Journal of Abnormal Child Psychology

, Volume 33, Issue 5, pp 551–563 | Cite as

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

  • Linda J. Pfiffner
  • Keith Mcburnett
  • Paul J. Rathouz
  • Samuel Judice


Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.

Key Words

ADHD comorbid disorders parenting parent psychopathology 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Anastopoulos, A. D., Shelton, T. L., DuPaul, G. J., & Guevremont, D. C. (1993). Parent training for Attention-Deficit Hyperactivity Disorder: Its impact on parent functioning. Journal of Abnormal Child Psychology, 21(5), 581–596.CrossRefPubMedGoogle Scholar
  2. Anderson, C. A., Hinshaw, S. P., & Simmel, C. (1994). Mother–child interactions in ADHD and comparison boys: Relationships with overt and covert externalizing behavior. Journal of Abnormal Child Psychology, 22, 247–265.CrossRefPubMedGoogle Scholar
  3. August, G. J., Realmuto, G. M., Joyce, T., & Hektner, J. M. (1999). Persistence and desistance of oppositional defiant disorder in a community sample of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1262–1270.CrossRefPubMedGoogle Scholar
  4. Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775–789.CrossRefPubMedGoogle Scholar
  5. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefPubMedGoogle Scholar
  6. Biederman, J., Faraone, S. V., Keenan, K., Knee, D., & Tsuang, M. T. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 526–533.PubMedGoogle Scholar
  7. Biederman, J., Munir, K., & Knee, D. (1987). Conduct and oppositional disorder in clinically referred children with attention deficit disorder: A controlled family study. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 724–727.PubMedGoogle Scholar
  8. Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564–577.PubMedGoogle Scholar
  9. Capaldi, D. M., Pears, K. C., Patterson, G. R., & Owen, L. D. (2003). Continuity of parenting practices across generations in an at-risk sample: A prospective comparison of direct and mediated associations. Journal of Abnormal Child Psychology, 31, 127–142.CrossRefPubMedGoogle Scholar
  10. Cleckley, H. M. (1951). The mask of sanity. Postgraduate Medicine, 9, 193–197.PubMedGoogle Scholar
  11. Conger, R. D., Neppi, T., Kim, K. J., & Scaramella, L. (2003). Angry and aggressive behavior across three generations: A Prospective, longitudinal study of parents and children. Journal of Abnormal Child Psychology, 31, 143–160.CrossRefPubMedGoogle Scholar
  12. Cunningham, C. E., Benness, B. B., & Siegel, L. S. (1988). Family functioning, time allocation, and parental depression in the families of normal and ADDH children. Journal of Clinical Child Psychology, 17, 169–177.Google Scholar
  13. Faraone, S. V., Biederman, J., & Milberger, S. (1994). An exploratory study of ADHD among second-degree relatives of ADHD children. Biological Psychiatry, 35, 398–402.CrossRefPubMedGoogle Scholar
  14. Farrington, D. P. (1995). The development of offending and antisocial behaviour from childhood: Key findings from the Cambridge Study in delinquent development. Journal of Child Psychology and Psychiatry, 360, 929–964.Google Scholar
  15. First, M., Gibbon, M., Spitzer, R., & Williams, J. (1995). User's guide for the structured clinical interview for DSM-IV axis I disorders. New York: Biometrics Research.Google Scholar
  16. Fletcher, K. E., Fischer, M., Barkley, R. A., & Smallish, L. (1996). A sequential analysis of the mother-adolescent interactions of ADHD, ADHD/ODD, and normal teenagers during neutral and conflict discussions. Journal of Abnormal Child Psychology, 24, 271–297.CrossRefPubMedGoogle Scholar
  17. Forehand, R., & McMahon, R. (1981). Helping the noncompliant child: A clinician's guide to parent training. New York: Guilford Press.Google Scholar
  18. Frick, P. J., Lahey, B. B., Christ, M. A., & Loeber, R. (1991). History of childhood behavior problems in biological relatives of boys with attention-deficit hyperactivity disorder and conduct disorder. Journal of Clinical Child Psychology, 20, 445–451.Google Scholar
  19. Frick, P. J., Lahey, B. B., Loeber, R., & Stouthamer-Loeber, M. (1992). Familial risk factors to oppositional defiant disorder and conduct disorder: Parental psychopathology and maternal parenting. Journal of Consulting and Clinical Psychology, 60, 49–55.CrossRefPubMedGoogle Scholar
  20. Frick, P. J., & Loney, B. R. (2002). Understanding the association between parent and child antisocial behavior. In R. J. McMahon & R. D. Peters (Eds.), The effects of parental dysfunction on children (pp. 105–126). New York: Plenum.Google Scholar
  21. Furman, W., & Giberson, R. (1995). Identifying the links between parents and their children's sibling relationships. In S. Shulman (Ed.), Close relationships and socioemotional development (pp. 95–108). Norwood, NJ: Aplex.Google Scholar
  22. Gadow, K. D., & Sprafkin, J. (1994). Child Symptom Inventories Manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  23. Greenberg, M. T., Speltz, M. L., & DeKlyen, M. (1993). The role of attachment in the early development of disruptive behavior problems. Development and Psychopathology, 5, 191–213.Google Scholar
  24. Hinshaw, S., Owens, E. B., Wells, K. C., Kraemer, H. C., Abikoff, H., Arnold, L. E., et al. (2000). Family processes and treatment outcome in the MTA: Negative/ineffective Parenting practices in relation to multimodal treatment. Journal of Abnormal Child Psychology, 28, 555–568.CrossRefPubMedGoogle Scholar
  25. Hollingshead. (1975). Four Factor Index of Social Status. New Haven, CT: Yale University Department of Sociology.Google Scholar
  26. Jensen, P., Hinshaw, S., Kraemer, H. C., Lenora, N., Newcorn, J., Abikoff, H., et al. (2001). ADHD Comorbidity findings from the MTA Study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 147–158.CrossRefPubMedGoogle Scholar
  27. Jensen, P. S., Martin, D., & Cantwell, D. P. (1997). Comorbidity in ADHD: Implications for research, practice, and DSM-V. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1065–1079.CrossRefPubMedGoogle Scholar
  28. Johnston, C., & Mash, E. J. (2001). Families of children with Attention-Deficit/Hyperactivity Disorder: Review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207.CrossRefPubMedGoogle Scholar
  29. Johnston, C., Murray, C., Hinshaw, S., Pelham, W., & Hoza, B. (2002). Responsiveness in interactions of mothers and sons with ADHD: Relations to maternal and child characteristics. Journal of Abnormal Child Psychology, 30, 77–88.CrossRefPubMedGoogle Scholar
  30. Kashdan, T. B., Jacob, R., Pelham, W., Lang, A. R., Hoza, B., Blumenthal, J. D., & Gnagy, E. (2004). Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: modeling relationships with family functioning. Journal of Clinical Child and Adolescent Psychology, 33, 169–181.CrossRefPubMedGoogle Scholar
  31. Kochanska, G. (1993). Toward a synthesis of parental socialization and child temperament in early development of conscience. Child Development, 64, 325–347.Google Scholar
  32. Lahey, B. B., McBurnett, K., & Loeber, R. (2000). Are Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder developmental precursors to Conduct Disorder? In A. J. Sameroff, M. Lewis & S. M. Miller (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 431–446). New York: Kluwer Academic.Google Scholar
  33. Lahey, B. B., Piacentini, J. C., McBurnett, K., Stone, P., Hartdagen, S., & Hynd, G. (1988). Psychopathology in the parents of children with conduct disorder and hyperactivity. Journal of the American Academy of Child Adolescent Psychiatry, 27, 163–170.Google Scholar
  34. Laub, J. H., & Sampson, R. J. (1988). Unraveling families and delinquency: A reanalysis of the Gluecks' data. Criminology, 26, 355–380.Google Scholar
  35. Lindahl, K. (1998). Family process variables and children's disruptive behavior problems. Journal of Family Psychology, 12, 420–436.CrossRefGoogle Scholar
  36. Loeber, R., & Tengs, T. (1986). The analysis of coercive chains between children, mothers, and siblings. Journal of Family Violence, 1, 51–70.CrossRefGoogle Scholar
  37. McCord, J. (1991). The cycle of crime and socialization practices. Journal of Criminal Law and Criminology, 82, 211–228.Google Scholar
  38. Moffitt, T. E. (1993). Adolescence-limited and life course persistent antisocial behavior: A Developmental typology. Psychological Review, 100, 674–701.CrossRefPubMedGoogle Scholar
  39. Nigg, J. T., & Hinshaw, S. P. (1998). Parent personality traits and psychopathology associated with antisocial behaviors in childhood attention-deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 39, 145–159.CrossRefPubMedGoogle Scholar
  40. Patterson, G. R., & Capaldi, D. M. (1991). Antisocial parents: Unskilled and vulnerable. In P. A. Cowan & M. Hetherington (Eds.), Family transitions (pp. 195–218). New Jersey: Erlbaum.Google Scholar
  41. Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys. Eugene, OR: Castalia.Google Scholar
  42. Pfiffner, L. J., McBurnett, K., Lahey, B. B., Loeber, R., Green, S., Frick, P. J., et al. (1999). Association of parental psychopathology to the comorbid disorders of boys with Attention-deficit Hyperactivity Disorder. Journal of Consulting and Clinical Psychology, 67, 881–893.CrossRefPubMedGoogle Scholar
  43. Pfiffner, L. J., McBurnett, K., & Rathouz, P. (2001). Father absence and familial antisocial characteristics. Journal of Abnormal Child Psychology, 29, 357–367.CrossRefPubMedGoogle Scholar
  44. Pruett, K. (1997). How men and children affect each other's development. Zero to Three, Aug/Sept, 3–11.Google Scholar
  45. Reynolds, C. R., & Kamphaus, R. W. (1992). Behavioral Assessment System for Children manual. Circle Pines, MN: American Guidance Service.Google Scholar
  46. Schachar, R. J., & Wachsmuth, R. (1991). Family dysfunction and psychosocial adversity: Comparison of attention deficit disorder, conduct disorder, normal and clinical controls. Canadian Journal of Behavioural Science, 23, 332–348.Google Scholar
  47. Shaffer, D., Fisher, P., Dulcan, M., Davies, M., Piacentini, J., Schwab-Stone, M., et al. (1996). The NIMH Diagnostic Interview Schedule for Children (DISC 2.3): description, acceptability, prevalences, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865–877.CrossRefPubMedGoogle Scholar
  48. Shelton, K. K., Frick, P. J., & Wootton, J. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329.Google Scholar
  49. Smith, C., & Farrington, D. (2004). Continuities in antisocial behavior and parenting across three generations. Journal of Child Psychology and Psychiatry, 45, 230–247.CrossRefPubMedGoogle Scholar
  50. Szatmari, P., Boyle, M., & Offord, D. R. (1989). ADDH and conduct disorder: Degree of diagnostic overlap and differences among correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 865–872.PubMedGoogle Scholar
  51. Thornberry, T. P., Freeman-Gallant, A., Lizotte, A. J., & Krohn, M. D. (2003). Linked lives: The intergenerational transmission of antisocial behavior. Journal of Abnormal Child Psychology, 31, 171–184.CrossRefPubMedGoogle Scholar
  52. Wells, K. C., Epstein, J. N., Hinshaw, S., Conners, C. K., Klaric, J., Abikoff, H. B., et al. (2000). Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An empirical analysis in the MTA study. Journal of Abnormal Child Psychology, 28, 543–553.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Linda J. Pfiffner
    • 1
    • 3
  • Keith Mcburnett
    • 1
  • Paul J. Rathouz
    • 2
  • Samuel Judice
    • 1
  1. 1.Department of PsychiatryUniversity of CaliforniaSan Francisco
  2. 2.Department of Health StudiesThe University of ChicagoChicago
  3. 3.Children's Center at Langley PorterUniversity of California, San FranciscoSan Francisco

Personalised recommendations