Aebi, M., Müller, U.C., Asherson, P., Banaschewski, T. Buitelaar, J. K., Ebstein, R.P., Eisenberg, J., Gill, M., Manor, I., Miranda, A. Oades, R. D., Roeyers, H., Rothenberger, A., Sergeant, J. A., Sonuga-Barke, E. J. S., Thompson, M., Taylor, E.A., Faraone, S. V., Steinhausen, H-C.
Predictability and construct validity of oppositional defiant disorder in children and adolescents with ADHD combined types. (2010) Psychological Medicine, 40, 2089-2100. doi:10.1017/S0033291710000590. [Request a copy] - view open access

Introduction: Oppositional Defiant Disorders (ODD) frequently occur in combination with ADHD. -- 3 recently identified dimensions of ODD (ODD-irritable, ODD-headstrong and ODD-hurtful) indicate different pathways of future emotional & behavioral problems. Our aim here was to test (1.) the diagnostic accuracy of 2 common parent rating scales in predicting ODD, (2.) the construct validity of these 3 dimensions of ODD & (3.) the prediction of these ODD-dimensions by 2 parent rating scales in a large referred sample of children and adolescents with ADHD combined type.

Methods: Receiver-operating characteristic analysis (ROC) was used in order to test the diagnostic accuracy of the Conners' parent rating scale revised (CPRS-R) and the parent version of the strength & difficulties questionnaire (SDQ) in the prediction of ODD in a trans-national sample of 1093 Ss (5-17 y) from the IMAGE Study.

In addition, we performed a confirmatory factor analysis of interview based ODD criteria aimed at the identification of 3 a priori defined dimensions, i.e., ODD-irritable, ODD-headstrong & ODD-hurtful. Finally, the prediction of these ODD-dimensions by the parent rating scales was assessed by backward linear regression analysess. [Dimension examples: Irritable = loses temper, often touchy/easily annoyed, angry-resentful; Headstrong = argues with adulty, blames others for own mistakes, defies rules; Hurtful = often deliberately annoys, often spiteful or vindictive]

Results:
1 - ROC analyses showed adequate diagnostic accuracy of the CPRS-R & the PSDQ in predicting ODD in this ADHD sample.

2 - The 3 factor structure of ODD was partly confirmed and the CPRS-R emotional lability scale significantly predicted the ODD irritable dimension.

3 - The PSDQ & the CPRS-R are suitable screening instrument in the identification of ODD.

4 - The emotional lability scale of the CPRS-R is a predictor of irritability & severe mood dysregulation in youth referred for ADHD.