Differentials
Attention deficit hyperactivity disorder (ADHD) in children
SIGNS / SYMPTOMS
Key symptoms of ADHD in children include persistent patterns of inattention and/or hyperactivity-impulsivity, which interfere with functioning and development. This may be characterised by features such as failure to pay close attention to details or making careless mistakes at school, work, or other activities, difficulty sustaining attention in tasks or play activities, and seeming not to listen when spoken to directly; other features include being easily distractible or forgetful, as well as tendencies to fidget, being unable to sit when expected to sit, and talking excessively.
Primary symptoms do not include irritability or anger (although it is important to note that the experience of ADHD can lead to frustration stemming from, and resistance to, activities that may be taxing to the patient, given their limited attentional capacities).
ADHD and ODD commonly co-occur; developmentally, ADHD often precedes ODD and may predict higher severity of ODD over time.[25][40]
INVESTIGATIONS
Diagnosis is clinical.
Attention deficit hyperactivity disorder (ADHD) in adults
SIGNS / SYMPTOMS
Key symptoms of ADHD in adults include persistent patterns of inattention and/or hyperactivity-impulsivity, onset of which must have occurred prior to 12 years of age. This may be characterised by features such as failure to pay close attention to details or making careless mistakes at work or in other activities, difficulty sustaining attention in tasks, and seeming not to listen when spoken to directly. Other features include being easily distractible or forgetful, and organisational difficulties, as well as tendencies to fidget, talk excessively, and interrupt others: for example, interrupting conversations.
There may be a history of past or present academic dysfunction, occupational dysfunction, and familial and relationship dysfunction. There may also be a history of drug and/or alcohol use disorders.
Primary symptoms do not include irritability or anger (although it is important to note that the experience of ADHD can lead to frustration stemming from, and resistance to, activities that may be taxing to the patient, given their limited attentional capacities).
ADHD and ODD commonly co-occur; developmentally, ADHD often precedes ODD and may predict higher severity of ODD over time.[25][40]
INVESTIGATIONS
Diagnosis is clinical.
Conduct disorder (CD)
SIGNS / SYMPTOMS
Conduct disorder is characterised by a repeated pattern of violating the rights of others or society's rules. These include 4 main groups of behaviour: aggression that hurts people or animals, destruction of property, lying or stealing, and serious rule violations.[14] Although ODD symptoms do not include aggression, severe forms of temper loss may include aggression towards objects or property and verbally abusive behaviour; these are typically circumscribed to outbursts or tantrums and are reactive rather than instrumental or goal-directed. CD is not characterised by chronic irritability.
ODD and CD commonly co-occur.
INVESTIGATIONS
Diagnosis is clinical.
Disruptive mood dysregulation disorder (DMDD)
SIGNS / SYMPTOMS
DMDD is defined by temper outbursts in the context of chronically irritable mood. As these symptoms overlap almost completely with the chronic irritability dimension of ODD symptoms, it may be difficult to distinguish between the two conditions.
While the criteria for DMDD describe a potentially higher intensity of outbursts of temper in comparison to ODD, in practice extraordinarily high rates of overlap of ODD and DMDD have been found when applied in clinical and community samples.[77]
The prohibition in the DSM against giving a diagnosis of ODD if the criteria for DMDD are met may prevent diagnostic representation of the non-chronic irritability symptoms of ODD and may, in turn, contribute to poor outcomes associated with ODD (e.g., school dropout, peer rejection, parental conflict, occupational impairment).[4][5][9][11]
Note that the ICD-11 criteria for diagnosis do not require exclusion of DMDD, and do recognise the chronic irritability dimension as a subtype of ODD.
INVESTIGATIONS
Diagnosis is clinical.
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