Oppositional defiant and conduct disorders: issues to be resolved for DSM-IV

Area of Science:

• Child and Adolescent Psychiatry
• Developmental Psychology
• Behavioral Science

Background:

• Oppositional defiant disorder (ODD) and conduct disorder (CD) are disruptive behavior disorders in youth.
• These disorders are characterized by patterns of hostility and defiance toward authority figures.

Purpose of the Study:

• To examine the distinctiveness and relationship between ODD and CD.
• To explore the developmental progression and hierarchical organization of these disorders.

Main Methods:

• Statistical analysis of symptom covariation and age of onset.
• Assessment of impairment and family history of antisocial behavior.
• Longitudinal observation of symptom development in clinic-referred youth.

Main Results:

• ODD and CD exhibit distinct symptom patterns and ages of onset.
• Both disorders correlate with impairment and family history of antisocial behavior, more strongly for CD.
• Youth with early-onset CD often exhibit prior ODD symptoms, indicating developmental progression.
• Some adolescent-onset CD cases appear independent of ODD, suggesting separate disorder classification.

Conclusions:

• ODD and CD may represent hierarchically organized, developmentally staged levels of severity of a single disorder.
• Distinct diagnostic categories in DSM-IV are supported by the independence of adolescent-onset CD and the fact that many ODD cases do not progress to CD.