Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers.

BACKGROUND: Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention. METHODS: Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis. RESULTS: Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years. CONCLUSIONS: These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

Further evidence of the reliability and validity of DSM-IV ODD and CD in preschool children.

OBJECTIVE: To test the reliability and validity of DSM-IV oppositional defiant and conduct disorders (ODD and CD) and symptoms using the Kiddie Disruptive Behavior Disorders Schedule and generate data on the manifestation of symptoms of ODD and CD in 3- to 5-year-old children. METHOD: One hundred twenty-three consecutive referrals to a child and adolescent psychiatry clinic and 100 children recruited from a pediatric clinic and their biological mothers participated. Mothers were interviewed about current ODD and CD symptoms, and mother and teachers completed measures of impairment. Twenty-five percent of the interviews were randomly selected and coded by a second rater to test interrater reliability. A separate sample of 31 children was recruited for a 1-week test-retest study. RESULTS: Overall, reliability of ODD and CD symptoms as measured by interrater and test-retest reliability was moderate to high. Reliability was not affected by age or sex of the child. Validity was demonstrated via associations with impairment and differentiation between referred and nonreferred children. CONCLUSIONS: Most DSM-IV ODD and CD symptoms can be reliably and validly assessed in preschool children. Some developmental modifications are recommended. The results add to the literature on best methods of assessment of preschool psychopathology.