Attention-Deficit Hyperactivity Disorder with and without Obsessive—Compulsive Behaviours: Clinical Characteristics,Cognitive Assessment,and Risk Factors
Free accessResearch articleFirst published online January, 2005
Attention-Deficit Hyperactivity Disorder with and without Obsessive—Compulsive Behaviours: Clinical Characteristics,Cognitive Assessment,and Risk Factors
To determine the prevalence of obsessive–compulsive behaviours (OCB) in a clinical sample of children with attention-deficit hyperactivity disorder (ADHD) and to compare ADHD children (with and without OCB) with respect to clinical and cognitive characteristics and risk factors.
Method:
We compared ADHD children (n = 134) with and without OCB, and we compared all ADHD children with a group of normal control subjects (n = 26) on various clinical, cognitive, and inhibitory control measures; neurobiological and psychosocial risk factors; and family histories of psychiatric illness.
Results:
Clinically significant OCB was identified in 11.2% (15/134) of children with ADHD. Comorbid OCB was associated with significantly increased perfectionism, improved teacher ratings of inattention, and a decreased likelihood of having a first-degree relative with ADHD. Comorbid ADHD and OCB may also be associated with increased oppositional behaviour at home and better inhibitory control, though these differences were not statistically significant.
Conclusions:
Comorbid OCB is common in clinically referred children with ADHD and is associated with increased impairment relative to ADHD alone. Further, children with ADHD and OCB may develop symptoms as the result of different genetic and environmental risk factors, compared with children with ADHD only.
CantwellD.Attention deficit disorder: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry1996;35:978–87.
2.
GellerDBiedermanJJonesJShapiroSSchwartzSParkK.Obsessive-compulsive disorder in children and adolescents: A review. Harv Rev Psychiatry1998;5:260–73.
3.
SwedoSRapoportJLeonardHLenaneMCheslowD.Obsessive-compulsive disorder in children and adolescents. Arch Gen Psychiatry1989;46:335–41.
4.
HannaG.Demographic and clinical features of obsessive compulsive disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry1995;34:19–27.
5.
GellerDBiedermanJGriffinSJonesLLefkowitzT.Comorbidity of juvenile obsessive–compulsive disorder with disruptive behaviour disorders. J Am Acad Child Adolesc Psychiatry1996;35:1637–46.
6.
LeonardHSwedoSLenaneMRettewDHamburgerS.A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Arch Gen Psychiatry1993;50:429–39.
7.
ReddyYJReddyPSSrinathSKhannaSSheshadriSGirimajiS.Comorbidity in juvenile obsessive–compulsive disorder: A report from India. Can J Psychiatry2000;45:274–8.
8.
JensenPMartinDCantwellD.Comorbidity in ADHD: Implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry1997;36:1065–79.
9.
JensenPHinshawSKraemerHLenoraNNewcornJAbikoffH, and others. ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry2001;40:147–58.
10.
MTA. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry1999;56:1073–86.
11.
CarlssonM.On the role of cortical glutamate in obsessive-compulsive disorder in obsessive–compulsive disorder and attention-deficit hyperactivity disorder, two hypothetically phenomenologically antithetical conditions. Acta Psychiatrica Scand2000;102:41–3.
12.
BorcherdingBKeysorCRapoportJEliaJAmassJ.Motor/vocal tics and compulsive behaviors on stimulant drugs: Is there a common vulnerability? Psychiatry Res1990;33:83–94.
13.
KourisS.Methylphenidate-induced obsessive-compulsiveness. J Am Acad Child Adolesc Psychiatry1998;37:135.
14.
RiddleMKingRHardinMScahillLOrtSChappellP, and others. Behavioral side effects of fluoxetine in children and adolescents. J Child Adolesc Psychopharmacol1991;1:193–8.
15.
TierneyEJoshiPLlinasJRosenbergLRiddleM.Sertraline for major depression in children and adolescents: Preliminary clinical experience. J Child Adolesc Psychopharmacol1995;5:13–27.
16.
SheppardDBradshawJPurcellRPantelisC.Tourette's and comorbid syndromes: Obsessive–compulsive and attention-deficit hyperactivity disorder. A common etiology? Clin Psychol Rev1999;19:531–52.
17.
FitzgeraldKMcMasterFPaulsonLRosenbergD.Neurobiology of childhood OCD. Child and Adolescent Psychiatric Clinics of North America1999;8:533–75.
18.
BarkleyR.Genetics of childhood disorders: XVII. ADHD. Part 1. Executive functions and ADHD. J Am Acad Child Adolesc Psychiatry2000;39:1064–8.
19.
GreisbergSMcKayD.Neuropsychology of obsessive–compulsive disorder: A review and treatment implications. Clin Psychol Rev2003;23:95–117.
20.
BeersSRosenbergDDickEWilliamsTO'HearnKBirmaherB, and others. Neuropsychological study of frontal lobe function in psychotropic-naive children with obsessive–compulsive disorder. Am J Psychiatry1999;156:777–9.
21.
BiedermanJFaraoneSVKeenanKBenjaminJKrifcherBMooreC, and others. Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives psychiatrically and pediatrically referred samples. Arch Gen Psychiatry1992;49:728–38.
22.
NestadtGSamuelsJRiddleMBienvenuOJLiangKYLaBudaM, and others. A family study of obsessive–compulsive disorder. Arch Gen Psychiatry2000;57:358–63.
23.
PaulsDAlsobrookJPGoodmanWRasmussenSLeckmanJ.A family study of obsessive-compulsive disorder. Am J Psychiatry1995;152:76–84.
24.
GjoneHStevensonJSundetJM. Genetic influence on parent-reported attention-related problems in a Norwegian general population twin sample. J Am Acad Child Adolesc Psychiatry1996;35:588B96; discussion 596–8.
25.
CareyGGottesmanI.Twin and family studies of anxiety, phobic and obsessive disorders. In: KleinDRabkinJ, editors. Anxiety: New research and changing concepts. New York: Raven Press; 1981.
26.
InouyeE.Similar and dissimilar manifestations of obsessive–compulsive neurosis in monozygotic twins. Am J Psychiatry1965;121:1171–5.
27.
MilbergerSBiedermanJFaraoneSVGuiteJTsuangMT. Pregnancy, delivery and infancy complications and attention deficit hyperactivity disorder: Issues of gene–environment interaction. Biol Psychiatry1997;41(1):65–75.
28.
BiedermanJMilbergerSFaraoneSVKielyKGuiteJMickE, and others. Family–environment risk factors for attention-deficit hyperactivity disorder. A test of Rutter's indicators of adversity. Arch Gen Psychiatry1995;52:464–70.
29.
LouHC. Etiology and pathogenesis of attention-deficit hyperactivity disorder (ADHD): Significance of prematurity and perinatal hypoxic-haemodynamic encephalopathy. Acta Paediatr1996;85:1266–71.
30.
AronsonMHagbergBGillbergC.Attention deficits and autistic spectrum problems in children exposed to alcohol during gestation: A follow-up study. Dev Med Child Neurol1997;39:583–7.
31.
GellerDBiedermanJFaraoneSCradockKHagermoserLZamanN, and others. Attention-deficit/hyperactivity disorder in children and adolescents with obsessive–compulsive disorder: Fact or artifact? J Am Acad Child Adolesc Psychiatry2002;41(1):52–8.
32.
IckowiczASchacharRSugarmanRChenSMilletteCCookL, and others. Reliability and validity of the Parent Interview for Child Symptoms (PICS). Paper presented at the 49th Annual Meeting of the American Academy of Child and Adolescent Psychiatry; 2002 Oct 22–27; San Francisco (CA).
33.
TannockRHumMMasellisMHumphriesTSchacharR. Teacher Telephone Interview for children's academic performance, attention, behaviour, and learning: DSM-IV version (TTI-IV). Toronto: The Hospital for Sick Children; 2002.
34.
ConnersC. Conners' Parent Rating Scale-Revised: Long Version (CPRS- R:L). Toronto (ON): Multi-Health Systems; 1997.
35.
ConnersC. Conners' Teacher Rating Scale-Revised: Long Version (CTRS-R:L). Toronto (ON): Multi-Health Systems; 1997.
36.
WechslerD. Wechsler Intelligence Scale for Children-3rd ed. (WISC-III). San Antonio (TX): The Psychological Corporation-Harcourt Brace Jovanovich Inc; 1991.
37.
WilkinsonG. The Wide Range Achievement Test. 3rd ed (WRAT3). Wilmington (DE): Wide Range Inc; 1993.
38.
WoodcockR. Woodcock Reading Mastery Test-Revised (WRMT-R). Circle Pines (MN): American Guidance Service, Inc; 1987.
39.
SemelEWiigESecordW. Clinical Evaluation of Language Fundamentals-3rd ed (CELF-3). San Antonio (TX): The Psychological Corporation-Harcourt Brace & Co; 1995.
40.
ReynoldsCRichmondB. Revised Children's Manifest Anxiety Scale (RCMAS) Manual. Los Angeles: Western Psychological Services; 1985.
41.
KovacsM. Children's Depression Inventory (CDI). Toronto (ON): Multi-Health Systems; 1992.
42.
LoganGCowanWDavisK.On the ability to inhibit simple and choice reaction time responses: A model and a method. Journal of Experimental Psychology: Human Perception and Performance. 1984;10:276–91.
43.
BoyleMOffordDRacineYFlemingJSzatmariPSanfordM.Evaluation of the revised Ontario Child Health Study scales. J Child Psychol Psychiatry1993;34:189–213.
44.
OffordDBoyleMSzatmariP.Ontario Child Health Study. II. Six-month prevalence of disorder and rates of service utilization. Arch Gen Psychiatry1987;44:832–6.
45.
CrosbieJSchacharR.Deficient inhibition as a marker for familial ADHD. Am J Psychiatry2001;158:1884–90.
46.
HeymanIFombonneESimmonsHFordTMeltzerHGoodmanR.Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health. Br J Psychiatry2001;179:324–9.
47.
PetersonBPineDCohenPBrookJ.Prospective, longitudinal study of tic, obsessive–compulsive, and attention-deficit hyperactivity disorders in an epidemiological sample. J Am Acad Child Adolesc Psychiatry2001;40:685–95.
48.
MollGEysenbachKWoernerWBanaschewskiTSchmidtMRothenbergerA.Quantitative and qualitative aspects of obsessive–compulsive behaviour in children with attention-deficit hyperactivity disorder compared with tic disorder. Acta Psychiatrica Scand2000;101:389–94.
49.
SchacharRTannockRMarriottMLoganG.Deficient inhibitory control in attention deficit hyperactivity disorder. J Abnorm Child Psychol1995;23:411–37.
50.
GellerDACoffeyBFaraoneSHagermoserLZamanNKFarrellCL, and others. Does comorbid attention-deficit/hyperactivity disorder impact the clinical expression of pediatric obsessive–compulsive disorder? CNS Spectr2003;8:259–64.
51.
BerksonJ.Limitations of the application of fourfold table analysis to hospital data. Biometrics1946;2:47–51.
52.
ScahillLRiddleMAMcSwiggin-HardinMOrtSIKingRAGoodmanWK, and others. Children's Yale-Brown Obsessive Compulsive Scale: Reliability and Validity. J Am Acad Child Adolescent Psychiatry1997;36:844–52.
