Childhood Disorders: Attention-Deficit and Disruptive Behavior Disorders

Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) are highly impairing conditions, with adverse functional consequences related to academic achievement/occupational attainment, family/peer relationships, psychological development, and behavioral function. Disruptive behavior is frequently but not always present, and there is an increased risk for substance abuse and criminality in a subset of individuals. The disorders often begin early in life, and symptoms frequently persist into adulthood. The disorders are frequently comorbid-both with each other and a large number of other disorders. Findings from pharmacological, neuroimaging, and animal studies implicate dopaminergic and noradrenergic neural circuits centered in the prefrontal cortex, striatum, cerebellum, and the brainstem nuclei which innervate them in the pathophysiology of ADHD, prefrontal and limbic structures are additionally involved in CD. A plethora of medication treatments are available for ADHD, including new longer acting stimulants and an approved nonstimulant, atomoxetine. Many of these same treatments, as well as others, have been used in treating disruptive behavior in ODD/CD. Psychosocial interventions have been found to be effective when administered alone or in combination with medications for all three conditions. However, despite impressive findings indicating short-intermediate term improvement with treatment, demonstrating long-term benefits remains challenging.