Psychological Medicine

Original Articles

Predictability of oppositional defiant disorder and symptom dimensions in children and adolescents with ADHD combined type

M. Aebia1 c1, U. C. Müllera1, P. Ashersona2, T. Banaschewskia3, J. Buitelaara4, R. Ebsteina5, J. Eisenberga5, M. Gilla6, I. Manora7, A. Mirandaa8, R. D. Oadesa9, H. Roeyersa10, A. Rothenbergera11, J. Sergeanta12, E. Sonuga-Barkea10a13, M. Thompsona13, E. Taylora2, S. V. Faraonea14 and H.-C. Steinhausena1a15a16

a1 Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland

a2 MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK

a3 Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, Mannheim, Germany

a4 Department of Psychiatry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

a5 Department of Psychology, Hebrew University, Jerusalem, Israel

a6 Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland

a7 Geha MHC, Petach-Tikva, Israel

a8 Department of Developmental and Educational Psychology, University of Valencia, Valencia, Spain

a9 Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany

a10 Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium

a11 Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany

a12 Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands

a13 School of Psychology, University of Southampton, Southampton, UK

a14 Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

a15 Aalborg Psychiatric Clinic, Aarhus University Hospital, Denmark

a16 Child and Adolescent Clinical Psychology, University of Basel, Switzerland


Background Oppositional defiant disorder (ODD) is frequently co-occurring with attention deficit hyperactivity disorder (ADHD) in children and adolescents. Because ODD is a precursor of later conduct disorder (CD) and affective disorders, early diagnostic identification is warranted. Furthermore, the predictability of three recently confirmed ODD dimensions (ODD-irritable, ODD-headstrong and ODD-hurtful) may assist clinical decision making.

Method Receiver-operating characteristic (ROC) analysis was used in order to test the diagnostic accuracy of the Conners' Parent Rating Scale revised (CPRS-R) and the parent version of the Strength and Difficulties Questionnaire (PSDQ) in the prediction of ODD in a transnational sample of 1093 subjects aged 5–17 years from the International Multicentre ADHD Genetics study. In a second step, the prediction of three ODD dimensions by the same parent rating scales was assessed by backward linear regression analyses.

Results ROC analyses showed adequate diagnostic accuracy of the CPRS-R and the PSDQ in predicting ODD in this ADHD sample. Furthermore, the three-dimensional structure of ODD was confirmed by confirmatory factor analysis and the CPRS-R emotional lability scale significantly predicted the ODD irritable dimension.

Conclusions The PSDQ and the CPRS-R are both suitable screening instruments in the identification of ODD. The emotional lability scale of the CPRS-R is an adequate predictor of irritability in youth referred for ADHD.

(Received February 16 2009)

(Revised August 12 2009)

(Accepted November 10 2009)

(Online publication April 12 2010)


c1 Address for correspondence: Dr M. Aebi, University of Zurich, Department of Child and Adolescent Psychiatry, Neptunstrasse 60, 8032 Zurich, Switzerland. (Email: