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

Gerald J. August, George M. Realmuto, Tamara Joyce, Joel M. Hektner

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Objective: To examine the developmental progression of comorbid oppositional defiant disorder (ODD) in a community sample of children with attention-deficit hyperactivity disorder (ADHD) with particular emphasis on persistence and desistance of ODD and the emergence of new cases of conduct disorder (CD). Method: A sample of disruptive children was identified from a multiple-gate epidemiological screen and stratified into diagnostic subgroups on the basis of a structured interview. A comparison sample of nondisruptive children was also identified. Group comparisons were performed on demographic, descriptive, family history, and clinical characteristics. Changes in rates of ODD symptoms and diagnostic subgroup membership were assessed after a 4-year longitudinal interval. Predictors of diagnostic group persistence were 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 parenting practices and mothers' psychiatric disorders predicted persistence of ODD. Conclusions: There was little evidence to show that ODD acted as a precursor to CD. However, when CD was diagnosed at baseline it was always associated with or preceded by ODD (i.e., prodrome). For a subgroup of children with ADHD, comorbid ODD symptoms are relatively unstable and may represent transient developmental perturbations that have little prognostic significance. For a larger subgroup of children with ADHD, ODD symptoms persist into the adolescent years and are associated with adverse parenting practices.

Original languageEnglish (US)
Pages (from-to)1262-1270
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number10
StatePublished - 1999

Bibliographical note

Funding Information:
AcceptedApril20, 1999. From the Division of Childand Adolescent Psychiatry, University ofMinnesotaMedicalSchool, Minneapolis. This research was supported by a grantfrom the NIMH (awarded to Dr. August). Reprint requests to Dr.August, Division of Child and AdolescentPrychiatry, Box 95 Mayo Building, University of Minnesota, Minneapolis, MN 55455.

Copyright 2017 Elsevier B.V., All rights reserved.


  • Attention-deficit hyperactivity disorder
  • Comorbidity
  • Conduct disorder
  • Desistance
  • Oppositional defiant disorder
  • Persistence


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