Review of attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder

The aim of this paper was to conduct a practitioner review of attention-deficit/hyperactivity disorder (ADHD) co-occurring with oppositional defiant disorder (ODD) encompassing aetiological factors, associated factors, assessment, treatment and prognosis.

ADHD and ODD have both shared and unique genetic influences. Persistence of ADHD and ODD in adolescence is linked with an increased risk of delinquent behaviour, substance dependence, anxiety, depression, and possibly bipolar disorder. The diagnostic work up for ADHD must include screening for ODD, which may be achieved through targeted questioning or the use of standard symptom checklists. Treatment requires management of the core symptoms of ADHD plus, in many cases, augmentation with other treatment to address the ODD. Mild cases may respond to behaviour management alone, or monotherapy with stimulant medication or atomoxetine. Moderate to severe cases usually require a combination of pharmacotherapy, which may include clonidine, and behaviour management. Severe or refractory cases may require the introduction of an atypical antipsychotic such as risperidone.