Co-Occurring ODD and GAD Symptom Groups: Source-Specific Syndromes and Cross-Informant Comorbidity

Abstract

Despite important clinical and nosological implications, the comorbidity of oppositional defiant disorder (ODD) and generalized anxiety disorder (GAD) has received little attention. A clinicbased sample of 243 boys (ages 6-10 years), their parents, and teachers participated in an evaluation that involved assessments of behavioral, academic, and family functioning. ODD and GAD symptom groups were defined using various combinations of mother and teacher reports. ODD symptom groups were associated with conduct disorder symptoms, and GAD symptom groups with major depressive disorder symptoms, regardless of rater. Attention deficit/ hyperactivity disorder (ADHD) symptoms were associated with ODD and GAD symptom groups; however, covarying ADHD symptoms altered few findings. The ODD+GAD symptom groups were associated with higher rates of co-occurring symptoms and risk factors within (sourcespecific syndromes) and across (cross-informant comorbidity) informants.Although comorbidity is more the rule than the exception among child emotional and behavioral disorders (Angold, Costello, & Erkanli, 1999;Lilienfeld, 2003), the cooccurrence of oppositional defiant disorder (ODD) and generalized anxiety disorder (GAD) has received relatively little attention in spite of the fact that ODD likely alters the course, correlates, and treatment response for children with GAD (Flannery-Schroeder, Suveg, Safford, Kendall, & Webb, 2004;Garland & Garland, 2001;Kendall, Panichelli-Mindel, Sugarman, & Callahan, 1997). For instance, oppositional behavior in the context of an anxiety disorder may lead to reluctance to engage in exposures and comply with treatment. In addition, parents of children with anxiety disorders report that their children's oppositional behavior is particularly difficult to manage (Garland & Garland, 2001). Unfortunately, research to date generally has examined overanxious disorder, which was replaced by GAD in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.[DSM-IV]; American Psychiatric Association, 1994), and/or has combined multiple anxiety or disruptive behavior disorders (for reviews, see Angold et al., 1999;Russo & Beidel, 1994), which obscures specific relations between ODD and GAD. Copyright © Taylor & Francis Group, LLCCorrespondence should be addressed to Deborah A. G. Drabick, Department of Psychology, Temple University, Weiss Hall, 1701 North 13th Street, Philadelphia, PA 19122-6085. ddrabick@temple.edu. Publisher's Disclaimer: The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. NIH Public AccessAuthor Manuscript J Clin Child Adolesc Psychol. Author...

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