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Course and Prevalence of Disruptive Behavior Disorders

Prevalence of Disruptive Behavior Disorders

Oppositional Defiant Disorder (ODD) and Conduct Disorder are among the most common reasons, along with ADHD, for why youths will be referred to mental health services [ref]. Estimates of the rates of Disruptive Behavior Disorders in the general population differ based on which study one reads, but one consistent finding seems to be that these conditions are more prevalent among youths growing up in lower socioeconomic settings [ref].

According to American statistics, about 10% of adults in the general population recall having met the diagnostic criteria of ODD during their childhood or adolescence, and these rates are similar for males and females [ref]. A UK study that directly assessed youths ages 5-15 and their families found that about 4.5% of boys and 2% of girls can, by age 7, be diagnosed with ODD [ref]. This condition can begin as early as age 4, though in the majority of cases it will begin around age 12 [ref]. Once present, the symptoms tend to persist for about 6 years [ref].

About 10% of American adults also recall having met the diagnostic criteria for Conduct Disorder during their childhood and adolescent years [ref]. The UK study mentioned above found that, by age 15, over 5% of boys and about 3% of girls can be diagnosed with Conduct Disorder [ref]. Most cases of Conduct Disorder start by ages 13-15, but a quarter have an early-onset, which is before age 10 [ref]. Once it starts, this condition tends to persist for a few years [ref].

Associated Conditions (Comorbidity) of Disruptive Behavior Disorders

Given that Oppositional Defiant Disorder (ODD) tends to occur in as many as 1 in every 10 individuals [ref], some could argue that it should not be considered as a mental health problem at all, but simply a normal feature of childhood and adolescence, as it is normal for youths to be oppositional and disruptive at times. Be that as it may, studies have shown that youths with ODD are at a very high risk for experiencing a variety of other psychiatric conditions, suggesting that this syndrome is an indicator of mental health problems in general.

In fact, over 90% of individuals with ODD will have another psychiatric condition at some point in their lives (including adulthood), and over 60% will have 3 or more other psychiatric conditions in their lifetimes [ref]. Anywhere from a third to half of youths with ODD will experience other serious psychiatric conditions at the same time as their ODD [ref]. About 40% of people with ODD will at some point in their lives suffer from Major Depression, 20% will develop Bipolar Disorder, about 60% will experience an Anxiety Disorder (including Social Phobia in 30%, Specific Phobias in 25%, PTSD in 20%, and Generalized Anxiety Disorder in 15%), 35% will have ADHD, and about 50% will have a Substance Use Disorder [ref]. About a third of people with Oppositional Defiant Disorder will develop Conduct Disorder [ref].

About 50% of youths with Conduct Disorder will have another mental health disorder, including about a third with ADHD, and over 15% for both Depression and Anxiety Disorders [ref, ref]. About half of these individuals will also have a Substance Use Disorder [ref].

Prognosis of Disruptive Behavior Disorders

For about 70% of individuals, Oppositional Defiant Disorder tends to resolve by age 18 [ref]. Still, many of these individuals will go on to develop other forms of mental health problems later on in life, as described above. Those individuals who are less likely to overcome their ODD symptoms are those whose condition started in early in life, that is before age 7, and who also have a number of concurrent psychiatric conditions, as described above [ref].

About a third of youths with ODD will go on to develop Conduct Disorder [ref]. This risk is especially high among individuals with ODD who also have ADHD [ref], or whose ODD began in the pre-school years [ref].

In turn, about a third of all cases of Conduct Disorder develop into Antisocial Personality Disorder by adulthood [ref]. This is more likely when the Conduct Disorder begins before age 10 (early onset), is accompanied by ADHD, or when it is characterized by overt styles of aggression, such as confronting and attacking others, as opposed to covert aggression, such as stealing or deceiving [ref].

 

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