Persistence and desistance of oppositional defiant disorder in a communitysample of children with ADHD

Objective: To examine the developmental progression of comorbid oppositiona l defiant disorder (ODD) in a community sample of children with attention-d eficit hyperactivity disorder (ADHD) with particular emphasis on persistenc e and desistance of ODD and the emergence of new cases of conduct disorder (CD). Method: A sample of disruptive children was identified from a multipl e-gate epidemiological screen and stratified into diagnostic subgroups on t he basis of a structured interview. A comparison sample of nondisruptive ch ildren was also identified. Group comparisons were performed on demographic , descriptive, family history, and clinical characteristics. Changes in rat es of ODD symptoms and diagnostic subgroup membership were assessed after a 4-year longitudinal interval. Predictors of diagnostic group persistence w ere tested. Results: Few differences distinguished diagnostic subgroups at baseline. Of the 43 children with baseline diagnoses of ADHD+ODD, only 1 (2 .3%) was found to have developed CD at follow-up. Over time there was a 57% rate of ODD persistence and a 43% rate of ODD desistance. Negative parenti ng practices and mothers' psychiatric disorders predicted persistence of OD D. Conclusions: There was little evidence to show that ODD acted as a precu rsor to CD. However, when CD was diagnosed at baseline it was always associ ated with or preceded by ODD (i.e., prodrome). For a subgroup of children w ith ADHD, comorbid ODD symptoms are relatively unstable and may represent t ransient developmental perturbations that have little prognostic significan ce. For a larger subgroup of children with ADHD, ODD symp toms persist into the adolescent years and are associated with adverse parenting practices.