Disruptive, Impulsive, Difficulty with self-control, self regulation, and other behavioral inhibition

ADHD

ODD

Key features of ODD highlighted by ICD-10 guidelines include a persistent pattern of provocative, hostile and non-compliant behavior, characterized by low temper threshold.

Many parents note their children are/were hyperactive, willful, obstinate, disobedient from an early age. Always on the move, never finishing what they started. Often have no sense of danger and require close supervision

"Because of frequent corrective feedback, children with ADHD frequently develop a poor sense of self-esteem and “defective self-concept.”

3 types: Inattentive, hyperactive impulsive, and combined.
The sub-types have different courses, prognoses, and comorbidities (see notes for details)

Depression and bipolar are highly comorbid, especially among females

Differentiating Bipolar Disorder from ADHD:

  1. ADHD is far more common than Bipolar disorder

  1. Venue is important: Bipolar is more likely to be presenting in inpatient setting rather than an outpatient/pediatric clinic

  1. Explore for episodes of mania/hypomania. If not present, search for episodes of irritability greater than baseline: ODD, conduct d/o, anxiety d/o and MDD produce irritability and are also more common than bipolar d/o.

  1. Consider DSM criterion B for mania (grandiosity, flight of ideas or racing thoughts, decreased need for sleep, and hypersexuality. These are not resultant of ADHD

"The examiner should be aware that the oppositional behavior may be related to a dysphoric state, an affective disorder, or another neuropsychiatric condition.”
Cepeda

See Cepeda pages 242-243 for specific interviewing techniques with hyperactive children

it is estimated that the costs arising for individuals with antisocial behaviours in childhood are at least 10 times higher than in non-antisocial individuals by the time they reach 28 years"

DSM-IV ODD symptoms

Is often angry and resentful

Often argues with adults

Is often touchy or easily annoyed by others

Often loses temper

Often deliberately annoys or irritates others

Often blames others for his or her mistakes or misbehavior

Often actively defies or refuses to comply with adult requests or rules

Is often spiteful and vindictive

ODD is generally thought of as a milder form and sometimes a precursor to Conduct Disorder; however, majority of those with ODD do not go on to develop Conduct Disorder

ODD has consistently been found to predict later depression & anxiety

Some research has shown: childhood ODD predicted young adult depression; YA depression & anxiety d/o’s often are preceded by adolescent ODD, but not Conduct Disorder

Strong genetic component involved in variability, and likely related to association of ODD + ADHD & ODD + depressive d/o