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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.

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.

Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers ( N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.

Attention deficit/hyperactivity disorder (ADHD) may affect all aspects of a child’s life. Indeed, it impacts not only on the child, but also on parents and siblings, causing disturbances to family and marital functioning. The adverse effects of ADHD upon children and their families changes from the preschool years to primary school and adolescence, with varying aspects of the disorder being more prominent at different stages. ADHD may persist into adulthood causing disruptions to both professional and personal life. In addition, ADHD has been associated with increased healthcare costs for patients and their family members.

Objectives: To quantitatively synthesise evidence from randomised controlled trials (RCTs) on the efficacy and safety of risperidone augmentation in children and adolescents with attention deficit hyperactivity disorder (ADHD) and comorbid disruptive behaviour disorders (DBDs). Methods: PubMed, EMBASE, and Scopus were searched for studies published from inception to 14 February 2025 using combinations of the following terms: ADHD, DBD, risperidone, aggression, and RCTs. Included studies were RCTs that evaluated the efficacy and/or safety of risperidone as an adjunct to optimise stimulant therapy in individuals aged 6 to 12 years diagnosed with ADHD and comorbid DBDs. The primary outcome was change in aggression from baseline to post-intervention, measured using standardised scales, between the risperidone and placebo groups. Secondary outcomes included the tolerability of risperidone in terms of weight gain and increased serum prolactin levels. Results: Three studies involving individuals aged 6 to 12 years with a dual diagnosis of ADHD and DBDs were included in the analysis. The overall sample size was 279, with 144 in the risperidone group and 135 in the placebo or active control (stimulant) group. Individuals receiving risperidone augmentation showed improvement in aggression (standardised mean difference [SMD] equivalent -0.79, p < 0.001), greater weight gain (2.1 vs 0.5 kg, SMD equivalent 0.22, p equivalent 0.06), and higher serum prolactin levels (28.5 vs 2.3 ng/mL, SMD equivalent 1.40, p < 0.001). Conclusion: Risperidone augmentation reduces aggression and oppositional symptoms in children and adolescents with ADHD and comorbid DBDs. Nonetheless, risperidone is associated with risks of weight gain, elevated serum prolactin, and metabolic syndrome.

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.

Background/Objectives: Oppositional defiant disorder (ODD) and conduct disorder (CD) are important behavior disorders in children and adolescents, often linked with long-term psychosocial problems. Antipsychotics are frequently prescribed to manage severe symptoms and improve behavior, but their efficacy in this population is still unclear and a lot of physicians are remittent in prescribing them. This systematic review aims to assess the effectiveness of antipsychotic treatment in reducing symptoms associated with ODD and CD in children and adolescents. Methods: Studies that investigated how effective antipsychotic treatments are for children and teens diagnosed with oppositional defiant disorder (ODD) and conduct disorder (CD) were reviewed. Only studies that met a few main criteria were included: participants were between 5 and 18 years old with an ODD or CD diagnosis; the treatment could be any type of antipsychotic, whether typical or atypical; the accepted study designs were randomized controlled trials (RCTs), cohort studies, systematic reviews with meta-analysis, or observational studies. The outcomes of interest were reductions in aggressive or defiant behaviors, improvements in social functioning, and the occurrence of any adverse effects from the medications. There was no restriction on the language of publication, and studies published from 2000 to 2024 were considered. Studies that focused only on non-antipsychotic drugs or behavioral therapies, as well as case reports, expert opinions, and non-peer-reviewed articles did not meet the inclusion criteria. Results: The review consisted of 13 studies. The results suggest that some antipsychotic drugs—especially atypical antipsychotics—can substantially reduce aggressive and defiant behavior in children and adolescents who have oppositional defiant disorder (ODD) or conduct disorder (CD). Common side effects of these medications include weight gain, sedation, and metabolic problems. Conclusions: Although adverse effects are a concern, the potential of these medications to manage disruptive behaviors should not be overlooked. When used in combination with behavioral therapy and other forms of treatment, antipsychotics can markedly improve the outcomes of these very difficult-to-treat patients. Clinicians who treat these patients need to consider antipsychotics as a serious option. If they do not, they are denying their patients medication that could greatly benefit them.