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Defining oppositional defiant disorder.

Richard Rowe1, Barbara Maughan, E Jane Costello

  • 1MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London, UK. r.rowe@iop.kcl.ac.uk

Journal of Child Psychology and Psychiatry, and Allied Disciplines
|November 30, 2005
PubMed
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The International Classification of Diseases, 10th Revision (ICD-10) identifies children with oppositional defiant disorder (ODD) subtypes missed by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). These children exhibit significant impairment, suggesting a diagnostic gap.

Area of Science:

  • Child and Adolescent Psychiatry
  • Developmental Psychology
  • Clinical Psychology

Background:

  • Conduct disorder (CD) and oppositional defiant disorder (ODD) diagnostic criteria differ between ICD-10 and DSM-IV.
  • ICD-10 jointly considers CD and ODD symptom lists, unlike DSM-IV's separate approach.
  • This divergence results in ICD-10 identifying a subgroup of children with ODD not diagnosed under DSM-IV.

Purpose of the Study:

  • To investigate the characteristics of children diagnosed with ODD under ICD-10 but not DSM-IV.
  • To compare the psychiatric comorbidity, delinquent activity, and psychosocial impairment of this group with those meeting DSM-IV criteria.

Main Methods:

  • Utilized data from the Great Smoky Mountains Study of children aged 9-16.
  • Employed standardized diagnostic interviews for child and parent reports on symptoms.

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  • Assessed psychosocial impairment through both cross-sectional and longitudinal analyses.

    • Main Results:

    • Children receiving an ICD-10 ODD diagnosis but not a DSM-IV diagnosis showed comparable psychiatric comorbidity.
    • This group exhibited similar levels of delinquent activity and psychosocial impairment to DSM-IV diagnosed children.
    • Both cross-sectional and longitudinal data supported these findings.

    Conclusions:

    • DSM-IV criteria may exclude substantially disturbed children who meet ICD-10 ODD subtype criteria.
    • The study highlights a potential diagnostic gap in DSM-IV for certain pediatric behavioral disorders.
    • Consideration of alternative diagnostic approaches is warranted to ensure comprehensive identification of affected children.