Comorbidity of Disruptive Behavior Disorders and ADHD


A child with ODD (Oppositional Defiant Disorder) or conduct disorder is more likely to be diagnosed with ADHD (Attention-Deficit/Hyperactivity Disorder) than a child with ADHD is to be diagnosed with ODD or conduct disorder. Research indicates that 50% of children with ADHD will either develop ODD or conduct disorder at some point in their development, which can explain why the percentage of adults and adolescents with ADHD and comorbid conduct disorder is higher than the percentage of children with ADHD or conduct disorder alone. About 40 % of individuals with ADHD have ODD, 27 % of children with ADHD have conduct disorder, 50 % of adolescents and 25 % of adults with ADHD have conduct disorder.

Attention Deficit Disorder, more commonly known as ADHD, is a struggle to live with on its own, but if a Disruptive Behavior Disorder gets tossed into the mix, it becomes even more complicated. Children with comorbid ADHD and conduct disorder engage in more delinquent behaviors than their peers and are at a higher risk of engaging in criminal behaviors in the future. They display “behavioral profiles similar to adult psychopaths” (Rapposelli, 2015). Those with comorbid ADHD and ODD express behaviors such as arguing, losing one’s temper, refusing to follow rules, blaming others for their behaviors, and deliberately annoying others. They are often angry, resentful, spiteful, and vindictive. In addition to this, youth with comorbid ADHD and ODD experience greater academic difficulties and rejection from their peers than youth with ADHD alone. There is an extremely strong relationship between academic failure, learning disabilities, and conduct disorder.

When there is a comorbidity between two disorders, it makes treating and living with both conditions complicated. A comorbidity of ADHD and ODD or ADHD and conduct disorder means that the quality of life will be very low due to the characteristics of both disorders. An individual with ADHD has the ability to learn information and skills, but they do not know how to use the information or implement those skills. This can cause them frustration and agitation. Throw in ODD, and you now have a person who is frustrated and agitated because their brain doesn’t let them use the information they have and they have a disregard for authority and rules. Conduct disorder involves extreme aggression, damaging property, and hurting other people and animals. When these symptoms are mixed with symptoms of ADHD, such as difficulty paying attention and the feelings associated with both these disorders, it becomes clear why these individuals have a low quality of life. But what can be done to help them?

Treatment options are available in the forms of therapy and medication, but emphasis is placed on preventative measures. Schools have psychologists and social workers who can help children with these disorders, but they cannot intervene at the early stages because there isn’t much research on the early signs of these comorbid disorders. Parents can be the first line of defense. Parents should be aware of their children’s behaviors, and if they notice their child acting overly aggressive, or having extreme difficulties in school, they should talk to a medical professional about it.

Early intervention after diagnosis is inherently important because the long term outcomes of children with comorbid ADHD and conduct disorder or ODD are vastly different from those with ADHD alone. One study followed two groups of children with ADHD. One group had comorbid ADHD and conduct disorder, the other group had ADHD only. At fourteen, 30% of the group with comorbid ADHD and conduct disorder had engaged in drug and alcohol abuse. There was no case of substance abuse in the other group. A similar study showed that one third of boys with ADHD and conduct disorder had committed multiple crimes as teenages whereas less than four percent of boys diagnosed with only ADHD had committed multiple crimes.

Research has also shown that early intervention can help individuals with comorbid ADHD and ODD or conduct disorder to have better academic performance, engage in social behaviors in a positive manner, and improve the overall quality of life. But in order to have early intervention, parents and schools need more resources and information about these disorders and their relationship to each other. Further research must be conducted in order to provide these resources to parents and schools.

References

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). Coexisting Conditions. Retrieved April 17, 2019, from https://chadd.org/about-adhd/coexisting-conditions/

Rabiner, D., Ph.D. (n.d.). Behavior Disorders that often co-occur with ADHD. Retrieved April 17, 2019, from http://www.helpforadd.com/co-occurring-disorders/

Rapposelli, D. (2015, September 9). Nipping ADHD and conduct disorder in the Bud. Retrieved April 17, 2019, from https://www.psychiatrictimes.com/adhd/nipping-adhd-and-conduct-disorder-bud

Skitterphoto. (n.d.). [Girl standing in field]. Retrieved April 17, 2019, from https://pixabay.com/photos/girl-bicycle-garden-people-outdoor-535251/

Turgay, A. (2005). Treatment of comorbidity in conduct disorder with attention-deficit hyperactivity disorder (ADHD). Retrieved April 17, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/16222912

Virginia Commission on Youth. (2017). Disruptive, Impulse-Control, and conduct disorders. Retrieved April 17, 2019, from http://vcoy.virginia.gov/documents/collection/021 Disruptive ODD2.pdf

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