Abstract
Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) take into account the underlying continuum of externalizing behaviors. However, most of this research has not included measures of disorders that appear in childhood [e.g., attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD)], nor has it considered the full range of possibilities for the latent structure of externalizing behaviors, particularly factor mixture models, which allow for a latent factor to have both continuous and categorical dimensions. Finally, the majority of prior studies have not tested multidimensional models. Using lifetime diagnoses of externalizing disorders from participants in the Fast Track Project (n = 715), we analyzed a series of latent variable models ranging from fully continuous factor models to fully categorical mixture models. Continuous models provided the best fit to the observed data and also suggested that a two-factor model of externalizing behavior, defined as (1) ODD+ADHD+CD and (2) SUD with adult antisocial behavior sharing common variance with both factors, was necessary to explain the covariation in externalizing disorders. The two-factor model of externalizing behavior was then replicated using a nationally representative sample drawn from the National Comorbidity Survey-Replication data (n = 5,692). These results have important implications for the conceptualization of externalizing disorders in DSM-5.
Similar content being viewed by others
References
Achenbach, T. M. (1966). The classification of children’s psychiatric symptoms: A factor-analytic study. Psychological Monographs, 80, 1–37.
Achenbach, T. M. (1991). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
American Psychiatric Association. (2010). Cross-cutting dimensional assessment in DSM-5. In DSM-5 development. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/CrossCuttingDimensionalAssessmentinDSM-5.aspx.
Barkley, R., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111, 279–289.
Beauchaine, T. P., Hinshaw, S. P., & Pang, K. L. (2010). Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: Biological, environmental, and developmental mechanisms. Clinical Psychology: Science and Practice, 17, 327–336.
Bentler, P. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.
Bezdjian, S., Krueger, R. F., Derringer, J., Malone, S., McGue, M., & Iacono, W. G. (2011). The structure of DSM-IV ADHD, ODD, and CD criteria in adolescent boys: A hierarchical approach. Psychiatry Research, 188, 411–421.
Brown, T. A., & Barlow, D. H. (2005). Categorical versus dimensional classification of mental disorders in DSM-V and beyond. Journal of Abnormal Psychology, 114, 551–556.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills, CA: Sage.
Burt, S. A., McGue, M., Krueger, R. F., & Iacono, W. (2005). How are parent–child conflict and childhood externalizing symptoms related over time? results from a genetically informative cross-lagged study. Development and Psychopathology, 17, 145–165.
Burke, J., & Loeber, R. (2010). Oppositional defiant disorder and the explanation of the comorbidity between behavioral disorders and depression. Clinical Psychology: Science and Practice, 17, 319–326. doi:10.1111/j.1468-2850.2010.01223.x.
Chassin, L., Pitts, S. C., & Prost, J. (2002). Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes. Journal of Consulting and Clinical Psychology, 70, 67–78.
Conduct Problems Prevention Research Group. (1992). A developmental and clinical model for the prevention of conduct disorders: The FAST Track program. Development and Psychopathology, 4, 509–527.
Conduct Problems Prevention Research Group. (1999). Initial impact of the Fast Track prevention trial for conduct problems: I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631–647.
Conduct Problems Prevention Research Group. (2000). Merging universal and indicated prevention programs: The Fast Track model. Addictive Behaviors, 25, 913–927.
Farmer, R. F., Seeley, J. R., Kosty, D. B., & Lewinsohn, P. M. (2009). Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood. Journal of Abnormal Psychology, 118, 699–710.
First, M. B. (2010). Defining mental disorder in DSM-V. Psychological Medicine, 40, 1779–1782.
Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2002). Young adult follow-up of hyperactive children: Self-reported psychiatric disorders, comorbidity, and the role of childhood conduct problems and teen CD. Journal of Abnormal Child Psychology, 30, 463–475.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
Jablensky, A. (2009). A meta-commentary on the proposal for a meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 2099–2103.
Jackson, K. M., Sher, K. J., & Schulenberg, J. E. (2008). Conjoint developmental trajectories of young adult substance use. Alcoholism, Clinical and Experimental Research, 32, 723–737.
Kamphuis, J. H., & Noordhof, A. (2009). On categorical diagnoses in DSM-V: Cutting dimensions at useful points? Psychological Assessment, 21, 294–301.
Kaplow, J. B., Curran, P. J., Angold, A., & Costello, E. J. (2001). The prospective relation between dimensions of anxiety and the initiation of adolescent alcohol use. Journal of Clinical Child Psychology, 30, 316–326.
Kendler, K. S., Aggen, S. H., Knudsen, G. P., Roysmb, E., Neale, M. C., & Reichborn-Kjennerud, T. (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. The American Journal of Psychiatry, 168, 29–39.
Kessler, R. C., & Ustan, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.
Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., Hiripi, E., et al. (2004). The US National Comorbidity Survey Replication (NCS-R): Design and field procedures. International Journal of Methods in Psychiatric Research, 13, 69–92.
King, K. M., Luk, J. W., Wu, J., Witkiewitz, K., Racz, S. J., McMahon, R. J., the Conduct Problems Prevention Research Group. (2012). The co-occurrence of externalizing behaviors during childhood: Factor structure and invariance over time. Manuscript in preparation.
Krueger, R. F., & Bezdjian, S. (2009). Enhancing research and treatment of mental disorders with dimensional concepts: Toward DSM-V and ICD-11. World Psychiatry, 8, 3–6.
Krueger, R. F., Hicks, B. M., Patrick, C. J., Carlson, S. R., Iacono, W. G., & McGue, M. (2002). Etiologic connections among substance dependence, antisocial behavior, and personality: Modeling the externalizing spectrum. Journal of Abnormal Psychology, 111, 411–424.
Krueger, R. F., Markon, K. E., Patrick, C. J., Benning, S. D., & Kramer, M. D. (2007). Linking antisocial behavior, substance use, and personality: An integrative quantitative model of the adult externalizing spectrum. Journal of Abnormal Psychology, 116, 645–666.
Krueger, R. F., Markon, K. E., Patrick, C. J., & Iacono, W. G. (2005). Externalizing psychopathology in adulthood: A dimensional-spectrum conceptualization and its implications for DSM-V. Journal of Abnormal Psychology, 114, 537–550.
Krueger, R. F., & South, S. C. (2009). Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 2061–2070.
Lahey, B. B., Rathouz, P. J., Applegate, B., Van Hulle, C. A., Garriock, H. A., Urbano, R. C., et al. (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of Abnormal Child Psychology, 36, 187–206.
Lahey, B. B., Van Hulle, C. A., Singh, A. L., Waldman, I. D., & Rathouz, P. J. (2011). Higher-order genetic and environmental structure of prevalent forms of child and adolescent psychopathology. Archives of General Psychiatry, 68, 181–189.
Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88, 767–778.
Loeber, R., & Burke, J. D. (2011). Developmental pathways in juvenile externalizing and internalizing problems. Journal of Research on Adolescence, 21, 34–46.
Lubke, G. H., Hudziak, J. J., Derks, E. M., van Bijsterveldt, T. C., & Boomsma, D. I. (2009). Maternal ratings of attention problems in ADHD: Evidence for the existence of a continuum. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 1085–1093.
Lubke, G. H., & Muthén, B. O. (2007). Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters. Structural Equation Modeling, 14, 26–47.
Lubke, G. H., & Neale, M. C. (2006). Distinguishing between latent classes and continuous factors: Resolution by maximum likelihood? Multivariate Behavioral Research, 41, 499–532.
Lubke, G. H., & Neale, M. C. (2008). Distinguishing between latent classes and continuous factors with categorical outcomes: Class invariance of parameters of factor mixture models. Multivariate Behavioral Research, 43, 592–620.
Lubke, G. H., & Spies, J. (2008). Choosing a ‘correct’ factor mixture model: Power, limitations, and graphical data exploration. In G. R. Hancock & K. M. Samuelsen (Eds.), Advances in latent variable mixture models (pp. 343–362). Charlotte, NC: Information Age Publishing.
MacLachlan, G. J., & Peel, D. (2000). Finite mixture models. New York, NY: Wiley.
Markon, K. E., Chmielewski, M., & Miller, C. J. (2011). The reliability and validity of discrete and continuous measures of psychopathology: A quantitative review. Psychological Bulletin, 137, 856–879.
Markon, K. E., & Krueger, R. F. (2005). Categorical and continuous models of liability to externalizing disorders: A direct comparison in NESARC. Archives of General Psychiatry, 62, 1352–1359.
Marti, C. N., Stice, E., & Springer, D. W. (2010). Substance use and abuse trajectories across adolescence: A latent trajectory analysis of a community-recruited sample of girls. Journal of Adolescence, 33, 449–461.
Masyn, K., Henderson, C. E., & Greenbaum, P. E. (2010). Exploring the latent structures of psychological constructs in social development using the dimensional-categorical spectrum. Social Development, 19, 470–493.
Muthén, B., & Muthén, L. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Authors.
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation. Structural Equation Modeling, 14, 535–569.
Rowe, R., Costello, E. J., Angold, A., Copeland, W. E., & Maughan, B. (2010). Developmental pathways in oppositional defiant disorder and conduct disorder. Journal of Abnormal Psychology, 119, 726–738.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147–177.
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6, 461–464.
Shaffer, D., & Fisher, P. (1997). NIMH-diagnostic interview schedule for children: Child informant. New York: New York State Psychiatric Institute.
Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.
Shaffer, D., Fisher, P., Lucas, C., & Comer, J. (2003). Scoring manual: Diagnostic interview schedule for children (DISC-IV). New York, NY: Columbia University.
Tackett, J. L. (2010). Toward an externalizing spectrum in DSM-V: Incorporating developmental concerns. Child Development Perspectives, 4, 161–167.
Tackett, J. L., Krueger, R. F., Sawyer, M. G., & Graetz, B. W. (2003). Subfactors of DSM-IV conduct disorder: Evidence and connections with syndromes from the child behavior checklist. Journal of Abnormal Child Psychology, 31, 647–654.
Todd, R. D., Rasmussen, E. R., Neuman, R. J., Reich, W., Hudziak, J. J., Bucholz, K. K., et al. (2001). Familiarity and heritability of subtypes of attention deficit hyperactivity disorder in a population sample of adolescent female twins. The American Journal of Psychiatry, 158, 1891–1898.
Tomarken, A. J., & Waller, N. G. (2003). Potential problems with “well fitting” models. Journal of Abnormal Psychology, 112, 578–598.
Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10.
Tuvblad, C., Zheng, M., Raine, A., & Baker, L. A. (2009). A common genetic factor explains the covariation among ADHD ODD and CD symptoms in 9–10 year old boys and girls. Journal of Abnormal Child Psychology, 37, 153–167.
Verona, E., Javdani, S., & Sprague, J. (2011). Comparing factor structures of adolescent psychopathology. Psychological Assessment, 23, 545–551. doi:10.1037/a0022055.
Walton, K. E., Ormel, J., & Krueger, R. F. (2011). The dimensional nature of externalizing behaviors in adolescence: Evidence from a direct comparison of categorical, dimensional, and hybrid models. Journal of Abnormal Child Psychology, 39, 553–561.
Werthamer-Larsson, L., Kellam, S., & Wheeler, L. (1991). Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems. American Journal of Community Psychology, 19, 585–602.
Widiger, T. A., & Samuel, D. B. (2005). Diagnostic categories or dimensions: A question for DSM-V. Journal of Abnormal Psychology, 114, 494–504.
Winters, K. C., Stinchfield, R. D., Latimer, W. W., & Stone, A. (2008). Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance abuse disorder. Journal of Substance Abuse Treatment, 35, 269–278.
World Health Organization. (1992). International statistical classification of disease and related health problems, tenth revision (ICD-10). Geneva: Author.
Wu, J., Witkiewitz, K., McMahon, R. J., Dodge, K. A., & the Conduct Problems Prevention Research Group. (2010). A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior. Drug and Alcohol Dependence, 111, 207–214.
Author Note
This work was supported by National Institute of Mental Health (NIMH) grants R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, and by National Institute on Drug Abuse (NIDA) grant 1 RC1 DA028248-01. The Center for Substance Abuse Prevention and NIDA also provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part by Department of Education grant S184U30002, NIMH grants K05MH00797 and K05MH01027, and NIDA grants DA16903, DA015226 and DA017589.
Katie Witkiewitz is now at the University of New Mexico. 1 University of New Mexico MSC03-2220, Albuquerque, NM 87131, (505) 277-4121, katiew@unm.edu
Members of the Conduct Problems Prevention Research Group, in alphabetical order, include Karen L. Bierman, Department of Psychology, Pennsylvania State University; John D. Coie, Duke University; Kenneth A. Dodge, Center for Child and Family Policy, Duke University; Mark T. Greenberg, Department of Human Development and Family Studies, Pennsylvania State University; John E. Lochman, Department of Psychology, the University of Alabama; Robert J. McMahon, Department of Psychology, Simon Fraser University, and the Child & Family Research Institute; and Ellen E. Pinderhughes, Department of Child Development, Tufts University.
Drs. Bierman, Coie, Dodge, Greenberg, Lochman, and McMahon are the developers of the Fast Track curriculum and have a publishing agreement with Oxford University Press. Dr. Greenberg is an author on the PATHS curriculum and has a royalty agreement with Channing-Bete, Inc. Dr. Greenberg is a principal in PATHS Training, LLC. Dr. McMahon is a coauthor of Helping the Noncompliant Child and has a royalty agreement with Guilford Publications, Inc.; he is also a member of the Treatments That Work Scientific Advisory Board with Oxford University Press.
The authors are grateful for the collaboration of the school districts that participated in the Fast Track Project as well as the hard work and dedication of the many staff members who implemented the project, collected the evaluation data, and assisted with data management and analyses. For additional information concerning Fast Track, see http://www.fasttrackproject.org.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Members of the Conduct Problems Prevention Research Group include Karen L. Bierman (Pennsylvania State University), Kenneth A. Dodge (Duke University), Mark T. Greenberg (Pennsylvania State University), John E. Lochman (University of Alabama), Robert J. McMahon (Simon Fraser University and Child & Family Research Institute), and Ellen E. Pinderhughes (Tufts University)
Rights and permissions
About this article
Cite this article
Witkiewitz, K., King, K., McMahon, R.J. et al. Evidence for a Multi-Dimensional Latent Structural Model of Externalizing Disorders. J Abnorm Child Psychol 41, 223–237 (2013). https://doi.org/10.1007/s10802-012-9674-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-012-9674-z