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Beyond Symptom Counts for Diagnosing Oppositional Defiant Disorder and Conduct Disorder?

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Abstract

Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD) are among the most commonly diagnosed childhood behavioral health disorders. Although there is substantial evidence of heterogeneity of symptom presentations, DSM diagnoses of CD and ODD are formally diagnosed on the basis of symptom counts without regard to individual symptom patterns. We used unidimensional item response theory (IRT) two-parameter logistic (2PL) models to examine item parameters for the individual symptoms of CD and ODD using data on 6,491 adolescents (ages 13–17) from the National Comorbidity Study: Adolescent Supplement (NCS-A). For each disorder, the symptoms differed in terms of severity and discrimination parameters. As a result, some adolescents who were above DSM diagnostic thresholds for disruptive behavior disorders exhibited lower levels of the underlying construct than others below the thresholds, based on their unique symptom profile. In terms of incremental benefit, our results suggested an advantage of latent trait scores for CD but not ODD.

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Acknowledgements

This study was supported by a grant from the National Institute of Mental Health (NIMH) to the first author (MH 093508). The NCS dataset was funded by the National Institute of Mental Health (Grants R01 MH/DA46376 and R01 MH49098), the National Institute of Drug Abuse (through a supplement to R01 MH/DA46376), and the W. T. Grant Foundation (Grant 90135190).

Conflict of Interest

The authors declare that they have no conflict of interest

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Authors and Affiliations

  1. Department of Psychiatry School of Medicine, University of Pittsburgh, 3811 O’Hara St. 537 Bellefield Towers, Pittsburgh, PA, 15213, USA

    Oliver Lindhiem, Alison E. Hipwell & Dustin A. Pardini

  2. University of Pittsburgh Medical Center, Pittsburgh, USA

    Charles B. Bennett

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  1. Oliver Lindhiem
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  2. Charles B. Bennett
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  3. Alison E. Hipwell
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  4. Dustin A. Pardini
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Correspondence to Oliver Lindhiem.

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Oliver Lindhiem is Assistant Professor of the University of Pittsburgh holds a Ph. D. in journal layout

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Lindhiem, O., Bennett, C.B., Hipwell, A.E. et al. Beyond Symptom Counts for Diagnosing Oppositional Defiant Disorder and Conduct Disorder?. J Abnorm Child Psychol 43, 1379–1387 (2015). https://doi.org/10.1007/s10802-015-0007-x

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