Is Oppositional Defiant Disorder a Meaningful Diagnosis in Adults?

Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 08/2007; 195(7):601-5. DOI: 10.1097/NMD.0b013e318093f448
Source: PubMed


We examined the prevalence and clinical characteristics of oppositional defiant disorder (ODD) in a sample of clinically referred adults with attention deficit hyperactivity disorder (ADHD). Subjects were consecutively referred adults with a DSM-III R/IV diagnosis of ADHD with or without ODD. Nearly half of subjects (43%) had a history of ODD. Subjects with a childhood history of ODD had increased risk for bipolar disorder, multiple anxiety disorders, and substance use disorders relative to the ADHD subjects without ODD. We concluded, as in children with ODD, adults with a childhood history of ODD have high rates of psychiatric comorbidity and more impaired psychosocial functioning than those without this condition. A better understanding of the course, phenomenology, and clinical significance of ODD in adults is needed to better understand therapeutic approaches for this disorder.

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    • "This ambiguity may account for why factor analyses of the ODD symptoms have yielded inconsistent findings, with some researchers finding that spiteful behavior loads on a negative affect factor (Burke, Hipwell, & Loeber, 2010) and others finding it loads on either a headstrong (Rowe, Costello, Angold, Copeland, & Maughan, 2010) or conduct-disordered factor (Lahey et al., 2004). Given the increasing interest in ODD in adulthood (Harpold et al., 2007), and the changes to the DSM–5 criteria to better identify adult ODD (e.g., changing " adults " to " authority figures " ), a spitefulness measure may contribute to the diagnosis of ODD. "
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    ABSTRACT: Spite is an understudied construct that has been virtually ignored within the personality, social, and clinical psychology literatures. This study introduces a self-report Spitefulness Scale to assess individual differences in spitefulness. The scale was initially tested on a large sample of 946 college students and cross-validated on a national sample of 297 adults. The scale was internally consistent in both samples. Factor analysis supported a 1-factor solution for the initial pool of 31 items. Item response theory analysis was used to identify the best performing of the original 31 items in the university sample and reduce the scale to 17 items. Tests of measurement invariance indicated that the items functioned similarly across both university and national samples, across both men and women, and across both ethnic majority and minority groups. Men reported higher levels of spitefulness than women, younger people were more spiteful than older people, and ethnic minority members reported higher levels of spitefulness than ethnic majority members. Across both samples, spitefulness was positively associated with aggression, psychopathy, Machiavellianism, narcissism, and guilt-free shame, and negatively correlated with self-esteem, guilt-proneness, agreeableness, and conscientiousness. Ideally, this Spitefulness Scale will be able to predict behavior in both laboratory settings (e.g., ultimatum games, aggression paradigms) and everyday life, contribute to the diagnosis of personality disorders and oppositional defiant disorder, and encourage further study of this neglected, often destructive, trait. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Assessment 02/2014; 26(2). DOI:10.1037/a0036039 · 2.99 Impact Factor
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    • "Whereas the onset of unproblematic substance use is associated with environmental factors (in particular peer influence), the transition from substance use to use SUD is strongly associated with genetic factors (Dawes et al., 2000; Kendler et al., 2003). Among the known risk factors for SUD in psychiatric populations – and especially in ADHD – are early onset of smoking (Biederman et al., 2006), disruptive behavior in childhood (Compton et al., 2005; Harpold et al., 2007), and a parental history of SUD (Biederman et al., 2008). None of these risk factors have, to our knowledge, been studied for the relationship between ASD and SUD. "
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    ABSTRACT: Little is known about Autism Spectrum Disorder (ASD) in adults, especially not about ASD with co-morbid Substance Use Disorder (SUD). We wanted to examine how adults with ASD compare to adults with ADHD on prevalence and risk factors for co-morbid SUD, and on disability levels associated with SUD. We stratified 123 treatment seeking adults with ASD (n=70) or ADHD (n=53), into current, former and no history of SUD (SUD+, SUD(wedge), and SUD-), and conducted interviews to explore associated risk factors and current levels of disability. Prevalence of co-morbid SUD was higher in ADHD than in ASD in our sample (58% versus 30%, p=0.001). There was no statistically significant difference between ASD and ADHD in risk factors or disability scores. Patients with lifetime SUD started regular smoking earlier in life (OR=5.69, C(95%) 2.3-13.8), reported more adverse family events (OR=2.68; CI(95%) 1.2-6.1), and had more parental SUD (OR=5.36; CI(95%) 1.0-14.5). Disability scores were significantly lower in SUD- and SUD(wedge) groups compared to the SUD+ group. These findings suggest that ASD and ADHD share similar risk factors for SUD. High disability in ASD and ADHD with SUD may normalize after prolonged abstinence. Early onset of SUD was not associated with more severe disability scores than later onset. Results suggest that a subgroup of patients with former SUD may have a higher level of functioning before the onset of SUD in comparison to those without lifetime SUD.
    Drug and alcohol dependence 09/2009; 107(1):44-50. DOI:10.1016/j.drugalcdep.2009.09.003 · 3.42 Impact Factor
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    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.
    Current Attention Disorders Reports 03/2009; 1(1):5-11. DOI:10.1007/s12618-009-0002-7
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