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Preschool boys with oppositional defiant disorder: clinical presentation and diagnostic change
M L Speltz1, J McClellan, M DeKlyen
1University of Washington School of Medicine, Seattle 98105, USA.
Insights
Oppositional defiant disorder (ODD) in preschoolers is a significant risk indicator, particularly when co-occurring with attention-deficit hyperactivity disorder (ADHD). Many children maintain ODD or ADHD diagnoses over time.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Behavioral Science
Background:
- Oppositional defiant disorder (ODD) is a common behavioral disorder in children.
- Limited research exists on the clinical presentation and long-term course of ODD diagnosed in preschool-aged children.
- Understanding early ODD is crucial for timely intervention and predicting outcomes.
Purpose of the Study:
- To investigate the clinical presentation and course of oppositional defiant disorder (ODD) in clinic-referred preschool boys.
- To examine patterns of ODD symptomatology, comorbidity, persistence, and predictors of diagnostic outcomes.
- To identify risk factors associated with the persistence of ODD and related disorders.
Main Methods:
- Prospective longitudinal study of boys aged 4-5.5 years with a DSM-III-R diagnosis of ODD.
- Follow-up assessments conducted over a 2-year period.
- Utilized multiple assessment procedures including the Diagnostic Interview Schedule for Children and parent/teacher ratings.
Main Results:
- Ninety-two preschool boys with ODD were followed; 42 had comorbid attention-deficit hyperactivity disorder (ADHD).
- After 2 years, 76% of 79 assessed boys had ODD, ADHD, or both; 25% had additional diagnoses (anxiety, mood disorders).
- Comorbid ODD/ADHD at intake predicted a higher likelihood of psychiatric disorders at follow-up, particularly ADHD alone.
Conclusions:
- Preschool ODD is a significant indicator of high risk for persistent and comorbid psychiatric disorders, especially when co-occurring with ADHD.
- The findings highlight the importance of early identification and intervention for ODD in preschool settings.
- Further research into individual ODD symptom expression patterns is recommended for tailored treatment approaches.
Objective:
Little is known about the clinical presentation and course of oppositional defiant disorder (ODD) when first diagnosed in the preschool years. Patterns of ODD symptomatology, comorbidity, persistence of disorder, and predictors of diagnostic outcome were examined in clinic-referred preschool boys.
Method:
Boys (aged 4-5.5 years) with a DSM-III-R diagnosis of ODD were prospectively followed over a 2-year period. Multiple assessment procedures were used, including a modified version of the Diagnostic Interview Schedule for Children and parent and teacher ratings.
Results:
Ninety-two boys (mean age 56.9 months) with ODD were followed; 42 had comorbid attention-deficit hyperactivity disorder (ADHD). Among 79 boys assessed 2 years later, 76% had ODD, ADHD, or both. Of those, 25% had other diagnoses as well, primarily anxiety and/or mood disorders. Conduct disorder was rare. Subjects with comorbid ODD/ADHD at intake were significantly more likely to have a psychiatric disorder at follow-up, especially ADHD alone.
Conclusions:
The findings suggest that ODD in the preschool period is a clear indicator of high risk, especially when co-occurring with ADHD. Further investigation of individual patterns of ODD symptom expression is recommended.