Oppositional Defiant Disorder as a Clinical Phenotype in Children with Autism Spectrum Disorder
Abstract
Study Purpose: Examine the validity of oppositional defiant disorder (ODD) as distinct from attention-deficit hyperactivity disorder (ADHD) in children with autism spectrum disorder (ASD).
Methods: Data from a DSM-IV-referenced rating scale and background questionnaire for 608 children with ASD, divided into four groups: ODD, ADHD, ODD + ADHD, and NONE.
Findings: ASD children with ODD/ADHD differentiated from NONE group. ODD + ADHD had the most severe symptoms, medication use, and environmental disadvantages. ASD + ODD and ASD + ADHD groups showed few differences.
Conclusion: Supports overlapping mechanisms in ODD pathogenesis.
Introduction
Prevalence: High prevalence of ODD symptoms in children with ASD, similar to non-ASD children in psychiatric settings.
Co-occurrence: ODD often co-occurs with ADHD.
Distinction: ODD and ADHD are generally considered distinct disorders.
Objective: Investigate if ODD in ASD is a distinct syndrome or an epiphenomenon.
Method
Participants
Sample: Children referred to clinics and schools in Long Island, NY.
Age Groups: 3-5 and 6-12 years.
Diagnostics: Based on developmental history and clinician evaluations. High interrater reliability.
Procedure
Clinic Samples: Behavioral ratings and background info collected before evaluations.
Community Controls: Ratings obtained for normative data study.
Measures
ECI-4/CSI-4 Scores: Used to determine symptom severity and diagnose.
Parent Questionnaire: Includes demographic and medical history.
Subgrouping
Children classified into ODD Only, ADHD Only, ODD + ADHD, or NONE based on ECI-4/CSI-4 scores.
Statistical Analyses
Comparison Methods: ANOVAs and chi-square tests.
Outcome: ODD + ADHD group displayed unique severity of co-occurring symptoms.
Results
Parent-defined Groups
Main Effects: Significant main effects for symptom categories, especially for ODD + ADHD group.
Teacher-defined Groups
Findings: Similar to parent-defined groups, with differences in perseverative behaviors.
Interactions with Age
Findings: No significant interactions with age.
External Validators
Differences found in SES, medication use, and single-parent homes.
Discussion
Validity: First study to examine ODD in ASD. Supports DSM-IV-defined ODD as a behavioral syndrome in ASD children.
Comparison: Findings comparable to non-ASD children and adults with ODD/ADHD.
Clinical Implications: Systematic assessment of comorbid disturbances in ASD is crucial for treatment.
Limitations
Participant Demographics: Generalizations may not apply to all populations.
Assessment Methods: Symptom severity, not clinical diagnoses, were evaluated.
Future Directions
Research Needs: Explore genetic, environmental, and psychosocial factors influencing ODD in ASD.
Developmental Impact: Study how ODD symptoms evolve with ASD over time.
Conclusion
Study Contribution: Enhances understanding of ODD as a potential phenotype in ASD.
Research Implications: Inform treatment and possibly prevention of comorbid conditions in ASD.