Disruptive behavior disorders are highly correlated with ADHD. According to a study by Wilens et al. (2002), from 30 to 50 percent of children with ADHD in a community sample and 50 percent in a clinically referred sample are likely to have some other type of disruptive behavior disorder. The most common disorder related to ADHD is oppositional defiant disorder (ODD). Children with ADHD are more likely to develop conduct disorder (CD) than those who do not have ADHD. Presence of ODD/CD in ADHD is associated with more aggression and delinquency, greater academic underachievement, greater risk of substance abuse, increased social maladjustment, and lower self-esteem. The severity of conduct problems in children with ADHD predicts antisocial personality in adulthood.
Children with ADHD are often considered to have behavioral problems as a result of ADHD and are not likely to be diagnosed as having the comorbid conditions of ODD/CD. Because the correlation is high, the possibility should be considered. The presence of the following symptoms indicate possible behavioral disorders:
- Consistent negativity
- Disobedience in numerous situations
- Hostile behavior toward authority
- Repetitive and persistent behavior that varies from age-related social norm and threatens the rights of others.
Diagnosing behavior disorders may be difficult because extreme, irritable aggression may be a sign of mood disorder; those children with ADHD with severe aggression should be also evaluated for bipolar disorder.
The presence of ODD/CD complicates the presentation of ADHD and is associated with overall impairment, a greater risk for substance abuse, and worse overall long-term prognosis. Considering the negative predictions, early identification and treatment of conduct problems in ADHD is imperative.
According to Kunwar et al. (2007), medications used for ADHD such as stimulants and atomoxetine are effective and used as the first line for treatment of ADHD and comorbid ODD/CD. If the symptoms of ADHD appear to respond but ODD/CD symptoms persist, psychosocial treatment should be added. If symptoms are extreme, multimodal treatment is often needed from the beginning. In clinical practice, atypical antipsychotics are needed in selected cases.
According to a study by Dr. Nigel Mellor (2008), teachers and parents need to be aware of confusing children who are attention seeking with those who suffer from ADHD. Mellor, an educational psychologist, presented research at a January 2008 meeting of the British Psychological Society's Division of Child and Educational Psychology Annual Conference. He emphasized that researchers have largely neglected children who are seeking attention; the two problems can appear very similar. His research focused on fifteen schools over a period of time. Mellor determined that it is possible to distinguish between the two. Children who were acting up were doing so to gain attention of nearby adults and were able to relate well to older or younger people, not just their peers. They also have good language skills. He believes that attention seekers can be corrected with as little as two to five sessions.
1) Kunwar, A. et al. 2007. Treating common psychiatric disorders associated with attention-deficit/hyperactive disorder. Expert Opinion Pharmacotherapy 8:555-62
2) Mellor, Nigel; Wilens, T. E. et al. 2002. Psychiatric comorbidity and functioning in clinically referred preschool children and schoolage youths with ADHD. Journal of American Academy of Child Adolescent Psychiatry 41:262-68.
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