Examination of key child and psychosocial predictors of Oppositional Defiant Disorder (ODD) in young people with Attention Deficit Hyperactivity Disorder (ADHD)

Abstract

Introduction: ADHD and ODD are two common developmental mental health conditions that can co-occur. There are associated functional impairments across clinical, biological, psychological, and social domains, which may be more severe when they co-occur. It is important to understand and recognise risk factors for young people with ADHD who are developing or maintaining ODD in order to target them early with appropriate and effective therapy interventions. To date, there are limited longitudinal datasets examining key risk factors associated with these comorbid conditions and more research is needed to investigate what places a young person with ADHD more at risk for ODD. This study examines the role of key child characteristics, psychosocial factors, ADHD subtypes and commodities.

Methods: A three-year blinded evaluation of children with ADHD, investigating those with and without follow-up ODD. At baseline, relevant demographic, functional and clinical information was collected from clinically referred participants with ADHD (N=419). All participants were followed up three years later. Twenty-five percent (N=104), were unable to be reassessed. 150 participants were recruited with ADHD and follow-up ODD (120 males; 30 females) and 60 were recruited with ADHD alone (43 males; 17 females). Groups were compared for clinical presentations (ADHD subtype, comorbid disorders), key child characteristics (gender, IQ, temperament, Visual Spatial Working Memory, academic ability, emotional regulation, social problems), and psychosocial factors (parental level of education, family functioning, parental relationship functioning, parenting skill, parental psychopathology).

Results: The two groups did not differ for age, gender, or SES at baseline. Young people with ADHD and follow-up ODD had increased temperament activity level, worse Verbal Comprehension, worse Visual Spatial Working Memory, increased aggression, and worse social problems in comparison with the ADHD alone group. In the psychosocial domain, lower parental level of education, overall higher parental psychopathology, and higher parental Obsessive Compulsive symptoms and Interpersonal Sensitivity significantly predicted ADHD and follow up ODD. ODD, CD and ADHD-C significantly predicted ADHD and follow up ODD group membership. In contrast, GAD acted as a protective factor, predicting membership in the ADHD alone group. Backwards stepwise logistical regressions were completed for all significant factors, finding that increased temperament activity, parent reported increased aggression and teacher reported increased social problems were the strongest predictors of ADHD and ODD follow up compared to the ADHD alone group.

Discussion: The findings suggest that when working with young people with ADHD it is important to effectively manage their temperament activity levels, aggression and to teach skills that improve their social skills. Effectively treating ADHD-C symptoms, aiding Verbal Comprehension and Visual Spatial Working Memory difficulties, and supporting parents with furthering their education and mental health difficulties should be included in a comprehensive treatment plan. It is important for clinician’s to be aware of the bi-directional relationship between ADHD and parent behaviour and functioning, which highlights the importance of systemic intervention. Further understanding how to optimally manage the helpful aspects of a young person’s anxiety may assist in preventing behavioural problems. Study limitations, future clinical and research directions are discussed.