Further Evidence of the Reliability and Validity of DSM-IV ODD and CD in Preschool Children

Viewing Preschool Disruptive Behavior Disorders and Attention-Deficit/Hyperactivity Disorder Through a Developmental Lens: What We Know and What We Need to Know

“…15 Most recently, interviews specifically validated for the preschool period have been employed, including the Preschool Age Psychiatric Assessment (PAPA), 3 in addition to other diagnostic tools (Kiddie Disruptive Behavior Disorders Schedule), which have been evaluated using clinical samples. 16 Across community samples, prevalence rates of ODD have ranged from 4% to 16.6%, which is similar to that found in older children. 17 Importantly, although Lavigne and colleagues 15 found the highest rates of ODD (i.e., 16.6%), this rate was reduced in half when impairment associated with the symptoms was required for the diagnosis (i.e., 8.1%).…”

“…Not surprisingly, children who meet symptom criteria for DBDs also experience substantial impairment in these domains. 3,16 Several investigators have also assessed predictive validity. Wakschlag and colleagues 6 found that 55% of their clinically enriched sample retained DBD status at one-year follow-up.…”

“…Keenan and colleagues 16 observed that virtually all preschoolers who met criteria for CD also met criteria for ODD. The one study that has examined the "fit" of this DSM diagnostic differentiation in preschoolers did not provide support for the ODD/CD distinction but rather for a unidimensional DBD construct.…”

“…Although this is particularly true for ODD and ADHD, even some CD symptoms that are generally defined as more serious, low-incidence behaviors may be prevalent in young children. For example, Keenan and colleagues 16 found that a significant number of nonreferred preschool children without behavioral concerns met DSM-IV symptom criteria for "uses object to harm" (14%) and "often lies" (20%). Further, these symptoms are defined solely by frequency ("i.e., often") during a period in which the presence of these behaviors per se is not pathognomonic.…”

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

“…The eight DSM-IV-TR diagnostic symptom criteria for ODD were modified by cutpoints for the frequency level of symptoms and reflect the top 10% of frequency for preschool children (31). Eight of the 15 DSM-IV-TR diagnostic symptom criteria that had previously been found applicable for CD in preschool-aged children were used for diagnostic decision making (31,32).…”