August G J, Realmuto G M, Joyce T, Hektner J M
Division of Child and Adolescent Psychiatry, University of Minnesota, Minneapolis 55455, USA.
J Am Acad Child Adolesc Psychiatry. 1999 Oct;38(10):1262-70. doi: 10.1097/00004583-199910000-00015.
To examine the developmental progression of comorbid oppositional defiant disorder (ODD) in a community sample of children with attention-deficit hyperactivity disorder (ADHD) with particular emphasis on persistence and desistance of ODD and the emergence of new cases of conduct disorder (CD).
A sample of disruptive children was identified from a multiple-gate epidemiological screen and stratified into diagnostic subgroups on the basis of a structured interview. A comparison sample of nondisruptive children was also identified. Group comparisons were performed on demographic, descriptive, family history, and clinical characteristics. Changes in rates of ODD symptoms and diagnostic subgroup membership were assessed after a 4-year longitudinal interval. Predictors of diagnostic group persistence were tested.
Few differences distinguished diagnostic subgroups at baseline. Of the 43 children with baseline diagnoses of ADHD + ODD, only 1 (2.3%) was found to have developed CD at follow-up. Over time there was a 57% rate of ODD persistence and a 43% rate of ODD desistance. Negative parenting practices and mothers' psychiatric disorders predicted persistence of ODD.
There was little evidence to show that ODD acted as a precursor to CD. However, when CD was diagnosed at baseline it was always associated with or preceded by ODD (i.e., prodrome). For a subgroup of children with ADHD, comorbid ODD symptoms are relatively unstable and may represent transient developmental perturbations that have little prognostic significance. For a larger subgroup of children with ADHD, ODD symptoms persist into the adolescent years and are associated with adverse parenting practices.
在注意缺陷多动障碍（ADHD）儿童的社区样本中，研究共病对立违抗障碍（ODD）的发展进程，特别关注ODD的持续存在和缓解情况以及品行障碍（CD）新病例的出现。
从多阶段流行病学筛查中确定一组破坏性行为儿童样本，并根据结构化访谈将其分层为诊断亚组。还确定了一组无破坏性行为儿童作为对照样本。对两组在人口统计学、描述性、家族史和临床特征方面进行比较。在4年的纵向随访期后，评估ODD症状发生率和诊断亚组归属的变化。对诊断组持续存在的预测因素进行测试。
基线时诊断亚组之间几乎没有差异。在43名基线诊断为ADHD + ODD的儿童中，随访时仅发现1名（2.3%）发展为CD。随着时间推移，ODD持续存在的比例为57%，缓解的比例为43%。消极的养育方式和母亲的精神障碍可预测ODD的持续存在。
几乎没有证据表明ODD是CD的前驱症状。然而，当基线时诊断为CD时，它总是与ODD相关或先于ODD出现（即前驱症状）。对于一部分ADHD儿童，共病的ODD症状相对不稳定，可能代表短暂的发育扰动且预后意义不大。对于更大比例的ADHD儿童，ODD症状持续到青少年期，并与不良养育方式有关。
