Utility of Multiple Specifiers for Subtyping Oppositional Defiant Problems: Investigating Multiple Psychopathy Dimensions as Specifiers.

Past research has speculated that using grandiose-manipulative (GM) and daring-impulsive (DI) traits, rather than solely callous-unemotional (CU) traits, could better inform subtyping youths with behavioral problems. However, this approach remains largely untested. To further enhance our understanding of this matter, the current study utilized self-report (n = 2,381) and parent-report (n = 1,846) data to examine the utility of three psychopathic dimensions as specifiers for oppositional defiant problems (ODP). Findings showed that ODP was a significant predictor of negative outcomes, while the GM, CU, and DI traits emerged as significant predictors of theoretically and clinically relevant external variables (e.g., conduct problems and proactive aggression), independent of ODP (and age, gender, and socioeconomic status), forming the potential foundation for the development of specifiers for ODP. Furthermore, children presenting ODP alongside heightened levels of the three psychopathic traits demonstrated notably higher scores in important external variables compared to other groups, including but not confined to the subgroup of children with ODP and high CU trait levels. Findings provide preliminary support for employing GM and DI traits as specifiers for ODP. However, more comprehensive evaluations of these specifiers' utility would help inform ongoing discussions before definitively concluding they should be included in diagnostic manuals.

Evidence-Based Assessment of DSM-5 Disruptive, Impulse Control, and Conduct Disorders.

The assessment of oppositional defiant disorder, conduct disorder, antisocial personality disorder, and intermittent explosive disorder-the Disruptive, Impulse Control and Conduct Disorders-can be affected by biases in clinical judgment, including overestimating concerns about distinguishing symptoms from normative behavior and stigma associated with diagnosing antisocial behavior. Recent nosological changes call for special attention during assessment to symptom dimensions of limited prosocial emotions and chronic irritability. The present review summarizes best practices for evidence-based assessment of these disorders and discusses tools to identify their symptoms. Despite the focus on disruptive behavior disorders, their high degree of overlap with disruptive mood dysregulation disorder can complicate assessment. Thus, the latter disorder is also included for discussion here. Good practice in the assessment of disruptive behavior disorders involves using several means of information gathering (e.g., clinical interview, standardized rating scales or checklists), ideally via multiple informants (e.g., parent-, teacher-, and self-report). A commitment to providing a full and accurate diagnostic assessment, with careful and attentive reference to diagnostic guidelines, will mitigate concerns regarding biases.

Evaluating alternative models of youth externalizing using quantitative genetic analyses.

Interest has increased in the recent literature on characterizing psychopathology dimensionally in hierarchical models. One dimension of psychopathology that has received considerable attention is externalizing. Although extensively studied and well-characterized in late adolescents and adults, delineation of the externalizing spectrum in youth has lagged behind. As a complement to structural analyses of externalizing, in this study, we use quantitative genetic analyses of twin data to adjudicate among alternative models of youth externalizing that differ in granularity. Specifically, we compared model fit, estimates of genetic and environmental influences on the externalizing dimension, and the average, variability, and precision of genetic and environmental influences on individual symptoms due to the externalizing dimension, specific symptom dimensions, and unique etiological influences. Given that none of these criteria are definitive on their own, we looked to the confluence of these criteria to exclude particular models while highlighting others as leading contenders. We analyzed parent-report data on 38 externalizing symptoms from a population-representative, ethnically diverse sample of 883 youth twin pairs (51% female), who were on average 8.5 years old. Although models including an externalizing composite and attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder diagnoses and symptom dimensions showed similar heritability to latent variable models of externalizing, models that included latent dimensions of externalizing and more fine-grained symptom dimensions fit better and were more balanced in the magnitude of genetic and environmental influences on individual symptoms due to the externalizing dimension and specific symptom dimensions. Pending replication, these more granular and elaborated model(s) can be useful for advancing research on causes and outcomes of youth externalizing and its fine-grained specific components. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Oppositional defiant disorder.

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

The Disruptive Behavior Disorders Rating Scale: Updated Factor Structure, Measurement Invariance, and National Caregiver Norms.

OBJECTIVE: To provide the first caregiver-report national norms for the Disruptive Behavior Disorders Rating Scale (DBDRS) and an updated evaluation of its factor structure and measurement invariance across child sex, informant sex, and child age. METHODS: Caregivers of children aged 5-12 years (N = 962) based in the United States completed the four DBDRS subscales. Using both severity scoring and dichotomous scoring procedures, confirmatory factor analyses supported a four-factor model of inattentive and hyperactive/impulsive symptoms, oppositional defiant symptoms, and conduct disorder symptoms. RESULTS: Measurement invariance was supported, indicating that the DBDRS functions similarly across demographic characteristics. Boys were reported to have more severe symptoms than girls (Cohen's d = 0.33 [inattention], 0.30 [hyperactivity/impulsivity], 0.18 [oppositional defiant disorder], 0.14 [conduct disorder]), female caregivers rated ADHD symptoms as more severe than male caregivers (ds = 0.15 and 0.19 for inattention and hyperactivity/impulsivity, respectively), and older children were reported to experience more inattention than younger children (d = 0.18). Overall, group differences were modest in magnitude. CONCLUSION: This psychometric study supports the continued use of the DBDRS in school-aged youth and will enhance the measure's clinical and research utility by providing the first caregiver-report norms.

Oppositional Defiant Disorder in the DSM-5: Does the Limited Prosocial Emotions Specifier Portend a More Severe Clinical Presentation?

This study investigated whether oppositional defiant disorder (ODD) with the DSM-5 limited prosocial emotions (LPE) specifier marks a more severe clinical presentation than ODD alone. Mothers, fathers, and teachers of 2,142 Spanish children (49.49% girls; ages 8 to 13 years) completed measures of ODD, LPE, ADHD-hyperactivity/impulsivity (HI), ADHD-inattention (IN), cognitive disengagement syndrome (CDS), anxiety, depression, social impairment, academic impairment, and peer rejection (teacher only measure). Scores greater or less than 1.50 SDs above the ODD and LPE means were used to create ODD-only (5.89-7.22% of the sample, depending on informant), LPE-only (7.61-8.25%), ODD + LPE (1.69-2.20%), and comparison groups (82.96-84.68%) for each source. For all three sources, the LPE-only group scored higher than the comparison group on social impairment, peer rejection, and academic impairment but did not differ significantly on anxiety. Although the ODD-only and ODD + LPE groups scored higher than the LPE-only group on all symptom and most impairment dimensions, the ODD + LPE group did not show a consistent pattern of higher scores than the ODD-only group. There were no differences on mother ratings, and higher scores for the ODD + LPE group emerged on only three of seven father-report measures (depression, CDS, and ADHD-IN) and three of eight teacher-report measures (peer rejection, social impairment, and academic impairment). Limited differences between the ODD + LPE and ODD-only groups raise questions about the usefulness of LPE as a severity specifier for ODD among children. Future studies need to address this issue with adolescents and clinical samples.

Latent classes of oppositional defiant disorder in adolescence and prediction to later psychopathology.

Current conceptualizations of oppositional defiant disorder (ODD) place the symptoms of this disorder within three separate but related dimensions (i.e., angry/irritable mood, argumentative/defiant behavior, vindictiveness). Variable-centered models of these dimensions have yielded discrepant findings, limiting their clinical utility. The current study utilized person-centered latent class analysis based on self and parent report of ODD symptomatology from a community-based cohort study of 521 adolescents. We tested for sex, race, and age differences in the identified classes and investigated their ability to predict later symptoms of depression and conduct disorder (CD). Diagnostic information regarding ODD, depression, and CD were collected annually from adolescents (grades 6-9; 51.9% male; 48.7% White, 28.2% Black, 18.5% Asian) and a parent. Results provided evidence for three classes of ODD (high, medium, and low endorsement of symptoms), which demonstrated important developmental differences across time. Based on self-report, Black adolescents were more likely to be in the high and medium classes, while according to parent report, White adolescents were more likely to be in the high and medium classes. Membership in the high and medium classes predicted later increases in symptoms of depression and CD, with the high class showing the greatest risk for later psychopathology.

Is the distinction between tonic and phasic irritability meaningful in 3-year-old children?

Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.

Some critical comments on the paper titled "Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders".

Frick (2022) presented a narrative review of some literature and made several critical comments regarding the extension of the full psychopathy construct to research and classification of childhood disruptive behavior disorders (DBDs). His arguments cautioned against the use of the multicomponent concept of psychopathy for specification of DBDs for several reasons including definitional issues, symptom sequencing, specifier versus risk factor considerations, potential overlap with other disorders and criteria (e.g., ADHD), and concerns regarding harm. While I agree with Frick (2022) that we need to be cautious when extending personality constructs to the DBDs, the remaining arguments in his paper fall short of calling for the exclusion of psychopathy components in the examination of DBDs. Rather, the counterpoints in this paper further convince that the multidimensional model of psychopathy, when applied to the DBDs, could better facilitate understanding of the etiology and mechanisms for Conduct Disorder (CD), and, it may help us to predict the prognosis and treatment outcomes of children with various forms of DBDs such as CD and Oppositional Defiant Disorder (ODD). To have the most informative designs, future research should examine the broad construct to glean a better understanding of psychopathy and the DBDs. Further, research should continue to examine sequencing and external correlates at the component level and to test the incremental value of the multicomponent model of psychopathy to help us better comprehend how each component may facilitate our understanding of the types and severity of conduct problems exhibited by youth with DBDs (i.e., CD, ODD).

The conduct and oppositional defiant disorder scales (CODDS) for disruptive behaviour disorders.

This study evaluates the clinical validity of a five-minute instrument, the Conduct and Oppositional Defiant Disorder Scales (CODDS), for assessing oppositional defiant disorder (ODD) and conduct disorder (CD). Children (N = 428) aged 11-12 years and their caregiver were administered the NIMH DISC-IV (Diagnostic Interview Schedule for Children), the CODDS, and validity measures. A second sample (N = 671) was utilized to develop a brief measure of limited prosocial emotions based on DSM 5. Receiver operating characteristic (ROC) curves documented good sensitivity and specificity for CODDS scales in predicting DISC-IV clinical diagnoses of ODD (85%, 72% respectively) and CD (85%, 88%) diagnoses. Baseline CODDS provided added value over and above baseline clinical DISC- diagnoses in predicting future DISC ODD and CD diagnoses 12 months later, as well as in predicting social and school functioning. Study 2 further established psychometric properties of the CODDS, with brief measures of CODDS limited prosocial emotions (LPE) having a good fit to the hypothesized DSM 5 four-factor structure of LPE. Findings indicates that the CODDS has utility as a five-minute proxy for diagnoses of ODD and CD in clinical research and potentially practice where time and resources are limited.

Effects of a smartphone app-augmented treatment for children with oppositional defiant disorder / conduct disorder and peer-related aggressive behavior - a pilot study.

BACKGROUND: Social competence training interventions, especially child-focused ones, have proven to be effective in the treatment of children with conduct disorder. Therapy homework assignments implemented between the therapy sessions are essential for practicing strategies developed during treatment sessions and transferring them to everyday life. However, clinical experience shows that patients' adherence regarding these assignments is often low, thus diminishing the treatment success. One obstacle in this regard is a lack of motivation. The use of smartphone apps in the context of child and adolescent psychotherapy is relatively new, and may provide novel ways to improve the transfer of coping strategies to daily life between treatment sessions. However, only a small number of high-quality studies have analyzed the systematic use of smartphone apps in therapy. The present study will therefore evaluate patients' homework assignment adherence when using a smartphone app as compared to a paper-and-pencil method. METHOD: The study will be conducted as a randomized controlled trial to evaluate the impact of a smartphone app on the adherence to therapy homework assignments (n = 35) in the treatment of children with aggressive behavior aged 6-12 years compared to paper-and-pencil homework assignments (n = 35). DISCUSSION: This trial is intended as a pilot study and aims to provide a basis for a subsequent multicenter trial. However, the results may already lead to recommendations for the development and use of mental health-related smartphone apps for children and adolescents with aggressive behavior problems. TRIAL REGISTRATION: Trial registration AUTHARK: German Clinical Trials Register (DRKS) DRKS00015625 . Registered on 15th October 2019.

Debate: Oppositional defiant disorder is a real disorder.

Oppositional defiant disorder (ODD) is a valid mental health disorder, characterized by negativistic defiant behavior and angry, irritable mood. The very low and stable prevalence rate over development from early childhood into adulthood suggests that ODD does not erroneously medicalize normative childhood behavior. ODD is associated with significant impairments across multiple contexts and raises risks for other future psychopathology. Although simplistic tropes often suggest that ODD is merely the product of bad parenting, substantial evidence shows that it is instead influenced by a variety of factors, including genetic and neurobiological factors. Individuals with ODD evoke negative interactions with peers, teachers, coworkers, romantic partners, and parents. ODD is often misunderstood as being a mild form of conduct disorder (CD). Rather, in stark contrast to ODD, CD reflects a pattern of aggressive behaviors, violations of laws or status offenses, and psychopathic features. Mounting evidence for their distinction led to diagnostic changes distinguishing ODD and CD nearly a decade ago. Empirically supported treatments are available and help caregivers to develop specific parenting practices to meet the needs of children with ODD. Minimizing and mischaracterizing ODD increases the likelihood that families who are suffering may not seek the treatment that they need.

Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders.

The recent inclusion of callous-unemotional traits in the diagnostic criteria for serious conduct problems has led to renewed interest in more comprehensive integrations of the construct of psychopathy into research and clinical classification of childhood disruptive behavior disorders. There have been a number of recent reviews of research focusing the many potential benefits for this integration. However, there are also a number of issues that could reduce these benefits and even potentially lead to harmful effects. The current paper focuses on several of these issues, some of which are common when attempting to integrate research findings across areas that have been conducted independently of each other. Other issues are more specific to the construct of psychopathy. Specifically, the current paper focuses on the lack of agreement on the necessary and sufficient dimensions needed to define psychopathy, the need to consider developmental relationships among these dimensions, the implications of the different associations among the dimensions of psychopathy with conduct problems in children and adolescents, the need to consider how these dimensions relate to existing constructs used in the classification of disruptive behavior disorders, and the potential harmful effects of labeling something "a dimension of psychopathy". These issues have several clear implications for using the construct of psychopathy to guide research on and diagnostic classification of childhood disruptive behavior disorders.

Network analyses of Oppositional Defiant Disorder (ODD) symptoms in children.

Based on parent and teacher ratings of their children, this study used regularized partial correlation network analysis (EBIC glasso) to examine the structure of DSM-5 Oppositional Defiant Disorder (ODD) symptoms. Parent and teachers (N = 934) from the general community in Malaysia completed questionnaires covering DSM-5 ODD symptoms. The most central ODD symptom for parent ratings was anger, followed by argue. For teacher ratings, it was anger, followed by defy. For both parent and teacher ratings, the networks revealed at least medium effect size connections for temper and argue, defy, and argue, blames others, and annoy, and spiteful and angry. Overall, the findings were highly comparable across parent and teacher ratings, and they showed a novel understanding of the structure of the ODD symptoms. The clinical implications of the findings for assessment and treatment of ODD are discussed.

Where Should Psychopathic Traits Be Placed in a Diagnostic Framework? Evidence for a Grandiose-Manipulative Specifier for ODD.

Youth exhibiting psychopathic traits are at increased risk for a more severe, persisting, and treatment-resistant course of antisocial behavior. To reflect this diagnostically, the specifier with limited prosocial emotions (LPE) was added to the criteria for conduct disorder (CD). Yet, psychopathic traits often show an earlier onset than CD symptoms and LPE may exclude important dimensions of psychopathy. This study examines grandiose-manipulative (GM) traits both dimensionally and as a diagnostic specifier for behavioral disorders.Data come from a clinic sample of 177 boys aged 7-12 followed up annually through age 17. Annual parent reports of children's GM, and symptoms of CD, oppositional defiant disorder (ODD), and attention-deficit/hyperactivity disorder (ADHD) were tested, controlling for other psychopathology and demographics. A categorical GM specifier for ODD or ADHD was also tested as a predictor of CD or ODD diagnosis.GM and ODD were significantly predictive of increases in CD. Reciprocal associations were observed between GM and ODD symptoms. The GM specifier was most commonly associated with ODD (91.9%), compared to CD (44.1%) or ADHD (67.1%), and was significantly predictive of future CD when applied to ODD. GM as a specifier for ADHD enhanced the prediction from ADHD to ODD, but not to CD. Including GM as a specifier for disorders beyond CD improves the prediction of future behavioral disorders, distinguishing youth with ODD at risk for CD, and youth with ADHD at risk for ODD. Failing to do so may miss a substantial portion of elevated GM.

Reliability and validity of the DSM-5 Diagnostic Interview Schedule for Children, Adolescents, and Parents-5 in externalizing disorders and common comorbidities.

The Diagnostic Interview Schedule for Children Adolescents and Parents (DISCAP) is a semi-structured diagnostic interview for assessing psychiatric disorders in children and adolescents. Changes to diagnostic criteria introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) required the DISCAP to be revised accordingly. The aim of this study was to evaluate the reliability and validity of the updated DISCAP-5 in clinic-referred children. The DISCAP-5 was administered to parents of n=60 clinic-referred children aged 2-9 years with externalizing problems and a range of comorbid disorders. Inter-rater reliability data were collected using independent ratings of video-recorded DISCAP-5 interviews, and concurrent and discriminant validity were indexed against mother and father reports on the Strengths and Difficulties Questionnaire. Inter-rater reliability agreement was high for the presence and absence of any diagnosis, common externalizing (e.g., oppositional defiant disorder, conduct disorder) and internalizing disorders (separation anxiety disorder, generalized anxiety disorder), and severity of primary and secondary diagnoses. Rating scale data supported the concurrent and discriminant validity of diagnoses based on the DISCAP-5. The DISCAP-5 appears to provide valid and reliable data in the diagnostic assessment of clinic-referred children with behavioral and emotional difficulties across broad ranges of severity and complexity.

Early Development of ADHD and ODD Symptoms from the Toddler to Preschool Years.

OBJECTIVE: ADHD and ODD are commonly co-occurring, but often studied individually. This study evaluated common trajectories of these disorders and explored how they co-develop in early childhood. METHOD: Community parents (N = 273) completed online surveys about their 2-year-old. Children's inattention, hyperactivity/impulsivity, and oppositional defiant disorder symptoms over 2 years were examined using latent class, dual trajectory, and cross-lagged analyses. RESULTS: Most children followed low symptom trajectories. A small portion showed high, moderate, or increasing trajectories. The hyperactive/impulsive domain of ADHD showed a declining symptoms group. Children in high ODD groups were likely to be in high ADHD symptom groups; the converse was true but probabilities were lower. Hyperactive/impulsive symptoms predicted ODD symptoms across time, more than vice versa. CONCLUSION: The study extends the small body of literature assessing early development of ADHD and ODD. Findings suggest that earlier intervention for symptoms of ADHD may mitigate risk of developing ODD.

Attention-Deficit/Hyperactivity Disorder Symptoms and Externalizing Progression in the LAMS Study: A Test of Trait Impulsivity Theory.

OBJECTIVE: To test differential prospective prediction of growth in externalizing behavior, including oppositional defiant disorder, conduct disorder, and substance use disorders, by earlier hyperactive-impulsive (HI) vs inattentive (IN) symptoms of attention-deficit/hyperactivity disorder (ADHD). METHOD: Participants in the Longitudinal Assessment of Manic Symptoms (LAMS) Study (N = 685 at study entry), including 458 boys and 227 girls ages 6-12, completed full parent report and self-report assessments every year for 8 years on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Three sets of analyses were conducted. First, hierarchal regression (block entry) was used to test independent associations between HI symptoms and later externalizing outcomes, controlling for IN symptoms, and IN symptoms and later externalizing outcomes, controlling for HI symptoms. Second, logistic regression was used to test progression of DSM externalizing disorders. Third, tests of mediation were used to assess potentiation of externalizing progression through environmental risk mediators (eg, family environment, neighborhood violence). RESULTS: Consistent with hypotheses derived from trait impulsivity theories of externalizing behavior, HI symptoms of ADHD were associated independently with long-term externalizing outcomes, whereas IN symptoms were not. Between months 48 and 96, ADHD-HI/combined symptom subtype diagnoses predicted later oppositional defiant disorder diagnoses, oppositional defiant disorder diagnoses predicted later conduct disorder diagnoses, and conduct disorder diagnoses predicted later substance use disorder diagnoses. Evidence for environmental risk mediation (eg, parental monitoring, neighborhood violence) was also found. CONCLUSION: Findings support trait impulsivity models of externalizing progression, whereby ADHD-HI/combined symptoms subtypes predispose to increasingly severe externalizing behaviors, which are magnified in contexts of environmental risk.

ADHD and ODD Dimensions: Time Varying Prediction of Internalizing Problems from Childhood to Adolescence.

OBJECTIVE: Although childhood ADHD is a risk factor for internalizing problems, it consists of separable inattention and hyperactivity dimensions that differentially predict outcomes. Oppositional defiant disorder also consists of separable dimensions (i.e., irritable, oppositional), co-occurs with ADHD, and predicts internalizing outcomes. To discern independent associations with internalizing problems, dimensions must be considered simultaneously. METHODS: Controlling for age, sex, and race, we tested inattention, hyperactivity, irritability, and oppositionality as time-varying predictors of 6 to 7-year prospective change in parent- and teacher-rated internalizing problems in 230 ethnically- diverse (50% Caucasian) 5 to 10 year old youth (M = 7.4 years, 68% male) with (n = 120) and without ADHD (n = 110). RESULTS: Escalating inattention and irritability, but not hyperactivity and oppositionality, uniquely predicted internalizing problems. CONCLUSION: These findings suggest that inattention and irritability are unique risk factors for later internalizing problems. These dimensions may catalyze internalizing problems across development and constitute important intervention targets.

Characterizing Underlying Cognitive Components of ADHD Presentations and Co-morbid Diagnoses: A Diffusion Decision Model Analysis.

OBJECTIVE: To Explore whether subtypes and comorbidities of attention-deficit hyperactivity disorder (ADHD) induce distinct biases in cognitive components involved in information processing. METHOD: Performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared between 150 children (aged 7 to 10) with ADHD, grouped by DSM-5 presentation (ADHD-C, ADHD-I) or co-morbid diagnoses (anxiety, oppositional defiant disorder [ODD], both, neither), and 60 children without ADHD. Diffusion decision modeling decomposed performance into cognitive components. RESULTS: Children with ADHD had poorer information integration than controls. Children with ADHD-C were more sensitive to changes in presentation modality (auditory/visual) than those with ADHD-I and controls. Above and beyond these results, children with ADHD+anxiety+ODD had larger increases in response biases when targets became frequent than children with ADHD-only or with ADHD and one comorbidity. CONCLUSION: ADHD presentations and comorbidities have distinct cognitive characteristics quantifiable using DDM and IVA-CPT. We discuss implications for tailored cognitive-behavioral therapy.