Journal of Abnormal Child Psychology

, Volume 21, Issue 4, pp 377–410 | Cite as

Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder

  • Rolf Loeber
  • Kate Keenan
  • Benjamin B. Lahey
  • Stephanie M. Green
  • Christopher Thomas


This paper compares the validity of DSM-III-R diagnoses of oppositional defiant disorder (ODD) and conduct disorder (CD) and an alternative option which is subdivided into three levels according to developmental sequence and severity: modified oppositional disorder (MODD), intermediate CD (ICD), and advanced CD (ACD). Using a sample of 177 boys followed over 3 years, both the DSM-III-R and the alternative diagnostic constructs are evaluated on three criteria: symptom discriminative validity, and diagnostic external and predictive validity. Most DSM-III-R ODD and CD symptoms discriminated between ODD and CD, but exceptions are noted. Additional analyses demonstrated considerable overlap among DSM-III-R oppositional symptoms. The majority of the symptoms proposed for the alternative option could be assigned to a specific level based on acceptable symptom discrimination. External validity lent support to the distinctions between DSM-III-R ODD and CD, and between MODD, ICD, and ACD. MODD was a better predictor than ODD of which boys received a later diagnosis of CD. Suggestions are made for the inclusion and exclusion of symptoms for developmentally based diagnoses of oppositional and conduct disorders.


Good Predictor External Validity Additional Analysis Conduct Disorder Discriminative Validity 
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  1. Achenbach, T. M. (1978). The child behavior profile: I. Boys aged 6–11.Journal of Consulting and Clinical Psychology, 46, 478–488.Google Scholar
  2. Achenbach, T. M., & Edelbrock, C. S. (1979). The child behavior profile: II. Boys aged 12–16 and girls aged 6–11 and 12–16.Journal of Consulting and Clinical Psychology, 47, 223–233.Google Scholar
  3. Achenbach, T. M., & Edelbrock, C. S. (1983).Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont.Google Scholar
  4. American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  5. American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  6. American Psychiatric Association. (1991).The DSM-IV options book. Washington, DC: Author.Google Scholar
  7. Barkley, R. A., Costello, A., & Spitzer, R. (1989).The development of the DSM-1U-R criteria for the disruptive behavior disorders. Unpublished manuscript, Department of Psychiatry, University of Massachusetts Medical Center, Worcester, MA.Google Scholar
  8. Cohen, J. (1960). A coefficient of agreement for nominal scales.Educational and Psychological Measures, 20, 37–46.Google Scholar
  9. Cohen, P., & Flory, M. (1990). Report on a senes of analyses of attention deficit disorder and oppositional defiant disorder undertaken for DSM-IV. Unpublished Manuscript. New York State Psychiatric Institute, New York, N.Y.Google Scholar
  10. Copas, J., & Loeber, R. (1990). Relative improvement over chance for 2 × 2 tables.British Journal of Statistical and Mathematical Psychology, 43, 293–307.Google Scholar
  11. Costello, A. J., Edelbrock, C. S., Dulcan, M. K., Kalas, R., & Klaric, S. H. (1984).Report on the NIMH Diagnostic Interview Schedule for Children (DISC). Unpublished manuscript, Western Psychiatric Institute and Clinic, Pittsburgh, PA.Google Scholar
  12. Farrington, D., & Loeber, R. (1989). RIOC and phi as measures of predictive efficiency and strength of association in 2 x 2 tables.Journal of Quantitative Criminology, 5, 201–213.Google Scholar
  13. Kolko, D. J., & Kazdin, A. E. (1991). Aggression and psychopathology in matchplaying and firesetting children: A replication and extension.Journal of Clinical Child Psychology, 20, 191–201.Google Scholar
  14. Lahey, B. B., Loeber, R., Quay, H. C., Frick, P. J., & Grimm, J. (1992). Oppositional defiant and conduct disorders: Issues to be resolved for DSM-IV.Journal of the American Academy of Child and Adolescent Psychiatry, 31(3), 539–546.Google Scholar
  15. Lahey, B. B., Loeber, R., Stouthamer-Loeber, M., Christ, M. A. G., Green, S., Russo, M. F. Frick, P. J., & Dulcan, M. (1990). Comparison of DSM-III and DSM-IH-R diagnoses for prepubertal children: Changes in prevalence and validity.Journal of the American Academy of Child and Adolescent Psychiatry, 29, 620–626.Google Scholar
  16. Loeber, R. (1982). The stability of antisocial and delinquent child behavior: A review.Child Development, 53, 1431–1446.Google Scholar
  17. Loeber, R., & Dishion, T. J. (1983). Early predictors of male delinquency: A review.Psychological Bulletin, 94, 68–99.Google Scholar
  18. Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals' perception of the utility of children, mothers, and teachers as informants on childhood psychopathology.Journal of Clinical Child Psychology, 19, 136–143.Google Scholar
  19. Loeber, R., Green, S. M., Lahey, B. B., & Stouthamer-Loeber, M. (1989). Optimal informants on childhood disruptive behaviors.Development and Psychopathology, 1, 317–337.Google Scholar
  20. Loeber, R., Lahey, B. B., & Thomas, C. (1991). The diagnostic conundrum of oppositional defiant disorder and conduct disorder.Journal of Abnormal Psychology, 100, 379–390.Google Scholar
  21. Loeber, R., & Stouthamer-Loeber, M. (1987). Prediction. In H. C. Quay (Ed.),Handbook of juvenile delinquency (pp. 325–382). New York: John Wiley & Sons.Google Scholar
  22. Loeber, R., Stouthamer-Loeber, M., Van Kammen, W. B., & Farrington, D. P. (1991). Initiation, escalation and desistance in juvenile offending and their correlates.Journal of Criminal Law and Criminology, 82, 36–82.Google Scholar
  23. Olweus, D. (1979). Stability of aggressive reaction patterns in males: A review.Psychological Bulletin, 86, 852–857.Google Scholar
  24. Robins, L. (1986). Changes in conduct disorder over time. In D. C. Farren & J. D. McKinney (Eds.),Risk in intellectual and psychosocial development (pp. 227–259). New York: Academic Press.Google Scholar
  25. Spitzer, R. L., Cohen, J., Fleiss, J. L., & Endicott, J. (1967). Quantification of agreement in psychiatric diagnosis.Archives of General Psychiatry, 17, 83–87.Google Scholar
  26. Stattin, H., & Magnusson, D. (1989). The role of early aggressive behavior in the frequency, seriousness, and types of later crimes.Journal of Consulting and Clinical Psychology, 57, 710–718.Google Scholar
  27. Stouthamer-Loeber, M. (1986). Boys who lie.Journal of Abnormal Child Psychology, 14, 551–564.Google Scholar
  28. Zimring, F. E. (1979). American youth violence: Issues and trends. In N. Morris & M. Tonry (Eds.),Crime and justice: An annual review of research (Vol. 1, pp. 67–107). Chicago: University of Chicago Press.Google Scholar

Copyright information

© Plenum Publishing Corporation 1993

Authors and Affiliations

  • Rolf Loeber
    • 1
  • Kate Keenan
    • 1
  • Benjamin B. Lahey
    • 2
  • Stephanie M. Green
    • 1
  • Christopher Thomas
    • 3
  1. 1.Western Psychiatric Institute and ClinicSchool of MedicinePhiladelphia
  2. 2.Department of PsychiatryUniversity of MiamiMiami
  3. 3.University of Texas Medical BranchGalveston

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