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•The mother-child dyads of ODD children exhibit lower neural synchrony across of parent-child interactions (positive, negative, and neutral).•The neural synchrony between mother and child was negatively associated ODD symptoms in children.•Various neural synchronies (positive, negative, and neutral) between mother and child all play a role in the network of ODD symptoms in children. Interpersonal neural synchrony (INS) between mothers and children responds to the temporal similarity of brain signals in joint behavior between dyadic partners and is considered an important neural indicator of the formation of adaptive social interaction bonds. Parent-child interactions are particularly important for the development and maintenance of oppositional defiant disorder (ODD) in children, but the underlying neurocognitive mechanisms are unknown. Therefore, in the current study we measured INS between mothers and children in interactions by using simultaneous functional Near-infrared Spectroscopy (fNIRS), and explored its association with ODD symptoms in children. Seventy-two mother-child dyads were recruited to participate in the study, including 35 children with ODD and 37 healthy children to be used as a control. Each mother-child dyad was measured for neural activity in frontal, parietal, and temporal lobe regions while completing free-play as well as positive, and negative topic discussion tasks. We used Phase-locked value to calculate the synchrony strength and then used the K-means algorithm and k-space based alignment tests to confirm the specific patterns of parent-child synchrony in different brain areas. The results showed that, in free-play (right MFG and bilateral SFG), positive (left TPJ and bilateral SFGdor), and negative (bilateral SFGmed, right ANG, and left MFG) topic discussions, the mother-child pairs showed different patterns of INS. These specific INS patterns were significantly lower in the ODD group compared to the control group and were negatively associated with ODD symptoms in children. Network analyses showed that these INS patterns were connected to different nodes in the ODD symptom network. Our findings suggest that ODD mother-child dyads exhibit lower neural synchrony across a wide range of parent-child interactions. Neural synchrony in the context of interpersonal interactions provides new insights into understanding the neural mechanisms of ODD and can be used as an indicator of neural and socio-environmental factors in the network of psychological disorder symptoms.

Background Attention Deficit Hyperactivity Disorder (ADHD) often coexists with Oppositional Defiant Disorder (ODD), exacerbating impairment. The distinct neurological and biological patterns that differentiate this comorbidity from ADHD alone remain unclear. Method We conducted systematic review of multi model correlates differentiating ODD+ADHD from ADHD alone following PRISMA 2020 with databases like MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Sciences until August 2025. 144 full texts were reviewed and 26 studies were selected for final inclusion after 1457 records with 37 other sources. Designs included cross-sectional case-control studies, longitudinal studies, and imaging based on the ABCD framework, while measures covered structural and functional MRI, diffusion MRI, resting and task fNIRS, EEG and ERP, HPA-axis and immune-metabolic biomarkers, and executive and cognitive indices. The evaluation of bias employed RoB 2, ROBINS-I, and JBI, while synthesis utilised Braun-Clarke thematic analysis. Results Oppositionality involved limbic–striatal and cerebello-cortical differences, with ODD+ADHD showing greater executive and emotion-processing deficits than ADHD alone. ODD was linked to lower cortisol and reduced sympathetic reactivity, while ADHD showed higher cortisol and tryptophan–kynurenine shifts, with cytokines decreasing after methylphenidate. Conclusion ODD along with ADHD showed a distinct neurobiological and physiological pattern from ADHD alone. Such pattern is marked by greater executive and emotional regulation deficits with unique stress-response patterns, highlighting the need for tailored assessments and intervention approaches.

Background Oppositional Defiant Disorder (ODD) is a multifaceted behavioral condition with a growing theoretical and empirical foundation regarding its etiology, risk factors, comorbidities, and developmental trajectories. This complexity necessitates integrated management strategies that simultaneously address co-occurring domains, such as child pragmatic language deficits and maternal psychological inflexibility, beyond the scope of conventional interventions like standard Parent Management Training (PMT). This study aims to determine the outcome of an intervention program that targeted pragmatic skills in children with ODD and their mothers’ psychological flexibility. Methods A sample of 100 children with ODD was recruited from the Child Psychiatry Clinic and assessed for co-occurring pragmatic language disorders using the Egyptian Arabic Pragmatics Language Test (EAPLT). Of these, 60 children exhibiting pragmatic deficits were randomly assigned to either Group I, which received the intervention program, or group II, which did not (30 per Group). Both groups were assessed twice, before and after the application of the intervention program, using EAPLT for children, the Maternal Psychological Flexibility Scale (MPFS) for mothers, and the ODD Scale (parents’ form). A third assessment was conducted as a follow-up after one and a half months to examine the longevity of the outcome. Results The participants in Group I, children and their mothers, showed significantly higher total pragmatic scores and maternal psychological flexibility scores than those in Group II. This improvement led to a decrease in the severity of ODD, as indicated by the ODD scale score among participants in Group I. The positive outcome of the intervention program remained evident for up to one and a half months following the completion of the rehabilitation program. Conclusions Implementing this intervention program for children who experience comorbidity between language disorders and emotional/behavioral disorders is recommended.

Although pharmacotherapy with atypical antipsychotics is common in child psychiatry, there has been little research on this issue. To compare the efficacy and safety of risperidone and aripiprazole in the treatment of preschool children with disruptive behavior disorders comorbid with attention deficit-hyperactivity disorder (ADHD). Randomized clinical trial conducted in a university-affiliated child psychiatry clinic in southwest Iran. Forty 3-6-year-old children, diagnosed with oppositional defiant disorder comorbid with ADHD, were randomized to an 8-week trial of treatment with risperidone or aripiprazole (20 patients in each group). Assessment was performed by Conners′ rating scale-revised and clinical global impressions scale, before treatment, and at weeks 2, 4, and 8 of treatment. The data were analyzed by SPSS version 16. Mean scores between the two groups were compared by analysis of variance and independent and paired t-test. Mean scores of Conners rating scales were not different between two groups in any steps of evaluation. Both groups had significantly reduced scores in week 2 of treatment (P = 0.00), with no significant change in subsequent measurements. Rates of improvement, mean increase in weight (P = 0.894), and mean change in fasting blood sugar (P = 0.671) were not significantly different between two groups. Mean serum prolactin showed a significant increase in risperidone group (P = 0.00). Both risperidone and aripiprazole were equally effective in reducing symptoms of ADHD and oppositional defiant disorder, and relatively safe, but high rates of side effects suggest the cautious use of these drugs in children.

Oppositional Defiant Disorder (ODD) is characterized by a recurrent pattern of angry/irritable emotional lability, argumentative/defiant behavior, and vindictiveness. Previous studies indicated that ODD typically might originate within a maladaptive family environment, or was at least maintained within such an environment. As such, the present review summarized pertinent research from the last 20 years that focused on the pathways connecting family risk factors to the development of child ODD symptoms. A systematic search of electronic databases was completed in August 2020, resulting in the inclusion of 62 studies in the review. The review established a multi-level framework to describe the mechanisms underlying the pathway from familial factors to ODD psychopathological symptoms: (a) the system level that is affected by the family’s socioeconomic status and family dysfunction; (b) the dyadic level that is affected by conflict within the marital dyad and parent–child interactions; and (c) the individual level that is affected by parent and child factors. Additionally, from the perspective of family systems theory, we pay special attention to the interactions among and between the various levels of the pathway (moderation and mediation) that might be associated with the occurrence and severity of ODD symptoms. Considering future prevention and intervention efforts, this three-level model emphasizes the necessity of focusing on familial risk factors at multiple levels and the mechanisms underlying the proposed pathways.

The co-occurrence Oppositional Defiant Disorder (ODD) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has been associated to difficulties in regulating adverse states, elevated functional impairment, deficits in Executive Functions and high risk for psychopathology. Recent studies have shown that ODD is a negative predictor of a positive response to methylphenidate (MPH) treatment for ADHD symptoms in children and adolescents and that patients with a diagnosis of comorbid ADHD and ODD are less likely to respond favorably to pharmacological treatment with MPH. We conducted a naturalistic study to understand the clinical characteristics of drug-naïve children and adolescents with ADHD that influence the response to MPH by measuring the effect on attention. Specifically, we investigated whether a single dose of MPH differently affects the performance of 53 children and adolescents with ADHD with or without ODD comorbidity. In addition, participant characteristics such as symptom severity, functional impairment, and associated behavioral and emotional symptoms at baseline were examined to better understand what aspects affect the response to MPH. We found that a single dose of MPH improved the attention of children and adolescents with ADHD without ODD more than those with comorbid ADHD and ODD, resulting in reduced reaction times. Our findings indicated that children and adolescents with comorbid ADHD and ODD and those with ADHD alone did not exhibit differences in measures of attention prior to taking MPH, nor in demographic variables (age, intelligence quotient, gender), clinical characteristics related to symptom severity, and adaptive behaviors. However, we observed differences between the two groups in certain behavioral aspects, including the Dysregulation Profile and disruptive behaviors. Assessing symptoms in combination with the presence of ADHD can be beneficial in determining which individuals would derive the greatest benefits from treatment.

Background Attention-deficit hyperactivity/impulsivity disorder (ADHD) commonly co-occurs with sensory processing (SP), autistic traits (ATs), and oppositional defiant disorder (ODD). Our aim is to explore the relationships among SP, ADHD symptoms, ATs, and ODD symptoms in a large sample of children with ADHD and elucidate the potential role of sensory dysfunction in ADHD comorbidity patterns using symptomatic network analyses. Methods A total of 2676 children with ADHD aged 6 to 11 years were recruited from Peking University Sixth Hospital. For all subjects, the ADHD symptom severity was rated using the ADHD Rating Scale, ODD symptom severity using the related items in the Children’s Clinical Diagnostic Interview Scale, SP symptom severity using the Child Sensory Integration Scale, and ATs using related items in the CBCL. R 4.2.1 packages including mgm , qgraph , and bnlearn were used for network analysis. Results In the Graphical Gaussian Model (GGM), the SP items were connected with ATs and ADHD core symptoms and positioned relatively high in the directed acyclic graph (DAG). ATs_S , located higher in the DAG, played an important role in communication in the network as a node for SP and ODD to exert their influence on ADHD, and ADHD items were downstream nodes seemingly dependent on SP nodes and ATs_S in the network. Conclusions SP may be fundamental to the complex manifestations in children with ADHD, especially given its close relationship with ATs profiles. ATs_S might play an essential role in communication in this symptomatic network. These findings may help clarify possible relationships of different symptoms in ADHD and provide potential targeted interventions to improve core symptoms of ADHD as well as ATs and ODD symptoms. Clinical trial number Not applicable.

This study analyzes whether the association between parental internalizing symptoms (depression, anxiety, stress) and child symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) is mediated by positive and negative parenting behaviors. Cross-sectional data of 420 parents of children (age 6–12 years) with elevated levels of externalizing symptoms were collected in a randomized controlled trial. Measures included parent ratings of their internalizing symptoms and parenting behaviors and of their child’s externalizing symptoms. Two mediation models were examined, one including ADHD symptoms and one including ODD symptoms as the dependent variable. Parental internalizing symptoms were modeled as the independent variable and positive and negative parenting behaviors were modeled as parallel mediators. Regression analyses support negative parenting behavior as a mediator of the association between parental internalizing symptoms and child ODD symptoms. For the ADHD model, no significant mediator could be found. Future studies should use prospective designs and consider reciprocal associations.

Conduct problems and anxiety symptoms commonly co-occur among youths with oppositional defiant disorder (ODD); however, how these symptoms influence functioning and treatment outcomes remains unclear. This study examined subtypes based on these co-occurring symptoms in a clinical sample of 134 youths (Mage = 9.67, 36.6% female, 83.6% white) with ODD and the predictive power of these subgroups for youth functioning and psychosocial treatment outcomes. The latent profile analysis (LPA) was used to identify subgroups based on parent- and self-reported conduct problems and anxiety symptoms. Differences among the subgroups in clinician-, parent-, and/or self-reported accounts of symptom severity, school performance, underlying processing known to be impaired across ODD, conduct and anxiety disorders, self-concept, and psychosocial treatment outcomes were examined. Four distinct profiles were identified: (1) Low Anxiety/Moderate Conduct Problems (n = 42); (2) High Anxiety/Moderate Conduct Problems (n = 33); (3) Moderate Anxiety/Moderate Conduct Problems (n = 40); and (4) Moderate Anxiety/High Conduct Problems (n = 19). The Moderate Anxiety/High Conduct Problems group exhibited more severe behavioral problems, greater difficulties with negative emotionality, emotional self-control, and executive functioning; they also demonstrated worse long-term treatment outcomes than the other subgroups. These findings suggest more homogeneous subgroups within and across diagnostic categories may result in a deeper understanding of ODD and could inform nosological systems and intervention efforts.