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

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.     

The Family Psychosocial Characteristics of Children with Attention-Deficit Hyperactivity Disorder with or Without Oppositional or Conduct Problems in Japan

We investigated whether the correlates of family psychosocial characteristics among Japanese children with attention-deficit hyperactivity disorder (ADHD) differ according to the comorbid condition of oppositional defiant disorder (ODD) or conduct disorder (CD). Three groups of children (12 ADHD, 15 ADHD + ODD/ CD, and 14 control) were compared on family psychosocial variables. Findings indicated that the interpersonal relationships in ADHD + ODD/ CD children's family were more conflictive and less organized than those of the control. Mental health among mothers of ADHD + ODD/CD children was worse than those of ADHD and control children. Childhood ADHD symptoms of parents were the most severe among parents of ADHD + ODD/CD children. These results support the nosological distinction between ADHD comorbid with ODD and CD. The need for specific clinical intervention according to the comorbid condition is stressed.     

Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder

OBJECTIVE: To compare the prevalence of psychological disorders in parents of young children with and without attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behavior disorders (DBD). METHOD: Subjects included 98 three- to seven-year-old children with DSM-IV ADHD (68 with ADHD and comorbid oppositional defiant or conduct disorder [ADHD+ODD/CD]) and 116 non-ADHD comparison children recruited in 1995-96 during the first wave of a longitudinal study. Biological mothers were administered interviews to assess ADHD and DBD in their children and mood, anxiety, and substance use disorders in themselves. In addition, they were queried about symptoms of childhood ADHD and DBD, and antisocial personality disorder in themselves and their children's biological fathers. RESULTS: Child ADHD was associated with increased rates of maternal and paternal childhood ADHD relative to comparison children. Child ADHD+ODD/CD was associated with maternal mood disorders, anxiety disorders, and stimulant/cocaine dependence, and paternal childhood DBD. Mothers of children with ADHD+ODD/CD also reported increased drinking problems in their children's fathers. CONCLUSIONS: These findings indicate that many young children with ADHD, particularly those with comorbid ODD/CD, require comprehensive services to address both their ADHD and the mental health needs of their parents.     

Do executive function deficits differentiate between children with Attention Deficit Hyperactivity Disorder (ADHD) and ADHD comorbid with Oppositional Defiant Disorder? A cross-cultural study using performance-based tests and the Behavior Rating Inventory of Executive Function

This study examined the differential executive dysfunction of children with attention deficit hyperactivity disorder (ADHD) and those with ADHD and oppositional defiant disorder (ODD) in Han Chinese. A total of 258 children (89 ADHD, 53 ADHD + ODD, 116 controls) completed performance-based executive function tests and had their everyday life executive skills rated by their parents using the Behavior Rating Inventory of Executive Function (BRIEF). Both the ADHD and ADHD + ODD groups performed worse than the controls in the Stroop and Trail-making tests and the BRIEF. The ADHD + ODD group were rated worse than the ADHD group on the BRIEF, but the two groups showed no significant difference in the performance-based tests. These findings suggest Han Chinese children with ADHD display executive dysfunction in performance-based tests and everyday life scenarios, in a similar way to findings in Western counterparts. However, children with ADHD + ODD showed more severe executive dysfunction in everyday life scenarios than those with ADHD only.     

Oppositional Defiant Disorder as a Clinical Phenotype in Children with Autism Spectrum Disorder

To examine the validity of oppositional defiant disorder (ODD) as a clinical phenotype distinct from attention-deficit hyperactivity disorder (ADHD), parents and teachers completed a DSM-IV-referenced rating scale and a background questionnaire for 608 children (ages 3-12 years) with autism spectrum disorder (ASD). The ASD sample was separated into four groups: ODD, ADHD, ODD + ADHD, and neither (NONE). Comparison samples were non-ASD clinic (n = 326) and community (n > 800) controls. In the ASD sample, all three ODD/ADHD groups were clearly differentiated from the NONE group, and the ODD + ADHD group had the most severe co-occurring symptoms, medication use, and environmental disadvantage. There were few differences between ASD + ODD and ASD + ADHD groups. Findings for ASD and control samples were similar, supporting overlapping mechanisms in the pathogenesis of ODD.     

What single reports from children and parents aggregate to attention deficit-hyperactivity disorder and oppositional defiant disorder diagnoses in epidemiological studies

Objective  To analyze information on attention deficit-hyperactivity disorder (ADHD)–oppositional defiant disorder (ODD) and its consequences, provided separately or in combination by children and their parents in a longitudinal prospective study of 9–15 year-old children from the general population. Method  Cross-sectional and longitudinal epidemiological indexes were compared for single and multiple reports. We evaluated which informant is required for the identification of each DSM-IV criterion. Logistic regressions determined which features were related with the reporting of the “absence” of symptoms. Results  Both informants were required in order to obtain complete psychopathological profiles. Single reports provide infra-estimated prevalences (between 8.8 and 22.9% of ADHD and between 1.7 and 7.6% of ODD), risks (around 3% for ADHD and 2% for ODD) and comorbidities. Psychological and functional measures analyzed in the study were relatively similar for cases presenting ADHD/ODD diagnosis, regardless of the diagnostic algorithm (based on single or combined reports); however, these clinical profiles were different to those obtained for non-diagnosed children. The main predictors of not reporting the presence of psychopathology were: large families (OR between 2 and 2.5), children that are conflictive at school (OR ranging between 1.3 and 4.3) or those with poor mental health (OR between 1.1 and 1.6). Conclusions  These results may provide guidance for obtaining accurate diagnostic information, properly identifying children with mental health needs and planning the required preventive and corrective measures. This work was supported by grants BS02002-3850 and SEJ2005-01786 of the Ministry of Science and Technology, Spain.     

The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey

Abstract Objective The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in school age children in Sivas province centre and to examine the distribution of symptoms according to subtypes. Method The study population was made up of 1425 children between the ages of 6 and 15 from eight primary schools selected by random sampling method in Sivas province centre. All students were given a questionnaire prepared according to DSMIV criteria that was completed by their parents or teachers. This form includes 18 symptoms of ADHD and eight symptoms of ODD. Students t-test and variance analysis were used for statistical evaluation. Results A prevalence of 8.1% was found for ADHD in our study. According to subtypes, 32.2% of these were inattentive, 40% were hyperactive and 27.8% were combined type. A prevalence of 11.5% was found for ODD. The boy/girl ratio was > 1 for both ADHD and ODD, and 52.2% of those with ADHD were established as having ODD at the same time. Conclusions The prevalence of ADHD and ODD in primary school children was not considered to be small. Studies concerning the distribution of symptoms in different societies, cultures, and viewpoints and identification of children with this type of problem are beneficial for early diagnosis and prophylactic treatment.     

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder

It has been observed that it is relatively difficult for children with attention-deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty-three ADHD preschoolers (age: 3-6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10-session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale-Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.     

Temperamental and character profiles of preschool children with ODD,ADHD, and anxiety disorders

BackgroundThe aim of the present research was to identify profiles of Cloninger's temperament and character dimensions associated with anxiety disorders, oppositional defiant disorder (ODD) and attention- deficit/hyperactive disorder (ADHD) in preschoolers.MethodThe parents of 120 children (mean age = 4.65 years; S.D. = .88) completed the Preschool Temperament and Character Inventory (PsTCI). The sample consisted of 4 groups (n = 30 per group): ADHD, anxious, ODD and control children. To diagnose the different disorders, the Preschool Age Psychiatric Assessment and Child Behavior Checklist 1.5-5 was administered to the parents.ResultsThe discriminant analysis showed that three temperamental dimensions (Harm Avoidance, Novelty Seeking and Persistence) enabled the correct classification of 75% of cases within their own group, which demonstrated an adequate accuracy rate. The ADHD children showed a temperamental profile that was characterized by high Novelty Seeking, low Reward Dependence and low Persistence, while the anxious children obtained high scores in Harm Avoidance. The profiles of the ODD children shared some common features (high Novelty Seeking) with the ADHD children, but the ODD children were characterized by higher Persistence and Harm Avoidance compared with ADHD children.ConclusionsThe present results indicate that Cloninger's temperamental dimensions allow to differentiate the three most frequent psychiatric disorders in preschoolers.     

Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8-year-old children with ADHD

This study aimed to characterize the nature and impact of disruptive mood dysregulation disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning. Children with ADHD (6–8 years) were recruited through 43 Melbourne schools, using a 2-stage screening (parent and teacher Conners 3 ADHD index) and case-confirmation (Diagnostic Interview Schedule for Children, Version IV; [DISC-IV]) procedure. Proxy DMDD diagnosis was confirmed via items from the oppositional defiant disorder (ODD) and major depressive disorder modules of the DISC-IV. Outcome domains included comorbid mental health disorders, academic functioning, social functioning, child and family quality of life, parent mental health, and parenting behaviors. Unadjusted and adjusted linear and logistic regression were used to compare children with comorbid ADHD and DMDD and children with ADHD without DMDD. Thirty-nine out of 179 children (21.8 %) with ADHD had comorbid DMDD. Children with ADHD and DMDD had a high prevalence of ODD (89.7 %) and any anxiety disorder (41.0 %). Children with ADHD and DMDD had poorer self-control and elevated bullying behaviors than children with ADHD without DMDD. Children with ADHD and DMDD were similar to children with ADHD in the other domains measured when taking into account other comorbidities including ODD. One in five children with ADHD in their second year of formal schooling met criteria for DMDD. There was a very high diagnostic overlap with ODD; however, the use of a proxy DMDD diagnosis containing items from the ODD module of the DISC-IV may have artificially inflated the comorbidity rates. DMDD added to the burden of ADHD particularly in the area of social functioning.     

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD)

Background The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown. Objective The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers. Study design We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD. For comparison’s sake, we also included a non-matched group of 35 children with behaviour problems and 60 children with no behaviour problem from a large school population-based study on the detection of ADHD. We collected information on the health care utilisation of the children applying the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness’ (TiC-P). Their health related quality of life was collected by using the Dutch 50-item parent version of the Child Health Questionnaire (CHQ PF-50). Measurements were at baseline and at 6 months. Subsequently, we collected data on the health utilisation of the mothers and their production losses due to absence from work and reduced efficiency. Results The mean direct medical costs per ADHD patient per year were €2040 or €1173 when leaving out one patient with a long-term hospital admission, compared to €288 for the group of children with behaviour problems and €177 for the group of children with no behaviour problems. The direct medical costs for children who had psychiatric co-morbidities were significantly higher compared to children with ADHD alone. The mean medical costs per year for the mothers of the ADHD patients were significantly higher than for the mothers of the children with behaviour problems and the mothers of children with no behaviour problems respectively €728, €202 and €154. The physical summary score showed no significant differences between the groups. However, the score on the Psychosocial Summary Score dimension was significantly lower for ADHD patients compared to the scores of the children in the two other samples. The mean annual indirect costs due to absence from work and reduced efficiency at work were €2243 for the mothers of the ADHD patients compared to €408 for the mothers of children with behaviour problems and €674 for the mothers of children with no behaviour problems. Conclusion Our study showed that the direct medical costs of ADHD patients were relatively high. Additionally, our study indicated that ADHD appears to be accompanied by higher (mental) health care costs for the mothers of ADHD patients and by increased indirect costs for this group.     

Social Adjustment Among Taiwanese Children with Symptoms of ADHD,ODD, and ADHD Comorbid with ODD

This study examined social problems at school and relationships with peers, siblings, mothers, and fathers among children with ADHD only (n = 41), ODD only (n = 14), ADHD + ODD (n = 47), and normal controls (n = 204) from a school-based sample of 2,463 first to ninth graders in Taiwan. ADHD and ODD symptoms were determined by teacher and mother reports on the Conners’ Rating Scales and social adjustment problems were assessed by mother reports on the Social Adjustment Inventory for Children and Adolescents. Results indicated that relative to normal controls, children with ADHD + ODD displayed greater levels of social adjustment problems across domains (i.e., school, peers, siblings, and parents) while children with ADHD were significantly more impaired only in social adjustment at schools and children with ODD were more impaired only in social adjustment at home. Some similarities and differences in our findings, in relation to the Western literature, were discussed.     

ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity

OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.     

Increased adrenal androgen functioning in children with oppositional defiant disorder: a comparison with psychiatric and normal controls

OBJECTIVE: To examine the relationship between adrenal androgens and aggression in children with oppositional and antisocial behavior and to compare their levels with those of psychiatric and normal controls. METHOD: Dehydroepiandrosterone sulfate (DHEAS) was measured in 24 children with oppositional defiant disorder (ODD), 42 psychiatric controls (including 20 children with attention-deficit/hyperactivity disorder [ADHD]), and 30 normal controls. The children's parents filled out the Child Behavior Checklist (CBCL). RESULTS: Children with ODD had higher DHEAS levels than either the psychiatric control or normal control groups; DHEAS levels of the latter groups did not differ. Moreover, it was possible to classify children as having either ODD or ADHD on the basis of their DHEAS levels, whereas this was not the case on the basis of the CBCL data. CONCLUSIONS: The results indicate that adrenal androgen functioning is specifically elevated in children with ODD. It is speculated that the mechanism could be a shift in balance of ACTH-beta-endorphin functioning in the hypothalamic-pituitary-adrenal axis due to early stress or genetic factors.     

Treatment of attention deficit hyperactivity disorder in children

Objective The present study investigated the predictive power of anxiety, IQ, severity of ADHD and parental depression on the outcome of treatment in children with ADHD. Method Fifty children with ADHD (ages 8–12) were randomized to a 10-week treatment of methylphenidate or to a treatment of methylphenidate combined with multimodal behavior therapy. Prior to treatment predictors were assessed. Outcome was assessed separately for parents and teachers on a composite measure of inattentive, hyperactive, oppositional- and conduct disorder symptoms. Results There was neither a significant difference between the two treatments at baseline nor did treatment condition predict outcome. Therefore the data were collapsed across the two treatments. A combination of anxiety and IQ predicted teacher-rated outcome, explaining 18% of the variance. Higher anxiety and higher IQ’s indicated better treatment outcome. There were no significant predictors of the parent-rated outcome. Conclusion This study showed a small but significant predictive effect of IQ and anxiety on treatment outcome in children with ADHD. Clinical implications This study supports the idea that for the treatment of ADHD children with comorbid anxiety and higher IQ respond better to the two most used treatments for ADHD.     

Does multimodal treatment of ADHD decrease other diagnoses?

Comorbid conditions in children with attention deficit hyperactivity disorder (ADHD) are frequent and can affect treatment response and life course. From the multimodal treatment study of ADHD (MTA), we examined the persistence or development of conditions other than ADHD, e.g. oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, depression, and learning disorder (LD) in 576 children, age 7–9 years, diagnosed rigorously with ADHD, who were randomly assigned to four different treatments for 14 months. The treatment groups were medication management alone (MedMgt), behavioral treatment alone (Beh), the combination (Comb), and community comparison routine care (CC). For the sample as a whole, we found significant decreases from baseline to 14 months in diagnoses of ODD, CD, and anxiety disorder but not LD or mood disorder. The CC group developed significantly more new ODD and retained more baseline ODD than the Comb or MedMgt groups. There were no significant treatment group differences for specific other conditions. Only the Comb group was significantly better than the CC group in reducing total number of disorders and impairment at 14 months in subjects with multiple conditions at baseline. Well-titrated and monitored stimulant medication can decrease ODD and possibly prevent future CD. Combined treatment may be required for the most disturbed children with ADHD who have multiple disorders and severe impairment.     

Factor structure and cultural factors of disruptive behaviour disorders symptoms in Italian children.

OBJECTIVE: Poor parent and teacher awareness for attention-deficit/hyperactivity disorder (ADHD) and the scepticism of many clinicians on the prevalence of the disorder, make Italy an interesting environment in which to verify neuropsychological constructs generated in a predominantly Northern American cultural contest. The aim of the study was to verify, by factor confirmatory analysis, the empirical validity of the DSM constructs underlying the diagnostic criteria for developmental disruptive behaviour disorders in Italian school-age children. METHODS: Scores for DSM-IV inattention and hyperactivity/impulsivity, for oppositional defiant disorder (ODD) and for conduct disorder (CD) symptoms in 6-12 years old Italian children were analysed from 1575 parent and 1085 teacher forms of the disruptive behaviour disorders questionnaires collected in four different Italian regions. RESULTS: Reliability indicates high internal consistencies for both parent and teacher rating of inattention, hyperactivity/impulsivity, and oppositionality, but not for conduct problems. In accordance with the literature, a relatively low inter-rater convergent and discriminant validity correlation was observed comparing measures obtained by between parents and teachers. Confirmatory factor analysis of both parent and teacher data showed a better fit for a four-factor model, indicating a factor structure in accordance with the DSM-IV taxonomy. When completed by parents and teachers of clinically assessed ADHD, dyslexic or normal children, the disruptive behavioural disorder questionnaires showed a significant predictive diagnostic value. CONCLUSION: Although an informant variance higher that dimensional (trait) variance was observed, the study provides support for DSM-IV taxonomy for developmental disruptive disorders, showing construct validity of ADHD. ODD and CD could also be distinguished from each other.     

Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a genetically as well as environmentally determined disorder with a high rate of psychiatric comorbidity. In this study, non-genetic biological and psychosocial risk factors for ADHD symptom severity and comorbid disorders were assessed in 275 children with ADHD, aged 5–13 years, mean age 9.7 (SD 1.9). Pre-/perinatal biological and lifetime psychosocial risk factors as well as data on parental ADHD were obtained. A different pattern of risk factors emerged for inattentive and hyperactive-impulsive ADHD symptoms. Inattentive symptoms were strongly influenced by psychosocial risk factors, whereas for hyperactive-impulsive symptoms, predominantly biological risk factors emerged. Hyperactive-impulsive symptoms also were a strong risk factor for comorbid oppositional defiant (ODD) and conduct disorder (CD). Smoking during pregnancy was a risk factor for comorbid CD but not ODD and further differential risk factors were observed for ODD and CD. Comorbid anxiety disorder (AnxD) was not related to ADHD symptoms and additional biological and psychosocial risk factors were observed. This study adds to the body of evidence that non-genetic biological and psychosocial risk factors have an impact on ADHD symptom severity and differentially influence comorbid disorders in ADHD. The findings are relevant to the prevention and treatment of ADHD with or without comorbid disorders.     

Does oppositional defiant disorder have temperament and psychopathological profiles independent of attention deficit/hyperactivity disorder?

Background

Most studies on temperamental and behavioral/emotional characteristics of oppositional defiant disorder (ODD) did not rule out the effect of comorbid attention-deficit/hyperactivity disorder (ADHD). The main objective of this study was to identify the temperamental and psychopathological patterns of ODD independent of comorbid ADHD. We also aimed to compare the patterns of temperament and psychopathology between ODD with and without ADHD.

Method

Parents of 2673 students, randomly selected from 19 representative schools in Seoul, Korea, completed the Diagnostic Interview Schedule for Children Version IV. Among 118 children and adolescents with ODD diagnosed by the Diagnostic Interview Schedule for Children Version IV, the parents of 94 subjects (mean age, 10.4 ± 3.0 years) and the parents of a random sample of 94 age- and gender-matched non-ODD/non-ADHD children and adolescents completed the parent's version of the Child Behavior Checklist (CBCL) and the Junior Temperament and Character Inventory.

Results

Subjects with ODD showed temperament and character profiles of high Novelty Seeking, low Self-directedness, and low Cooperativeness, a distinct pattern on the CBCL, and were at increased risk for anxiety and mood disorders compared to the controls after controlling for the effect of comorbid ADHD. The children and adolescents with both ODD and ADHD showed decreased levels of Persistence and Self-directedness and higher scores on 4 subscales of the CBCL (Anxious/Depressed, Attention Problems, Delinquent Behaviors, and Aggressive Behaviors) compared to those with ODD only.

Conclusions

Oppositional defiant disorder is associated with specific temperamental and behavioral/emotional characteristics, independent of ADHD. Moreover, the results of this study support that co-occurring ADHD and ODD have differentially higher levels of behavioral and emotional difficulties.