OCP scores when ant throughout development, would be compatible with ODD and OCD coexist. Therefore, it is crucial to develop children with oppositional defiant problems who also prevention programs for these ages in community settings showed marked self-reported anger, high comorbidity, and such as schools to help manage emotions, and specifically other disruptive behavior problems, such as attention pro- irritability, and to promote cognitive processing that may blems and their related cognitive regulation difficulties. A decrease the OCP and ODD behaviors and their associated comorbid class also emerged (class 4). This study makes an clinical characteristics (peer problems, comorbidity, daily original contribution to the field by simultaneously ana- functioning). This may prepare the children for the impor- lyzing the co-development of irritability, defiant, and OCP tant maturation challenges of adolescence. Adolescence is a from childhood to early adolescence in 8 yearly based period when the brain undergoes marked changes that affect follow-ups of a wide sample of boys and girls from the behavior and cognition and is the stage when executive general population. The present study goes beyond previous functions start their full maturation. Good adjustment in works, which have mainly focused on the study of exter- previous stages may therefore facilitate the transition to nalizing symptoms in children with OCD using variable- adolescence. centered analyses. Three relevant parallel processes (irrit- ability, defiant, and OCP) reported by different informants (parents and teachers) were able to be analyzed simulta- Conclusion neously using LCGA, modeling heterogeneity by classify- ing individuals into groups with similar patterns, or latent There is a lack of studies in community samples on how classes of trajectories. As a result, different classes that oppositional and obsessive-compulsive symptoms code- reflect the observed phenomenology of oppositional and velop from childhood to adolescence and their associated OCP problems were obtained. The results, however, should characteristics through development. This gap makes it be interpreted considering that this was a community sam- difficult to design preventive strategies that facilitate ple in which, as expected, psychopathology was not very optimal development in children in the community. Sev- prevalent. This especially affects obsessive-compulsive eral classes reflecting different developmental trajectories behaviors. Such few cases may have implied that differ- of oppositional defiant dimensions and OCP from child- ences between measures did not emerge. It should also be hood to adolescence were identified. Coherence between considered that the high-low qualification of the labels in classes and clinical phenotypes may provide criterion the trajectories refers to the levels in the same sample and validity evidence for the classes obtained. The co- these may not necessarily be high or low according to development of oppositional defiant dimensions (irrit- normative values, which unfortunately do not exist. ability and defiant) and OCP is frequent, affects about Coherence between classes and clinical phenotypes, how- 9.4% of the children aged between 6 and 13, and is ever, provides criterion validity evidence for the classes associated with psychological difficulties throughout obtained. Furthermore, because different contexts (school development. Children in the comorbid trajectory pre- and home) elicit different behaviors, the study used a multi- sented a more severe externalizing symptomatology and informant approach and different reporters to obtain the comorbidity with ADHD, used psychological services information (parents, teachers, and child themselves). more frequently, had higher functional impairment and Although this approach allows us to understand how chil- difficulties with peers and effortful control, had higher dren display concerning behaviors in the different contexts, scores in anger/irritability and, by adolescence (age 13), it is well known that informants who observe the child in displayed generalized difficulties with executive func- different settings tend to obtain lower levels of correspon- tions. Clinicians should be aware that ODD and OCP may dence than those reporting about the same setting (De Los coexist, and that this coexistence is associated with Reyes et al., 2015), and this may have decreased the asso- compromised development. Therefore, faced with oppo- ciations. Dimensional measures also show greater levels of sitional defiant problems or OCP, an appropriate assess- cross-informant correspondence than categorical measures ment of both conditions and a good differential diagnosis (De Los Reyes et al., 2015). Last, more high SES children is necessary. In children sharing oppositional and 1102 Journal of Youth and Adolescence (2022) 51:1089–1105 −0.51 −2.67 <0.001 −14.39 −2.58 <0.001 −11.70 −0.93 <0.001 −5.34 −4.14 <0.001 −24.54 −0.40 <0.001 −1.79 −3.61 <0.001 −15.66 −3.21 <0.001 −11.35 −0.05 <0.001 −6.51 −0.05 <0.001 −4.00 −0.54 <0.001 −8.18 −0.15 <0.001 −5.38 obsessive-compulsive characteristics, preventive strate- <0.001 7.92 <0.001 5.41 <0.001 8.01 Comparison: 3 vs 4 d gies targeting executive functioning, effortful control, peer relations, and irritability may be indicated to facil- p itate better adjustment during development. 0.59 0.53 0.03 MD −0.79 <0.001 −8.42 −0.26 <0.001 −5.73 −0.06 <0.001 −9.85 −0.03 <0.001 −4.73 <0.001 10.72 Acknowledgements We would like to thank the participating families <0.001 1.88 <0.001 1.69 <0.001 4.89 <0.001 7.02 Comparison: 2 vs 4 d and schools. p Authors’ Contributions LE conceived of the study, participated in its −0.50 <0.001 −7.59 0.08 0.01 0.05 0.55 0.43 MD design and coordination, and drafted the manuscript; EP performed the statistical analysis; JBN performed the statistical analysis; NdlO par- <0.001 10.51 <0.001 10.41 <0.001 7.90 <0.001 8.26 ticipated in the design and measurement selection; ET participated in Comparison: 2 vs 3 d the coordination of field study. All authors read and approved the final −0.52 <0.001 −4.20 −3.10 <0.001 −25.61 −0.09 0.001 manuscript. p 0.05 0.09 1.09 0.58 MD Funding This work was supported by the Spanish Ministry of Science, −0.69 <0.001 −8.23 −0.16 <0.001 −2.30 −1.15 <0.001 −13.66 −0.06 <0.001 −0.89 −0.60 <0.001 −8.92 −0.65 <0.001 −13.36 −0.08 <0.001 −1.98 −0.23 <0.001 −5.86 Innovation, and Universities [Grant PGC2018-095239-B-I00 (MICIU/ <0.001 3.23 0.32 <0.001 4.72 <0.001 8.90 Comparison: 1 vs 4 FEDER)]. Open Access Funding provided by Universitat Autonoma d de Barcelona. 0.128 p −0.43 <0.001 −7.85 0.15 0.00 0.04 0.04 MD Data Sharing Declaration This data contained in this manuscript will not be deposited. <0.001 8.09 <0.001 8.38 <0.001 2.54 Comparison: 1 vs 3 d Compliance with Ethical Standards p 0.05 0.09 0.01 MD Conflict of Interest The authors declare no competing interests. −0.43 <0.001 −5.23 <0.001 −0.95 −0.53 <0.001 −4.12 <0.001 −0.53 <0.001 13.11 <0.001 1.61 <0.001 1.44 Comparison: 1 vs 2 d Compliance with Ethical Standards The submitted work complies with ethical standards. It is an original work and has not been published p elsewhere in any form or language. The work is part of a wider project I Intercept, S Slope, Q Quadratic trend. In italics: pair-wise comparison with p > 0.05 and the participants and methodology are shared with several −0.15 (0.06) 0.07 −0.05 (0.01) −0.01 (0.01) 0.00 0.10 −0.08 (0.01) −0.03 (0.01) 0.00 −0.07 (0.01) −0.01 (0.00) −0.04 (0.00) 0.08 MD Comparison of Parameter Estimates for the Selected 4-Class Model published works. 3.78 (0.26) 4.92 (0.32) 0.12 (0.06) 1.29 (0.05) 0.15 (0.01) class 4 Ethical Approval This project was approved by the Ethics Committee on Animal and Human Experimentation of the author’s institution. 1.20 (0.20) −0.06 (0.02) 0.44 (0.08) 1.71 (0.27) 2302.6 (3. 558) <0.001 −0.04 (0.07) −0.14 (0.03) 0.65 (0.11) 0.75 (0.07) 0.01 (0.03) class 3 Informed Consent Families gave written consent for the assessment, and the children and adolescents gave their assent to participate. 1.11 (0.07) 0.00 (0.00) 1.31 (0.09) 0.01 (0.00) 1.83 (0.15) 3518.8 (3. 558) <0.001 −0.07 (0.04) 0.58 (0.09) class 2 Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Means (SD) 7775.0 (3. 558) <0.001 0.68 (0.08) 2264.0 (3. 558) <0.001 0.00 (0.05) 2174.0 (3. 558) <0.001 0.00 (0.01) 7607.2 (3. 558) <0.001 0.78 (0.13) 2473.0 (3. 558) <0.001 0.01 (0.01) 3756.8 (3. 558) <0.001 0.69 (0.07) 3685.2 (3. 558) <0.001 0.00 (0.00) class 1 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as p long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if Overall test changes were made. The images or other third party material in this Parameter F (df) article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. 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