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The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study

  • J. Biederman (a1), C. R. Petty (a1), C. Dolan (a1), S. Hughes (a1), E. Mick (a1), M. C. Monuteaux (a1) and S. V. Faraone (a1)...

A better understanding of the long-term scope and impact of the co-morbidity with oppositional defiant disorder (ODD) and conduct disorder (CD) in attention deficit hyperactivity disorder (ADHD) youth has important clinical and public health implications.


Subjects were assessed blindly at baseline (mean age=10.7 years), 1-year (mean age=11.9 years), 4-year (mean age=14.7 years) and 10-year follow-up (mean age=21.7 years). The subjects' lifetime diagnostic status of ADHD, ODD and CD by the 4-year follow-up were used to define four groups (Controls, ADHD, ADHD plus ODD, and ADHD plus ODD and CD). Diagnostic outcomes at the 10-year follow-up were considered positive if full criteria were met any time after the 4-year assessment (interval diagnosis). Outcomes were examined using a Kaplan–Meier survival function (persistence of ODD), logistic regression (for binary outcomes) and negative binomial regression (for count outcomes) controlling for age.


ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder.


These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.

Corresponding author
*Address for correspondence: J. Biederman, M.D., Massachusetts General Hospital, Pediatric Psychopharmacology Unit, 55 Fruit Street, YAW 6A-6900, Boston, MA 02114, USA. (Email:
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JC Anderson , S Williams , R McGee , PA Silva (1987). DSM-III disorders in preadolescent children: prevalence in a large sample from the general population. Archives of General Psychiatry 44, 6976.

GJ August , GM Realmuto , T Joyce , JM Hektner (1999). Persistence and desistance of oppositional defiant disorder in a community sample of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry 38, 12621270.

GJ August , KC Winters , GM Realmuto , T Fahnhorst , A Botzet , S Lee (2006). Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants. Journal of the American Academy of Child and Adolescent Psychiatry 45, 824832.

J Berkson (1946). Limitations of the application of fourfold table analysis to hospital data. Biometrics Bulletin 2, 4753.

J Biederman , S Faraone , S Milberger , J Guite , E Mick , L Chen , D Mennin , A Marrs , C Ouellette , P Moore , T Spencer , D Norman , T Wilens , I Kraus , J Perrin (1996 a). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry 53, 437446.

J Biederman , SV Faraone , S Milberger , J Garcia Jetton , L Chen , E Mick , R Greene , RL Russell (1996 b). Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry 35, 11931204.

J Biederman , SV Faraone , W Weber , RL Russell , M Rater , K Park (1997). Correspondence between DSM-III-R and DSM-IV attention deficit hyperactivity disorder (ADHD). Journal of the American Academy of Child and Adolescent Psychiatry 36, 16821687.

J Biederman , E Mick , J Wozniak , M Monuteaux , M Galdo , SV Faraone (2003). Can a subtype of conduct disorder linked to bipolar disorder be identified? Integration of findings from the Massachusetts General Hospital Pediatric Psychopharmacology Research Program. Biological Psychiatry 53, 952960.

HR Bird , G Canino , M Rubio-Stipec , MS Gould , J Ribera , M Sesman , M Woodbury , S Huertas-Goldman , A Pagan , A Sanchez-Lacay , M Moscoso (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico: the use of combined measures. Archives of General Psychiatry 45, 11201126.

MA Brotman , M Schmajuk , BA Rich , DP Dickstein , AE Guyer , EJ Costello , HL Egger , A Angold , DS Pine , E Leibenluft (2006). Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biological Psychiatry 60, 991997.

JD Burke , R Loeber , BB Lahey (2001). Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry 42, 493502.

P Cohen , J Cohen , S Kasen , CN Velez , C Hartmark , J Johnson , M Rojas , J Brook , EL Streuning (1993). An epidemiological study of disorders in late childhood and adolescence. I. Age- and gender-specific prevalence. Journal of Child Psychology and Psychiatry 34, 851867.

RW Greene , J Biederman , S Zerwas , MC Monuteaux , JC Goring , SV Faraone (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. American Journal of Psychiatry 159, 12141224.

T Harpold , J Biederman , M Gignac , P Hammerness , C Surman , A Potter , E Mick (2007). Is oppositional defiant disorder a meaningful diagnosis in adults? Results from a large sample of adults with ADHD. Journal of Nervous and Mental Disease 195, 601605.

C Kadesjo , B Hagglof , B Kadesjo , C Gillberg (2003). Attention-deficit-hyperactivity disorder with and without oppositional defiant disorder in 3- to 7-year-old children. Developmental Medicine and Child Neurology 45, 693699.

BB Lahey , R Loeber , JD Burke , B Applegate (2005). Predicting future antisocial personality disorder in males from a clinical assessment in childhood. Journal of Consulting and Clinical Psychology 73, 389399.

R Loeber , JD Burke , BB Lahey , A Winters , M Zera (2000 a). Oppositional defiant and conduct disorder: a review of the past 10 years, part I. Journal of the American Academy of Child and Adolescent Psychiatry 39, 14681484.

R Loeber , S Green , K Keenan , B Lahey (1995). Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry 34, 499509.

R Loeber , SM Green , BB Lahey , PJ Frick , K McBurnett (2000 b). Findings on disruptive behavior disorders from the first decade of the Developmental Trends Study. Clinical Child and Family Psychology Review 3, 3760.

R Loeber , K Keenan (1994). The interaction between conduct disorder and its comorbid conditions: effects of age and gender. Clinical Psychology Review 14, 497523.

S Mannuzza , RG Klein , H Abikoff , JL Moulton 3rd (2004). Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study. Journal of Abnormal Child Psychology 32, 565573.

B Molina , W Pelham (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology 112, 497507.

R Rowe , B Maughan , A Pickles , EJ Costello , A Angold (2002). The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountains Study. Journal of Child Psychology and Psychiatry 43, 365373.

H Schubiner , A Tzelepis , S Milberger , N Lockhart , M Kruger , BJ Kelley , EP Schoener (2000). Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers. Journal of Clinical Psychiatry 61, 244251.

E Taylor , O Chadwick , E Heptinstall , M Danckaert (1996). Hyperactivity and conduct problems as risk factors for adolescent development. Journal of the American Academy of Child and Adolescent Psychiatry 35, 12131226.

H Wechsler , JE Lee , M Kuo , H Lee (2000). College binge drinking in the 1990s: a continuing problem. Results of the Harvard School of Public Health 1999 College Alcohol Study. Journal of American College Health 48, 199210.

NS Whittinger , K Langley , TA Fowler , HV Thomas , A Thapar (2007). Clinical precursors of adolescent conduct disorder in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 179187.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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