儿童注意缺陷多动障碍共患对立违抗障碍研究进展

Advances in attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder in children

摘要

注意缺陷多动障碍(ADHD)是一种以注意力不集中、多动和冲动为核心症状的神经发育障碍。对立违抗障碍(ODD)是以持续性的易怒情绪、争论反抗行为以及报复心理为临床特征的破坏性行为障碍,ODD是儿童ADHD常见共患病之一,当两者共病时,患儿临床表现更为复杂,治疗难度也相应增加。尽早准确识别儿童ADHD是否共患ODD,有助于对患儿及时实施个性化的干预措施,从而减少共患病给患儿带来的危害。本文阐述ADHD共患ODD的流行病学、发病原因、临床特征及干预措施,探索更有效的干预策略以提高患儿的生活质量和社会功能。

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity.Oppositional defiant disorder (ODD), characterized by a persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness, is one of the most prevalent comorbidities in children with ADHD.The co-occurrence of these disorders significantly exacerbates clinical presentations and complicates therapeutic interventions.Early and accurate identification of comorbid ODD in children with ADHD is crucial, as it facilitates the timely implementation of personalized interventions and mitigates the adverse outcomes associated with this comorbidity.This review comprehensively delineates the epidemiology, etiology, clinical characteristics, and intervention strategies for ADHD comorbid with ODD, exploring more effective approaches to improve the quality of life and psychosocial functioning of affected children.

关键词

儿童 / 青少年 / 注意缺陷多动障碍 / 对立违抗障碍 / 共患病

Key words

children / adolescents / attention deficit hyperactivity disorder / oppositional defiant disorder / comorbidity

[1] Faraone SV, Bellgrove MA, Brikell I, et al.Attention-deficit/hyperactivity disorder[J].Nature Reviews.Disease Primers, 2024, 10(1): 11.
[2] Liu J, Jiang Z, Li F, et al.Prevalence and comorbidity of attention deficit hyperactivity disorder in chinese school-attending students aged 6-16: A national survey[J].Annals of General Psychiatry, 2025, 24(1): 23.
[3] Silva LA, Eleutério RF, Sousa GD, et al.Signs and symptoms of attention deficit hyperactivity disorder and its main comorbidities: A systematic review[J].International Seven Journal of Health Research, 2023, 2(6): 1386-1397.
[4] Hawes DJ, Gardner F, Dadds MR, et al.Oppositional defiant disorder[J].Nat Revi Dis Primers, 2023, 9:31.
[5] Shi X, Ji Y, Cai S, et al.Comorbidities and functional impairments in children with attention deficit hyperactivity disorder in China: A hospital-based retrospective cross-sectional study[J].BMJ Open, 2021, 11(3): e042196.
[6] Mohammadi MR, Zarafshan H, Khaleghi A, et al.Prevalence of ADHD and its comorbidities in a population-based sample[J].J Atten Disord, 2021, 25(8): 1058-1067.
[7] Kao PH, Ho CH, Huang CL.Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study[J].PLoS One, 2025, 20(1): e0315587.
[8] Seppä S, Halt AH, Nordström T, et al. Effects of symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) on academic performance and educational attainment[J]. Child Psychiatry Hum Dev, 2025, 56(3): 696-703.
[9] 陈强, 李德欣, 李静, 等. 共患对立违抗障碍的注意缺陷多动障碍儿童社会功能特征[J]. 中国学校卫生, 2023, 44(2): 191-194, 199.
Chen Q, Li DX, Li J, et al. Social functioning characteristics of children with co-occurrence of attention deficit hyperactivity disorder and oppositional defiant disorder[J]. Chin J Sch Health, 2023, 44(2): 191-194, 199. (in Chinese)
[10] 丁凯景, 丁雨钦, 周圆月, 等. GRIN2A、GRIN2B基因多态性与注意缺陷多动障碍的关联研究[J]. 浙江医学, 2021, 43(10): 1066-1070.
Ding KJ, Ding YQ, Zhou YY, et al. Association of GRIN2A, GRIN2B gene polymorphisms with attention deficit hyperactivity disorder in children[J]. Zhejiang Med J, 2021, 43(10):1066-1070. (in Chinese)
[11] Tahillioğlu A, Salatino-Oliveira A, Wagner F, et al. Differentiating ADHD and oppositional defiant disorder through synapsin Ⅲ gene polymorphisms and neurocognitive profiles[J]. Appl Neuropsychol Child, 2026: 1-11.
[12] 王少华, 丁凯景, 刘瑞湘, 等.DAT1和DRD4基因启动子区甲基化与注意缺陷多动障碍临床症状的关联研究[J].中国神经精神疾病杂志, 2017, 43(2): 93-97.
Wang SH, Ding KJ, Liu RX, et al.Association between methylation status of CpG island in DAT1 and DRD4 genes and clinical symptoms of ADHD[J].Chin J Nerv Ment Dis, 2017, 43(2):93-97.(in Chinese)
[13] Eilertsen EM, Cheesman R, Ayorech Z, et al.On the importance of parenting in externalizing disorders: An evaluation of indirect genetic effects in families[J].J Child Psychology Psychiatry, 2022, 63(10): 1186-1195.
[14] Wang X, Guo Y, Xu J, et al. Decreased gray matter volume in the anterior cerebellar of attention deficit/hyperactivity disorder comorbid oppositional defiant disorder children with associated cerebellar-cerebral hyperconnectivity: insights from a combined structural MRI and resting-state fMRI study[J]. Int J Devlp Neuroscience: The official Journal of the International Soc Neuroscience, 2024, 84(6): 500-509.
[15] 王欣, 肖勇, 周仪, 等. 注意缺陷多动障碍共病对立违抗性障碍儿童脑灰质体积及脑功能连接的改变[J]. 中华行为医学与脑科学杂志,2022,31(9):833-839.
Wang X, Xiao Y, Zhou Y, et al. Changes of gray matter volume and brain functional connectivity in children with attention deficit hyperactivity disorder comorbid with oppositional defiant disorder[J]. Chin J Behav Med Brain Sci, 2022, 31(9):833-839. (in Chinese)
[16] Vetter NC, Backhausen LL, Buse J, et al.Altered brain morphology in boys with attention deficit hyperactivity disorder with and without comorbid conduct disorder/oppositional defiant disorder[J].Humn Brain Mapping, 2020, 41(4): 973-983.
[17] Wu ZM, Wang P, Liu XC, et al. Functional and structural connectivity of the subregions of the amygdala in ADHD children with or without ODD[J]. BMC Psychiatry, 2025, 25(1): 74.
[18] Bernhard A, Mayer JS, Fann N, et al. Cortisol response to acute psychosocial stress in ADHD compared to conduct disorder and major depressive disorder: A systematic review[J]. Neurosci Biobehavi Rev, 2021, 127: 899-916.
[19] Jendreizik LT, Hautmann C, von Wirth E, et al. The importance of familial risk factors in children with ADHD: Direct and indirect effects of family adversity, parental psychopathology and parenting practices on externalizing symptoms[J]. Child Adolesc Psychiatry Ment Health, 2022, 16(1): 96.
[20] Tulaci ÖD, Çetinkaya M, Tulac RG, et al. Impact of parental impulsivity on attention deficit hyperactivity disorder and oppositional defiant disorder: Do mothers' attitudes predict symptom severity in children?[J]. J Ner Ment Dis, 2021, 209(10): 759-763.
[21] 寇聪, 吴赵敏, 刘娟, 等. 注意缺陷多动障碍儿童共患对立违抗性障碍与父母养育方式的相关性[J]. 中国当代儿科杂志, 2022, 24(8): 869-873.
Kou C, Wu ZM, Liu J, et al. Association between oppositional defiant disorder and parenting style in children with attention deficit hyperactivity disorder[J]. Chin J Contemp Pediatr, 2022, 24(8): 869-873. (in Chinese)
[22] 熊伟, 张恩, 杨永春, 等. 家庭环境对伴对立违抗的注意缺陷多动障碍患儿的影响[J]. 临床精神医学杂志, 2020, 30(5): 349-351.
Xiong W,Zhang E,Yang YC,et al. Influences of family environment on children with attention deficit hyperactivity disorder comorbid oppositional defiant disorder[J]. J Clin Psychiatry, 2020, 30(5): 349-351. (in Chinese)
[23] Elbagir R, Faisal M, O'Hanharan S. Systematic review of environmental and psychosocial risk factors associated with attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder in children and adolescents[J]. Scand J Child Adolesc Psychiatry and Psychol, 2023, 11(1): 108-119.
[24] Noordermeer SDS, Luman M, Buitelaar JK, et al. Neurocognitive deficits in attention-deficit/hyperactivity disorder with and without comorbid oppositional defiant disorder[J]. J Atten Disord, 2020, 24(9): 1317-1329.
[25] Akinci MA, Turan B, Demïrdöğen EY, et al. The effects of ODD comorbidity on internalizing and externalizing symptoms in children and adolescents with ADHD[J]. Namik Kemal Med J, 2026.14(1):70-77.
[26] Sperry A, DeRonda AC, Plotkin M, et al. Differences in clinical symptoms and hot and cold executive function in girls and boys with ADHD with and without ODD[J]. Clin Neuropsychol, 2025: 1-22.
[27] Pan PY, Yeh CB. The role of methylphenidate and aripiprazole in the treatment of emotion dysregulation in children with ADHD[J]. J Clin Psychopharmacol, 2025, 45(4): 356.
[28] Ágrez K, Visky Z, Hámori G, et al. Not just old wine in new bottles: Polygenic liability for ADHD is associated with electrophysiological affective-motivational processing beyond anxiety, depression, and ODD[J]. Transl Psychiatry, 2025, 15(1): 213.
[29] Kim H, Jung E, Lee T, et al. Impact of comorbid oppositional defiant disorder on the clinical and neuropsychological characteristics of korean children with attention-deficit/hyperactivity disorder[J]. Psychiatry Investig, 2023, 20(10): 962-971.
[30] Pringsheim T, Hirsch L, Gardner D, et al. The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: A systematic review and meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and atomoxetine[J]. The Canadian Journal of Psychiatry, 2015, 60(2): 42-51.
[31] Pringsheim T, Hirsch L, Gardner D, et al.The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder: A systematic review and meta-analysis.Part 2: Antipsychotics and traditional mood stabilizers[J].The Canadian Journal of Psychiatry, 2015, 60(2): 52-61.
[32] Battagliese G, Caccetta M, Luppino OI, et al.Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness[J].Behav Res Ther, 2015, 75: 60-71.
[33] Fatemi Nayeri M, Soltanifar A, Moharreri F, et al.A randomized controlled trial of group reality therapy in attention deficit hyperactivity disorder and oppositional defiant disorder in adolescents[J].Iran J Psychiatry Behav Sci, 2021, 15(1):e68643.
[34] Valero-Aguayo L, Rodríguez-Bocanegra M, Ferro-García R, et al.Meta-analysis of the efficacy and effectiveness of parent child interaction therapy (PCIT) for child behaviour problems[J].Psicothema, 2021, 33(4): 544-555.
[35] Nobel E, Hoekstra PJ, Agnes Brunnekreef J, et al.Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: A randomized controlled trial[J].Eur Child Adolesc Psychiatry, 2020, 29(3): 395-408.
[36] Paiva GCC, de Paula JJ, Costa DS, et al.Parent training for disruptive behavior symptoms in attention deficit hyperactivity disorder: A randomized clinical trial[J].Front Psychol, 2024, 15:1293244.
[37] Döpfner M, Görtz-Dorten A, Häge A, et al.Efficacy of a mobile-based self-directed parent management training for parents of children with attention-deficit/hyperactivity disorder with or without oppositional defiant disorder - A randomized controlled trial[J].Eur Child Adolesc Psychiatry, 2025, 34(12): 3973-3985.
[38] Döpfner M, Liebermann-Jordanidis H, Kinnen C, et al.Long-term effectiveness of guided self-help for parents of children with ADHD in routine care - An observational study[J].J Attent Disord, 2021, 25(2): 265-274.
[39] Halse M, Steinsbekk S, Hammar Å, et al.Longitudinal relations between impaired executive function and symptoms of psychiatric disorders in childhood[J].J Child Psychology Psychiatry, 2022, 63(12): 1574-1582.
[40] Liu R, Wen Z, Han D, et al.Effects of exercise interventions on executive function in school-aged children with ADHD: A systematic review and meta-analysis[J].BMC Public Health, 2025, 25(1): 3265.
[41] Luo X, Huang X, Lin S.Yoga and music intervention reduces inattention, hyperactivity/impulsivity, and oppositional defiant disorder in children's consumer with comorbid ADHD and ODD[J].Fronti Psychol, 2023, 14: 1150018.
[42] Robinette LM, Hatsu LE,Johnstone JM, et al.Treatment response to supplemental nutrients for ADHD is independent of diet quality: The MADDY study RCT[J].Nutr Neurosci, 2024, 27(4): 319-328.

基金资助

广东省医学科学技术研究基金项目(A2022421)