Is Oppositional Defiant Disorder a Meaningful Diagnosis in Adults?

ArticleinJournal of Nervous & Mental Disease 195(7):601-5 · August 2007with9 Reads
DOI: 10.1097/NMD.0b013e318093f448 · Source: PubMed
Abstract
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.
    • 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.
    [Show abstract] [Hide abstract] 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).
    Full-text · Article · Feb 2014
    • These studies (e.g. Barkley, Edwards, Laneri, Fletcher, & Metevia, 2001; Harpold et al., 2007) suggest that ODD remains a valid and diagnosable condition in young adulthood, at least among groups with ADHD. The present data did not include the direct measurement of ODD symptoms in adulthood; further investigation is needed to help clarify to what degree ODD persists into adulthood and how it may affect important transitions into new or different social roles and expectations for independent functioning.
    [Show abstract] [Hide abstract] ABSTRACT: Oppositional defiant disorder(ODD) is considered to be a disorder of childhood, yet evidence suggests that prevalence rates of the disorder are stable into late adolescence and trajectories of symptoms persist into young adulthood. Functional outcomes associated with ODD through childhood and adolescence include conflict within families, poor peer relationships, peer rejection, and academic difficulties. Little examination of functional outcomes in adulthood associated with ODD has been undertaken. Data for the present analyses come from a clinic referred sample of 177 boys aged 7-12 followed up annually to age 18 and again at age 24. Annual parental report of psychopathology through adolescence was used to predict self-reported functional outcomes at 24. Controlling for parent reported symptoms of attention deficit hyperactivity disorder (ADHD), Conduct disorder (CD), depression and anxiety, ODD symptoms from childhood through adolescence predicted poorer age 24 functioning with peers, poorer romantic relationships, a poorer paternal relationship, and having nobody who would provide a recommendation for a job. CD symptoms predicted workplace problems, poor maternal relationship, lower academic attainment, and violent injuries. Only parent reported ODD symptoms and child reported CD symptoms predicted a composite of poor adult outcomes. Oppositional defiant disorder is a disorder that significantly interferes with functioning, particularly in social or interpersonal relationships. The persistence of impairment associated with ODD into young adulthood calls for a reconsideration of ODD as a disorder limited to childhood.
    Article · Oct 2013
    • DSM-5 has tweaked the diagnostic criteria so that the symptoms better capture ODD among adults (e.g., adding " authority figures " not just " adults " to the " often argues " criterion; American Psychiatric Association, 2013, p. 462). Likewise, recent studies have examined ODD symptoms among adults (e.g., Harpold et al., 2007; Reimherr et al., 2013; Witkiewitz et al., 2013) and concluded that ODD is a valid diagnosis for adults and is relatively common among adults, especially those with ADHD. Still, the preponderance of studies on ODD have been conducted on child and adolescent samples.
    [Show abstract] [Hide abstract] ABSTRACT: An understanding of the latent structure of oppositional defiant disorder (ODD) is essential for better developing causal models, improving diagnostic and assessment procedures, and enhancing treatments for the disorder. Although much research has focused on ODD-including recent studies informing the diagnostic criteria for DSM-5-research examining the latent structure of ODD is sparse, and no known study has specifically undertaken a taxometric analysis to address the issue of whether ODD is a categorical or dimensional construct. To address this gap, the authors conducted two separate studies using a set of taxometric analyses with data from the NICHD Study of Early Child Care and Youth Development (child study; n = 969) and with data from a large mixed sample of adults, which included participants reporting psychiatric difficulties as well as healthy controls (adult study; n = 600). The results of a variety of non-redundant analyses across both studies revealed a dimensional latent structure for ODD symptoms among both children and adults. These findings are consistent with previous studies that have examined latent structure of related constructs (e.g., aggression, antisocial behavior) as well as studies that have examined the dimensional versus categorical structure of ODD using methods other than taxometric analysis.
    Full-text · Article · Sep 2013
    • 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.
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Sep 2009
  • [Show abstract] [Hide abstract] ABSTRACT: A better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications. Subjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan-Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age. ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder. These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.
    Article · Aug 2008
  • [Show abstract] [Hide abstract] ABSTRACT: This study aimed to determine the prevalence of problem behaviors in adults with intellectual disabilities and to investigate which factors are independently associated with problem behaviors. A population-based cohort (n = 1023) had comprehensive individual assessments. Data were examined using multivariate logistic regression. The prevalence of problem behaviors was 22.5% (psychiatrists' opinion) or 18.7% (DC-LD criteria). Factors independently associated with problem behaviors were lower ability level, female gender, living in a congregate care setting or with paid carer support (rather than living with a family carer), having urinary incontinence; visual impairment, not having Down syndrome, and not having severe physical disabilities. Further studies focusing on the etiology, course, and treatment of problem behaviors are required.
    Article · Oct 2008
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