ADHD and Co-occurring Disorders

By Dr. Emily Kensington

Children with ADHD and co-occurring disorders such as Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), depression, anxiety, autism, Asperger's syndrome, and learning disorders including language and reading processing difficulties are at a higher risk for negative adult outcomes.

As the result of these multiple challenges, the long-term outcomes for children with ADHD and co-occurring disorders are likely to be worse than for a child who has ADHD alone.

Oppositional Defiant Disorder (ODD)

The symptoms for ODD typically include a child who is quick to anger/loses temper easily, often argues with adults, actively defies or refuses to comply with adult rules, deliberately annoys people, often blames others for mistakes or misbehavior, and irritability.

For ODD to be diagnosed, at least 4 of the symptoms listed above must be present for at least 6 months; the behavior must occur more frequently than is typical child of comparable age, and the behavior must create significant impairment in a child's social or academic functioning.

An important difference that you will note from the symptoms of ADHD is that none of the ADHD symptoms involve behavior that is considered to be deliberate and willful whereas ODD features more deliberate behavioral elements.

Conduct Disorder (CD)

Conduct Disorder (CD) is a more severe type of behavioral disorder than ODD that is also more likely to develop in children who also suffer from ADHD.

The essential feature of CD is a repetitive and persistent pattern of behavior in which the basic rights of others or age appropriate social norms or rules are violated.

These behaviors fall into 4 main groupings: aggressive behavior that causes or threatens to cause harm including initiating fights, cruelty to people or animals, non-aggressive conduct that causes property loss or damage including fire setting with intent to cause damage or deliberate destruction of property, deceitfulness or theft including shoplifting, breaking and entering, frequent lying to obtain goods or avoid obligations, and egregious violation of rules including school truancy, running away from home, and staying out at night prior to age thirteen.

For the diagnosis of CD to be correctly assigned, at least 3 of the specific symptoms must have occurred during the prior 12 months, with at least one criterion present in the last 6 months. In addition, the disturbance in behavior must clearly result in clinically significantly impairment in the child or teen's social, academic, or occupational functioning.

Note that the symptoms of CD do not really share any overlap with diagnostic criteria for ADHD.

Outcome Statistics for ADHD and Co-Occurring Disorders

Data collected in numerous studies indicate that about 50% of children with ADHD will also develop ODD or CD at some point during their development and the ensuing difficulties this creates in various relationships(parent-child, teacher-child, and peer relationships) and home life increases the risk for the kind of conflictual interactions that promote the development other disruptive behavior disorders.

For example, one study that followed two samples of ADHD children - one with high levels of aggressive behavior and the other without - there were no cases of drug or alcohol abuse at age 14 in the ADHD only group, while for the ADHD aggressive group, over 30% had engaged in substance abuse. In a similar study using different samples of children, approximately 1/3 of ADHD/CD boys had committed multiple crimes as teenagers compared to fewer than 4% of boys who had been diagnosed with ADHD alone.

Researcher are just beginning to examine the longitudinal studies that show, over time, the increased likelihood of incarceration and substance abuse in children and teens who sufer from ADHD and ODD or CD.


Given the above information, it is vital that parents learn about the types of specialized behavioral management techniques that can benefit children who suffer from ADHD and co-occurring disorders.

Probably the most important thing a parent can do to help promote their child's long-term success is to make sure that the proper steps are taken to prevent the development of these more severe behavior disorders that often develop in response to the problems that primary ADHD symptoms can cause.

For more information on how to treat your child's ADHD click here. For more information on how to treat your child's Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) click here.


The long term outcomes of children with ADHD and co-occurring disorders are often negative, but if treated early can be averted.

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