Episode 16: ADHD, ODD, and CD
ADHD tends to be one of the most common disorders we see in therapy with kids, likely in part due to the obvious and disruptive nature of the symptoms. But there are some other conditions that also have some overlap with ADHD, which families are not always aware of.
What was once Attention Deficit Disorder (ADD) is now always under the umbrella of Attention-Deficit/Hyperactivity Disorder. But there are different presentations.
Inattention symptoms (e.g., frequent daydreaming) can happen with hyperactivity. These symptoms can go largely unnoticed, and maybe never diagnosed. They are normal to an extent (as is true with pretty much any symptom of a mental health disorder). Sometimes kids who were hyperactive when younger transition into being more inattentive when older.
These are some of the more stereotypical ADHD symptoms. Hyperactivity makes it difficult to sit still for a long time, and can result in a lot of restless and fidgeting-type behaviors. Because they are more disruptive, these symptoms more often lead to a diagnosis, which may explain why they've become the stereotype.
Finally, a child can have both types of symptoms. We most often see children with a combined presentation in therapy because having both sets makes the disorder much more disruptive to day-to-day life.
Oppositional defiant disorder is characterized by various defiant behaviors. This can include irritability, defiance, aggression, frequently arguing, and so on. As you can imagine, impulsiveness from ADHD can sometimes lead to similar symptoms, hence there being some overlap between the two. There may also be a genetic link between ADHD and ODD, though by no means will all kids with ADHD develop ODD.
Even if a child does not meet criteria for ODD, they do sometimes meet criteria for a Disruptive Behavior Disorder. This is a more general diagnosis, and when it occurs with ADHD it may not be diagnosed separately. Hyperactive behaviors in general tend to be disruptive, but a child can have DBD without having ADHD.
Conduct Disorder involves more extreme behaviors, including property damage, physical aggression and harming others, and rule-breaking behaviors. It's sometimes thought of as similar to ODD, but more extreme. And while ODD does increase the risk of someone developing CD, it's again by no means all children with ODD who go on to develop this more severe classification.
Finally, in some extreme cases adolescents may go on to meet criteria for Antisocial Personality Disorder. This is rare, so please keep in mind that each of these diagnoses represents a subset of the "previous" diagnosis. While ADHD is relatively common, ASPD is rare. There just appears to be an underlying similarity between these disorders, with the more extreme cases ending up on a trajectory that results in ASPD.
- There is some evidence that ADHD may sometimes develop into ODD symptoms, which can then sometimes lead to CD. While this by no means happens in all cases, symptom overlap suggests they may be related.
- Those with more severe symptoms (e.g., ADHD Combined Presentation) are more likely to meet criteria for other challenges down the road (e.g., ODD). With each progression, it seems a subset develop the "next stage" of symptoms (i.e., a subset of those with ADHD develop ODD, a subset of those with ODD develop CD, and a subset of those with CD develop ASPD).
- That all being said, symptoms do not always follow this trajectory. ODD does not require a previous diagnosis of ADHD, for example.
- Treatment for ADHD and ODD is relatively similar in children. CD, in part due to it generally occurring more towards adolescence, requires a slightly different approach.
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