Hot Publication - Lindhiem et al.
Beyond Symptom Counts for Diagnosing Oppositional Defiant Disorder and Conduct Disorder
Lindhiem O, Bennett CB, Hipwell AE and Pardini DA
Journal of Abnormal Child Psychology, Published Online
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.
Dr. Oliver Lindhiem and his team used two-parameter logistic item response theory (IRT) 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. Based on latent trait scores, it was expected that some adolescents above DSM diagnostic thresholds for these disruptive behavior disorders may actually be exhibiting less severe (in terms of a latent trait) manifestations of ODD and CD than others below the thresholds.
For each disorder (ODD and CD), individual symptoms differed in terms of severity and discrimination parameters. As a result, some adolescents who were above DSM diagnostic thresholds for each disorder exhibited lower levels of the underlying construct than others below the thresholds, based on their unique symptom profiles.
In terms of incremental benefit, the results suggested an advantage of latent trait scores for CD but not ODD.
Based on the results of this study and a review of the literature, Dr. Lindhiem and his colleagues recommend that clinicians use caution in assigning diagnoses for borderline and mild cases of CD and ODD.
Oliver Lindhiem, PhD, Charles Bennett, BS, Alison Hipwell, PhD and Dustin Pardini, PhD (Department of Psychiatry, University of Pittsburgh)