OBJECTIVES: To study the association between oppositional defiant disorder (ODD) and parenting style in children with attention deficit hyperactivity disorder (ADHD). METHODS: A case-control study was performed on 482 children with ADHD, among whom 322 did not have ODD (simple ADHD group) and 160 had ODD (ADHD+ODD group). General demographic data and the Parenting Style Scale assessment scores were collected from the two groups. A multivariate logistic regression analysis was used to identify the association between parenting style and ODD in children with ADHD. RESULTS: There was no significant difference in parenting style scores (including rejection factor, emotional warmth factor, overprotection factor, and preference factor) and general demographic data between the simple ADHD and ADHD+ODD groups (P>0.05). Among the children with the predominantly inattentive type of ADHD, the older the child or the lower the father's educational level, the higher the risk of ODD (P<0.05), while there was no significant association between parenting style and the development of ODD (P>0.05). CONCLUSIONS Parenting style is not significantly associated with the development of ODD in children with ADHD. In clinical practice, it is necessary to eliminate the stereotype that the parents of children with ADHD and comorbid ODD have a poor parenting style and look for the causes of development of ODD from multiple perspectives, so as to provide reasonable intervention recommendations.
Attention Deficit Disorder with Hyperactivity ; Attention Deficit and Disruptive Behavior Disorders ; Case-Control Studies ; Child ; Comorbidity ; Humans ; Parenting ; Parents

BACKGROUND: This research compared the effectiveness of play therapy provided individually or in groups for oppositional defiant disorder (ODD) symptoms among children. METHODS: This was a randomized controlled trial that used a multi-stage random sampling method. Participants included 45 children aged 6 to 10 years old with ODD, all of whom had been referred to medical consultation centers in Ahvaz, Iran in 2012. Experimental groups consisted of 15 children receiving individual play therapy and 15 receiving group play therapy, while the control group consisted of 15 randomly selected children. Data were collected using the child behavior checklist parent report form and teacher report form, along with clinical interviews with the parents. Play therapy took place weekly for eight total sessions; individual sessions lasted 45 minutes each, while group sessions were each 60 minutes in duration. Participants were assessed in three stages, including pre-intervention, post-intervention, and at 2-month follow-up. PASW SPSS ver. 18.0 software (SPSS Inc., Chicago, IL, USA) and analysis of covariance analysis methods were used to analyze data. RESULTS: Results showed meaningful decreases in ODD symptoms in the experimental groups in comparison with the control group, based on parent reporting (P≤0.001 and F=129.40) and the teacher reports additionally showed meaningful decreases in ODD symptoms in the experimental groups compared to the control group, (P≤0.001 and F=93.14). Furthermore, the effects were maintained after 2 months. CONCLUSION: This research supports the efficacy of individual and group play therapy for the treatment of ODD in children, as well as the consistency of the effects at 2-month follow-up.
Attention Deficit and Disruptive Behavior Disorders ; Checklist ; Child Behavior ; Child ; Follow-Up Studies ; Humans ; Iran ; Methods ; Parents ; Play Therapy ; Psychotherapy

OBJECTIVE: To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/ hyperactivity disorder (ADHD) with comorbid disruptive, impulse-control, and conduct disorders (DICCD). METHODS: Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding. RESULTS: In Golden Stroop test, the interference scores (IGs) of errors and reaction time both differed significantly among the groups ( < 0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time (MRT) showed significant differences among the groups ( < 0.05); the MRT of positive- congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative- incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group. CONCLUSIONS The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.
Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; physiopathology ; Attention Deficit and Disruptive Behavior Disorders ; diagnosis ; physiopathology ; Case-Control Studies ; Child ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Emotions ; Humans ; Reaction Time ; Stroop Test

The neurocircuitries that constitute the cortico-striato-thalamo-cortical (CSTC) circuit provide a framework for bridging gaps between neuroscience and executive function in attention deficit hyperactivity disorder (ADHD), but it has been difficult to identify the mechanisms for regulating emotional problems from the understanding of ADHD comorbidity with disruptive behavior disorders (DBD). Research based on "cool" and "hot" executive functional theory and the dual pathway models, which are thought of as applied response inhibition and delay aversion, respectively, within the neuropsychological view of ADHD, has shed light on emotional responding before and after decontextualized stimuli, while CSTC circuit-related domains have been suggested to explain the different emotional symptoms of ADHD with or without comorbid DBD. This review discusses the role of abnormal connections in each CSTC circuit, especially in the emotion circuit, which may be responsible for targeted executive dysfunction at the neuroscience level. Thus, the two major domains - abstract thinking (cool) and emotional trait (hot) - trigger the mechanism of onset of ADHD.
Animals ; Attention Deficit Disorder with Hyperactivity ; complications ; pathology ; psychology ; Attention Deficit and Disruptive Behavior Disorders ; complications ; pathology ; psychology ; Brain ; physiopathology ; Cerebral Cortex ; physiopathology ; Corpus Striatum ; physiopathology ; Emotions ; Humans ; Inhibition (Psychology) ; Neuropsychological Tests ; Thalamus ; physiopathology

OBJECTIVE: Prior functional magnetic resonance imaging (fMRI) work has revealed that children/adolescents with disruptive behavior disorders (DBDs) show dysfunctional reward/non-reward processing of non-social reinforcements in the context of instrumental learning tasks. Neural responsiveness to social reinforcements during instrumental learning, despite the importance of this for socialization, has not yet been previously investigated. METHODS: Twenty-nine healthy children/adolescents and 19 children/adolescents with DBDs performed the fMRI social/non-social reinforcement learning task. Participants responded to random fractal image stimuli and received social and non-social rewards/non-rewards according to their accuracy. RESULTS: Children/adolescents with DBDs showed significantly reduced responses within the caudate and posterior cingulate cortex (PCC) to non-social (financial) rewards and social non-rewards (the distress of others). Connectivity analyses revealed that children/adolescents with DBDs have decreased positive functional connectivity between the ventral striatum (VST) and the ventromedial prefrontal cortex (vmPFC) seeds and the lateral frontal cortex in response to reward relative to non-reward, irrespective of its sociality. In addition, they showed decreased positive connectivity between the vmPFC seed and the amygdala in response to non-reward relative to reward. CONCLUSION: These data indicate compromised reinforcement processing of both non-social rewards and social non-rewards in children/adolescents with DBDs within core regions for instrumental learning and reinforcement-based decision-making (caudate and PCC). In addition, children/adolescents with DBDs show dysfunctional interactions between the VST, vmPFC, and lateral frontal cortex in response to rewarded instrumental actions potentially reflecting disruptions in attention to rewarded stimuli.
Amygdala ; Attention Deficit and Disruptive Behavior Disorders ; Conditioning, Operant ; Fractals ; Frontal Lobe ; Gyrus Cinguli ; Learning ; Magnetic Resonance Imaging* ; Prefrontal Cortex ; Problem Behavior* ; Reinforcement, Social* ; Reward ; Socialization ; Ventral Striatum

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is associated with a high rate of comorbid disorders. We aimed to investigate the medical and psychiatric comorbidities of Korean children and adolescents with ADHD. METHODS: Data were obtained from Korean National Health Insurance Review and Assessment Service-National Patient Sample (HI-RA-NPS) for 2011. We included 2,140 (mean age, 10.9±3.1 years; boys, 1,710) and 219,410 (non-ADHD; mean age, 12.4±3.7 years; boys, 113,704) children and adolescents with and without ADHD, respectively. We compared medical and psychiatric comorbidities between the groups, and performed weighted logistic regression analyses to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Most medical comorbidities were more likely in patients with ADHD and included nervous system disease (OR, 2.59; 95% CI, 2.52–2.66); endocrine, nutritional, and metabolic disease (OR, 2.09; 95% CI, 2.04–2.15); and congenital malformations, deformations, and chromosomal abnormalities (OR, 2.00; 95% CI, 1.90–2.11). Oppositional defiant disorder and conduct disorder were more prevalent in patients with ADHD (OR, 81.88; 95% CI, 79.00–84.86), followed by learning (OR, 75.61; 95% CI, 69.69–82.04), and depressive disorders (OR, 55.76; 95% CI, 54.44–57.11). CONCLUSION: Our results suggest that Korean children and adolescents with ADHD are more likely to suffer medical and psychiatric comorbidities than those without ADHD.
Adolescent* ; Attention Deficit and Disruptive Behavior Disorders ; Child* ; Chromosome Aberrations ; Comorbidity* ; Conduct Disorder ; Depressive Disorder ; Humans ; Learning ; Logistic Models ; Metabolic Diseases ; National Health Programs ; Nervous System Diseases ; Odds Ratio

OBJECTIVE: This study aims to explore the feature of emotional regulation and executive functions in oppositional defiant disorder (ODD) children. METHODS: The emotional regulation and executive functions of adolescents with ODD, as well as the relationship between the two factors were analyzed using tools including Adolescent Daily Emotional Regulation Questionnaire (ADERQ), Wisconsin Card Sorting Test (WCST) and Cambridge Neuropsychological Test Automated Battery (CANTAB), in comparison with attention deficit hyperactivity disorder (ADHD) children without behavioral problem and healthy children; the ADERQ assessed emotional regulation ability and others were used to assess executive function. RESULTS: Compared to normal children, the ODD group displayed significant differences in the scores of cognitive reappraisal, rumination, expressive suppression, and revealing of negative emotions, as well as in the score of cognitive reappraisal of positive emotions. WCST perseverative errors were well correlated with rumination of negative emotions (r=0.47). Logistic regression revealed that the minimum number of moves in the Stocking of Cambridge (SOC) test (one test in CANTAB) and negative emotion revealing, were strongly associated with ODD diagnosis. CONCLUSION: Children with ODD showed emotion dysregulation, with negative emotion dysregulation as the main feature. Emotion dysregulation and the lack of ability to plan lead to executive function deficits. The executive function deficits may guide us to understand the deep mechanism under ODD.
Adolescent ; Asian Continental Ancestry Group* ; Attention Deficit and Disruptive Behavior Disorders* ; Attention Deficit Disorder with Hyperactivity ; Child* ; Diagnosis ; Executive Function* ; Humans ; Logistic Models ; Neuropsychological Tests ; Social Control, Formal ; Wisconsin

Attention-deficit hyperactivity disorder (ADHD) occurs with a high prevalence of comorbid disorders, and these comorbid disorders can affect assessment, clinical symptoms, prognosis, and treatment strategies for children with ADHD. The goal of this study was to develop a clinical practice guideline for ADHD and its specific comorbid disorders. Due to limited numbers of previous clinical studies, current recommendations are based on literature review and expert consensus among Korean child and adolescent psychiatrists. We suggest the use of multidisciplinary evaluations, interview techniques, and assessment tools in order to differentiate major comorbid disorders from ADHD. Specific ADHD comorbid disorders (e.g., medical comorbidity, oppositional defiant disorder, conduct disorder, bipolar disorder, major depressive disorder, anxiety disorder, specific learning disorder, tic disorder, and substance use disorder) have suggested treatment protocols that include pharmacological and behavioral treatments. Children and adolescents with ADHD may have comorbid disorders. The use of current clinical practice guidelines will be helpful when treating ADHD children with comorbid disorders.
Adolescent ; Anxiety Disorders ; Attention Deficit and Disruptive Behavior Disorders ; Bipolar Disorder ; Child ; Clinical Protocols ; Comorbidity ; Conduct Disorder ; Consensus ; Depressive Disorder, Major ; Humans ; Prevalence ; Prognosis ; Psychiatry ; Specific Learning Disorder ; Tic Disorders

OBJECTIVES: Child abuse can affect mental and physical health of abused children. Accurate assessment of mental health of abused children is integral to providing proper treatment and preventing any further impact of childhood abuse on their future life. In this study, we investigated psychiatric illnesses among abused children. METHODS: Semi-structured interviews using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version were conducted for 61 abused children after obtaining consent from their guardians. We also assessed the relationship between the demographic data of these abused children and their diagnoses. RESULTS: Among the abused children, more than half had more than one psychiatric disorder. The most frequently diagnosed disorders were attention-deficit/hyperactivity disorder, posttraumatic stress disorder, depressive disorder, and oppositional defiant disorder. The incidence of posttraumatic stress disorder was higher in abused girls compared with abused boys. Abused children had a higher suicide risk than the general population. Among the parents of abused children, 50.8% had alcohol use disorders. CONCLUSION: Among the abused children, 50.8% had psychiatric disorders. Administration of intensive psychiatric treatment to abused children, and prevention of child abuse by education, treatment, and monitoring high-risk parents is imperative.
Attention Deficit and Disruptive Behavior Disorders ; Child Abuse ; Child* ; Depressive Disorder ; Diagnosis ; Education ; Female ; Humans ; Incidence ; Mental Disorders* ; Mental Health ; Mood Disorders ; Parents ; Stress Disorders, Post-Traumatic ; Suicide

OBJECTIVE: Oxidative metabolism is impaired in several medical conditions including psychiatric disorders, and this imbalance may be involved in the etiology of these diseases. The present study evaluated oxidative balance in pediatric and adolescent patients with attention deficit hyperactivity disorder (ADHD). METHODS: The study included 48 children and adolescents (34 male, 14 female) with ADHD who had no neurological, systemic, or comorbid psychiatric disorders, with the exception of oppositional defiant disorder (ODD), and 24 sex- and age-matched healthy controls (17 male and seven female). RESULTS: TAS was significantly lower, and TOS and OSI were significantly higher in patients with ADHD than in healthy controls. Total antioxidant levels were lower in patients with comorbid ODD than in those with no comorbidity. No difference was found in TOS or OSI among the ADHD subtypes; however, TAS was higher in the attention-deficient subtype. CONCLUSION: Our findings demonstrated that oxidative balance is impaired and oxidative stress is increased in children and adolescents with ADHD. This results are consistent with those of previous studies.
Adolescent* ; Attention Deficit and Disruptive Behavior Disorders ; Attention Deficit Disorder with Hyperactivity* ; Child* ; Comorbidity ; Humans ; Male ; Metabolism* ; Oxidative Stress