Study: ODD and CD More Prevalent Among Children with ADHD and Functional Impairments
Children with ADHD who experience significant social, emotional, and executive-function impairments also demonstrate significantly higher rates of oppositional defiant disorder and conduct disorder, according to a nationwide study of Turkish children.
May 28, 2021
Children with ADHD who experience significant social, emotional, and executive-function impairments also demonstrate significantly higher rates of oppositional defiant disorder (ODD) and conduct disorder (CD), according to a nationwide study of Turkish children published in the Journal of Attention Disorders.1 Impairment ratings by caregivers and educators considered the child’s relationship with his/her siblings, relationships with friends, ability to do homework, general adjustment at home, and self-esteem. In addition, the study’s nationwide representative samples demonstrated a prevalence of ADHD in Turkish children of 19.5% without impairment and 12.4% with impairment.
Researchers studied functional impairments in 5,842 students aged 8 to 10 years, who participated in a diagnostic interview, were screened with a DSM-IV-based scale for Disruptive Behavior Disorders, and had their impairments assessed by both parents and teachers.
When researchers considered the impairment criteria, the overall prevalence of ADHD was found to be 12.4%: 6.8% inattentive presentation, 0.7% hyperactive presentation, and 4.9% combined presentation. This overall prevalence of ADHD was much higher than the pooled prevalence rates of 5.29% and 7.1% reported in two extensive meta-regression-analysis studies.2,3 This is likely because the new study applied epidemiological methodology. All presentations of ADHD were significantly higher among boys, regardless of impairment criteria. In comparing psychiatric comorbidities between ADHD groups with and without impairment, researchers found a higher prevalence of ODD and CD in the former. ODD was found in 15.1% of children with ADHD and significant impairment from symptoms, but in only 8.7% of children with ADHD and no significant impairment. CD was found in 2.2% of children with ADHD and high impairment, yet in only .2% of children with ADHD and minimal impairment.
In addition to contributing to a more accurate understanding of nationwide ADHD prevalence, these findings suggest that children with ADHD who experience more severe impairment are at a greater risk for disruptive behavior disorders. This study was limited to children attending urban schools in Turkey, which represented 71.4% of the population.
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1 Ercan ES, Unsel-Bolat G, Tufan AE, et al. Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD. Journal of Attention Disorders. May 2021. doi:10.1177/10870547211017985
2 Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. The American Journal of Psychiatry, 164(6), 942–948. https://doi.org/10.1176/ajp.2007.164.6.942
3 Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8