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Oppositional Defiant Disorder in Autism and ADHD.
Susan D Mayes1, Sara K Pardej2, Daniel A Waschbusch2
1Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Dr., Hershey, PA, 17033, USA. smayes@psu.edu.
Journal of Autism and Developmental Disorders
|July 27, 2024
Summary
Oppositional defiant disorder (ODD) is highly prevalent in children with autism and ADHD-Combined. ADHD-Combined is the strongest risk factor for ODD, especially when comorbid with autism.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Behavioral Science
Background:
- Oppositional defiant disorder (ODD) frequently co-occurs with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
- Understanding the specific contributions of ASD and different ADHD presentations to ODD is crucial for accurate diagnosis and effective treatment.
Purpose of the Study:
- To compare the prevalence and characteristics of ODD in children with autism, ADHD-Combined presentation, and ADHD-Inattentive presentation.
- To identify risk factors and understand the interplay between autism, ADHD, and ODD.
Main Methods:
- Mothers of 2,400 children (3-17 years) with autism and/or ADHD completed the Pediatric Behavior Scale.
- Prevalence, ODD scores, and correlations with other behavioral problems were analyzed across diagnostic groups.
Main Results:
- ADHD-Combined presentation showed the highest ODD prevalence (53%), increasing to 62% when comorbid with autism.
- Autism was an independent risk factor for ODD, particularly the irritable/angry component.
- ODD scores were highest in the Autism+ADHD-Combined group, followed by ADHD-Combined Only, then Autism+ADHD-Inattentive and Autism Only, and lowest in ADHD-Inattentive Only.
Conclusions:
- ADHD-Combined is the strongest risk factor for ODD, and its high comorbidity with autism largely explains the elevated ODD rates in autistic children.
- Clinicians should assess for all three conditions (ADHD-Combined, autism, ODD) and implement evidence-based interventions to improve outcomes.
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