Skip to main content
SpringerLink
Log in

Attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder or conduct disorder

  • Published:
Current Attention Disorders Reports

Abstract

Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kessler RC, Adler L, Barkley R, et al.: The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006, 163:716–723.

    Article  PubMed  Google Scholar 

  2. Barkley RA: Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, edn 3. New York: Guilford; 2006.

    Google Scholar 

  3. Connor DF, Doerfler LA: ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or nondistinct disruptive behavior disorders? J Atten Disord 2008, 12:126–134.

    Article  PubMed  Google Scholar 

  4. Kuhne M, Schachar R, Tannock R: Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1997, 36:1715–1725.

    Article  PubMed  CAS  Google Scholar 

  5. Burns GL, Walsh JA: The influence of ADHD-hyperactivity/impulsivity symptoms on the development of oppositional defiant disorder symptoms in a 2-year longitudinal study. J Abnorm Child Psychol 2002, 30:245–256.

    Article  PubMed  Google Scholar 

  6. Lavigne JV, Cicchetti C, Gibbons RD, et al.: Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders. J Am Acad Child Adolesc Psychiatry 2001, 40:1393–1400.

    Article  PubMed  CAS  Google Scholar 

  7. Nock MK, Kazdin AE, Hiripi E, Kessler RC: Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry 2007, 48:703–713.

    Article  PubMed  Google Scholar 

  8. Burke JD, Loeber R, Birmaher B: Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry 2002, 41:1275–1293.

    Article  PubMed  Google Scholar 

  9. Wilens TE, Biederman J, Brown S, et al.: Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. J Am Acad Child Adolesc Psychiatry 2002, 4:262–268.

    Article  Google Scholar 

  10. Harpold T, Biederman J, Gignac M, et al.: Is oppositional defiant disorder a meaningful diagnosis in adults? Results from a large sample of adults with ADHD. J Nerv Ment Dis 2007, 195:601–605.

    Article  PubMed  Google Scholar 

  11. Sanson A, Smart D, Prior M, Oberklaid F: Precursors of hyperactivity and aggression. J Am Acad Child Adolesc Psychiatry 1993, 32:1207–1216.

    Article  PubMed  CAS  Google Scholar 

  12. Moffitt TE, Lynam D Jr: The neuropsychology of conduct disorder and delinquency: implications for understanding antisocial behavior. Prog Exp Pers Psychopathol Res 1994:233–262.

  13. Pfiffner LJ, McBurnett K, Rathouz PJ, Judice S: Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder. J Abnorm Child Psychol 2005, 33:551–563.

    Article  PubMed  Google Scholar 

  14. Weissman MM, Warner V, Wickramaratne P, et al.: Offspring of depressed parents. 10 Years later. Arch Gen Psychiatry 1997, 54:932–940.

    PubMed  CAS  Google Scholar 

  15. Patterson GR: Coercive Family Process. Eugene, OR: Castalia; 1982.

    Google Scholar 

  16. Loeber R, Burke JD, Lahey BB, et al.: Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry 2000, 39:1468–1484.

    Article  PubMed  CAS  Google Scholar 

  17. Steiner H, Remsing L: Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry 2007, 46:126–141.

    Article  PubMed  Google Scholar 

  18. Biederman J, Faraone SV, Milberger S, et al.: Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. J Am Acad Child Adolesc Psychiatry 1996, 35:1193–1204.

    Article  PubMed  CAS  Google Scholar 

  19. Cohen P, Cohen J, Brook J: An epidemiological study of disorders in late childhood and adolescence—II. Persistence of disorders. J Child Psychol Psychiatry 1993, 34:869–877.

    Article  PubMed  CAS  Google Scholar 

  20. Pelham WE Jr, Fabiano GA: Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 2008, 37:184–214.

    Article  PubMed  Google Scholar 

  21. Kaminski JW, Valle LA, Filene JH, Boyle CL: A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol 2008, 36:567–589.

    Article  PubMed  Google Scholar 

  22. Garland AF, Hawley KM, Brookman-Frazee L, Hurlburt MS: Identifying common elements of evidence-based psychosocial treatments for children’s disruptive behavior problems. J Am Acad Child Adolesc Psychiatry 2008, 47:505–514.

    Article  PubMed  Google Scholar 

  23. Kaplan S, Heiligenstein J, West S, et al.: Efficacy and safety of atomoxetine in childhood attention-deficit/hyperactivity disorder with comorbid oppositional defiant disorder. J Atten Disord 2004, 8:45–52.

    Article  PubMed  CAS  Google Scholar 

  24. Biederman J, Spencer TJ, Newcorn JH, et al.: Effect of comorbid symptoms of oppositional defiant disorder on responses to atomoxetine in children with ADHD: a meta-analysis of controlled clinical trial data. Psychopharmacology (Berl) 2007, 190:31–41.

    Article  CAS  Google Scholar 

  25. Hazell P, Zhang S, Wolanczyk T, et al.: Comorbid oppositional defiant disorder and the risk of relapse during 9 months of atomoxetine treatment for attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2006, 15:105–110.

    Article  PubMed  Google Scholar 

  26. Connor DF, Ford JD, Albert DB, Doerfler LA: Conduct disorder subtype and comorbidity. Ann Clin Psychiatry 2007, 19:161–168.

    Article  PubMed  Google Scholar 

  27. Nock MK, Kazdin AE, Hiripi E, Kessler RC: Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol Med 2006, 36:699–710.

    Article  PubMed  Google Scholar 

  28. Biederman J, Newcorn J, Sprich S: Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 1991, 148:564–577.

    PubMed  CAS  Google Scholar 

  29. Granic I, Patterson GR: Toward a comprehensive model of antisocial development: a dynamic systems approach. Psychol Rev 2006, 113:101–131.

    Article  PubMed  Google Scholar 

  30. Sinzig J, Dopfner M, Lehmkuhl G, et al.: Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007, 17:421–432.

    Article  PubMed  Google Scholar 

  31. Barkley RA, Fischer M, Smallish L, Fletcher K: Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry 2006, 45:192–202.

    Article  PubMed  Google Scholar 

  32. Huebner T, Vloet TD, Marx I, et al.: Morphometric brain abnormalities in boys with conduct disorder. J Am Acad Child Adolesc Psychiatry 2008, 47:540–547.

    Article  PubMed  Google Scholar 

  33. Barkley RA, Fischer M, Smallish L, Fletcher K: Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 2004, 45:195–211.

    Article  PubMed  Google Scholar 

  34. Pappadopulos E, Woolston S, Chait A, et al.: Pharmacotherapy of aggression in children and adolescents: efficacy and effect size. J Can Acad Child Adolesc Psychiatry 2006, 15:27–39.

    PubMed  Google Scholar 

  35. Connor DF, McLaughlin TJ, Jeffers-Terry M: Randomized controlled pilot study of quetiapine in the treatment of adolescent conduct disorder. J Child Adolesc Psychopharmacol 2008, 18:140–156.

    Article  PubMed  Google Scholar 

  36. Bangs ME, Hazell P, Danckaerts M, et al.: Atomoxetine for the treatment of attention-deficit/hyperactivity disorder and oppositional defiant disorder. Pediatrics 2008, 121: e314–e320.

    Article  PubMed  Google Scholar 

  37. Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry 1999, 56:1088–1096.

  38. Newcorn JH, Spencer TJ, Biederman J, et al.: Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry 2005, 44:240–248.

    Article  PubMed  Google Scholar 

  39. Spencer TJ, Abikoff HB, Connor DF, et al.: Efficacy and safety of mixed amphetamine salts extended release (adderall XR) in the management of oppositional defiant disorder with or without comorbid attention-deficit/hyperactivity disorder in school-aged children and adolescents: a 4-week, multicenter, randomized, double-blind, parallel-group, placebo-controlled, forced-dose-escalation study. Clin Ther 2006, 28:402–418.

    Article  PubMed  CAS  Google Scholar 

  40. Steele M, Weiss M, Swanson J, et al.: A randomized, controlled effectiveness trial of OROS-methylphenidate compared to usual care with immediate-release methylphenidate in attention deficit-hyperactivity disorder. Can J Clin Pharmacol 2006, 13:e50–e62.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Connecticut School of Medicine, MC1410, 263 Farmington Avenue, Farmington, CT, 06030, USA

    Daniel F. Connor

Authors
  1. Daniel F. Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonard A. Doerfler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel F. Connor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Connor, D.F., Doerfler, L.A. Attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder or conduct disorder. Curr Atten Disord Rep 1, 5–11 (2009). https://doi.org/10.1007/s12618-009-0002-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12618-009-0002-7

Keywords

Search

Navigation