Attention-deficit– hyperactivity disorder with and without oppositional defiant disorder in 3- to 7-year-old children

Abstract

Attention-deficit-hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a high degree of associated behavioural problems. In order to study characteristics of ADHD with and without oppositional defiant disorder (ODD) in a representative group of young children with clinical impairment in Sweden, 131 children (101 males, 30 females) with ADHD (mean age 5 years, SD 1 year 5 months; range 3 to 7 years) were clinically examined, and their parents interviewed. Independent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, ODD Rating Scale-IV, Conners Hyperactivity Index) were collected. For comparison 131 children without ADHD were matched for sex, age, marital status, and socioeconomic status (115 males, 16 females; mean age 4 years 10 months, SD 1 year 5 months; range 3 to 7 years). Sixty percent of those with ADHD met full DSM-IV criteria for ODD. Only 10 of the 131 children with ADHD had no symptoms of ODD at all. The rate of children meeting full diagnostic criteria for ODD was similar across all age cohorts. Males were overrepresented in ODD, as were children of divorced parents and of mothers with low socioeconomic status. ADHD combined subtype was a stable independent factor influencing the diagnosis of ODD, regardless of psychosocial factors. Those with ADHD with ODD consistently showed higher rates of ADHD symptoms than did those with ADHD without ODD. The prevalent comorbidity of ADHD with ODD indicates that all children presenting with ADHD or ODD symptoms need to be assessed with a view to exploring both types of problem behaviours. The link between ODD and some psychosocial variables indicates the need to address these, possibly by measures such as parent training and network support.

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

“…We found that children with symptoms of ADHD and co-occurring ODD were more impaired than children with ADHD alone, which is also in line with the findings of previous preschool studies (5,17,20), although neither group significantly differed from the group of children with co-occurring CD. To our knowledge, no previous preschool studies have compared the impact of the comorbidity of ODD versus CD.…”

“…Comorbid behavioral disorders -namely oppositional defiant disorder (ODD) and conduct disorder (CD) -have been found to be strongly associated with elevated levels of impairment in both school-aged children with ADHD (8;12-16) and preschoolers with ADHD (4,5,17,18). In most preschool samples, ODD and CD have been merged into one disruptive disorder construct when examining the impact of the comorbidity of ADHD (18)(19)(20). However, longitudinal studies have suggested that children with ADHD and cooccurring ODD may have a different developmental course than those with co-occurring CD (21)(22)(23)(24).…”

What have birth cohort studies asked about genetic, pre- and perinatal exposures and child and adolescent onset mental health outcomes? A systematic review

“…Epidemiological studies of CD/ODD in preschool children in the general population are rare (Kadesjö, Hagglof, Kadesjo, & Gillberg, 2003;Kim-Cohen et al, 2005;Egger & Angold, 2006). Furthermore important nosological questions remain, for example the contribution of callous-unemotional symptoms, the importance of gender differences, and the relationship between ODD, CD and anti-social personality disorder (Moffitt et al, 2008).…”

Parsing the familiality of oppositional defiant disorder from that of conduct disorder: A familial risk analysis

“…Studies have shown that as many as 65% of youth with ADHD have ODD (Biederman et al, 1996b;Kadesjo and Gillberg, 2001;Kadesjo et al, 2003). The behaviors characterizing ODD --temper outbursts, persistent stubbornness, resistance to directions, unwillingness to compromise with adults or peers, deliberate or persistent testing of limits, and verbal (and minor physical) aggression --compound the difficulties of children with ADHD (Biederman et al, 1987;Biederman et al, 1991).…”