Associations of Past Oppositional Defiant Disorder in Adults with Attention-Deficit/Hyperactivity Disorder~!2008-09-19~!2008-10-22~!2008-11-28~!

Abstract

Abstract:Objective: While DSM-IV Attention-deficit/hyperactivity disorder (ADHD) comorbid with antisocial behaviours identified by DSM-IV conduct disorder (CD) has been claimed as a 'distinct subtype', there is less information about the validity of a subtype based on the more prevalent comorbidity of oppositional defiant disorder (ODD). The present study investigated the associations of past ODD with past and recent psychopathology in adults with ADHD.Methods: 94 clinic-referred adults (73 male; 21 female) with DSM-IV ADHD, and their informants, completed questionnaires.Results: 59% of males had past ODD (with or without past CD), 42% had past CD (with or without past ODD) and 36% had past ODD and past CD; for females, 57%, 33% and 29% respectively. In males with the DSM-IV ADHD 'combined' type (i.e. the most common presentation of ADHD), ratings of past ODD, when compared with those of past CD, were more strongly correlated with past and recent ADHD-related hyperactivity/impulsivity and with past and recent functional impairment. In females, ratings of past ODD, compared with those of past CD, also yielded stronger correlations with features of ADHD. In males and females, ratings of past CD (but not of ODD) were correlated with features of personality disorders. Conclusions:The results indicated that ODD ( and a history of ODD) is relevant in studies of the validity of ADHD subtypes based on comorbid antisocial behaviour. Identification of valid subtypes is important for studies of clinical course and response to treatment.

Impulsive aggression in adults with attention‐deficit/hyperactivity disorder

“…The mean ADSA total score indicated ‘very considerable problems’ related to ADHD (33). Various aspects of the present methodology have been discussed previously (30–32).…”

“…Several studies have found associations of these covariables with aggression and/or ADHD. A history of past ODD, and to a lesser extent past CD, both of which incorporate aspects of aggression, have been reported to be associated with features of adult ADHD (32), verbal IQ has been negatively correlated with aggression in various male samples (38, 39) and features of ADHD have been reported to diminish with increasing age (1). Also, as increased aggression has been associated with comorbidity in ADHD samples (23, 24), the range of comorbidity reflected by ‘PD features’ and GSI were also selected as covariates.…”

“…All subjects in the study received a DSM‐IV diagnosis of ADHD, according to the following criteria which have been validated by previous studies (30–32): i) DSM‐IV ratings from an informant in relation to childhood features endorsed a specified number (see below) of the nine criteria for the ‘predominantly inattentive type’ (PIT) and/or of the nine criteria for the ‘predominantly hyperactive‐impulsive type’(PHIT), ii) DSM‐IV ratings by the patient and/or informant in relation to behaviour in the previous 6 months endorsed a specified number of the nine criteria for the PIT and/or for the PHIT, which corresponded to endorsements in relation to childhood (see below) and iii) a judgement made by a psychiatrist, based on all information, that the patient’s symptoms of ADHD often interfered with ability to function and were not explained by the presence of another disorder.…”