Examination of the relationship between i̇rritability level and emotional-behavioral problems and functionality level in children and adolescents with codiagnosis of attention deficit hyperactivity disorder and opposition defiant disorder

In our study, children and adolescents diagnosed with both attention-deficit and hyperactivity disorder and oppositional defiant disorder were compared with those diagnosed only with attention-deficit and hyperactivity disorder and a healthy control group in terms of sociodemographic characteristics, clinical variables, irritability, emotional and behavioral problems, and level of functioning. The sample included 53 untreated children and adolescents between the ages of 6 and 12, along with their mothers, who presented to the Child and Adolescent Mental Health and Diseases Outpatient Clinic of Trakya University Faculty of Medicine Hospital between August 20, 2024, and January 20, 2025. Additionally, 53 adolescents who met the inclusion criteria were recruited as the healthy control group. A sociodemographic data form was completed during interviews with all participants, and psychiatric comorbidities were assessed using the Turkish adaptation of a structured diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Children completed the Emotional Reactivity Index – Child Form, and caregivers completed the Emotional Reactivity Index – Parent Form, the Conners Parent Rating Scale – Revised Short Form, the Weiss Functional Impairment Rating Scale – Parent Form, and the Strengths and Difficulties Questionnaire – Parent Form. According to self-reports, irritability levels in the group with both attention-deficit and hyperactivity disorder and oppositional defiant disorder were significantly higher than in the other groups (p < .001). In caregiver reports, irritability levels were similar between the two clinical groups (p < .05). Additionally, emotional and peer problems were more pronounced in the comorbid group (p = .001), and significant impairments were observed in family and learning functioning compared to the healthy controls (p < .05). These findings indicate that high irritability is strongly associated with greater psychopathological burden and functional impairment. They highlight the importance of addressing irritability in the treatment process for children and adolescents diagnosed with attention-deficit and hyperactivity disorder and oppositional defiant disorder. Keywords: attention deficit hyperactivity disorder, oppositional defiant disorder, irritability, emotional-behavioral problems, functionality