Early ADHD and ODD symptoms linked to later bullying



Children with early symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional-defiant disorder (ODD) are more likely to become bullies or bully/victims, according to a recent study.

“ADHD and ODD at preschool age predicted children’s risk of bullying involvement in the first years of elementary school, suggesting a possible antecedent effect,” reported Marina Verlinden, Ph.D., of Erasmus University Medical Center Rotterdam (the Netherlands) and her associates.

©Mikael Damkier/

“The effects in the group of bully/victims were rather pronounced, and this is consistent with the studies showing that bully/victims are the most troubled group with the greatest levels of concurrent psychopathology,” the researchers wrote (J. Am. Acad. Child Adolesc. Psychiatry 2015;54:571-9).

The team tracked 3,192 children from a larger population-based birth cohort for at least 5 years after parents filled out reports about their children’s behavior using the Child Behavior Checklist. The children, assessed at 1.5 years, 3 years, and/or 5 years, were born between April 2002 and January 2006 in Rotterdam, the Netherlands.

Then, when the children were an average 6.6 years of age, teachers reported whether the children were involved in or victimized by any physical, verbal, relational, or material bullying. In addition, classmates rated the bullying involvement of 1,098 of the children when they were an average 7.6 years old. An overall 907 children from the cohort were assessed by both their teachers and their peers, with 66% agreement regarding bullying involvement.

Higher behavioral scores – indicating more symptoms of ADHD or ODD – at age 1.5 years were not associated with later bullying involvement. By 3 years old, however, those with greater ADHD symptoms had 20% greater odds of being a bully, and 28% greater odds of being a bully/victim. Those with symptoms of ODD at age 3 years had 17% greater odds of being a bully.

Behavioral scores at age 5 years had a stronger correlation with bullying involvement. Those with ADHD symptoms had 32% greater odds of bullying, 22% greater odds of being victimized, and 46% greater odds of being a bully/victim. Similarly, those with ODD symptoms had 30% greater odds of bullying and 35% greater odds of being a bully/victim, compared with those without high ODD symptom scores.

The researchers adjusted their calculations for the child’s age, gender, national origin, and daycare attendance, as well as the mother’s age, parity, educational level, marital status, household income, depression symptoms, parenting stress, and discipline practices. Additional adjustments for combined ADHD and ODD symptoms attenuated the association, but did not eliminate it.

“Because of the high comorbidity of ADHD and ODD conditions, it is difficult to disentangle their individual effects on children’s bullying involvement,” Dr. Verlinden and her associates wrote.

Overall, 69.9% of the children were not involved in bullying, based on teacher ratings, while 14.1% were bullies, 4.2% were victims, and 11.8% were both. Based on peer ratings, 70.1% were uninvolved in bullying, 10.8% were bullies, 13.1% were victims, and 6% were both.

The research was funded by the Erasmus University Medical Center, the Netherlands Organization for Health Research and Development, the Netherlands Organization for Scientific Research, and the Sophia Foundation for Medical Research. One author was paid as a contributing author of the Achenbach System of Empirically Based Assessment, and one author has received grants from the National Institutes of Health. Dr. Verlinden and the remaining authors had no relevant financial disclosures.

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