Journal of the American Academy of Child & Adolescent Psychiatry
Research Update ReviewOppositional Defiant and Conduct Disorder: A Review of the Past 10 Years, Part I
Section snippets
FEATURES OF ODD AND CD
The essential features of ODD are a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures, which leads to impairment, and the essential features of CD are a repetitive and persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated (American Psychiatric Association, 1994). See Table 1 for DSM-IV symptoms of ODD and CD. Regarding the recent development of diagnostic criteria,
ASSESSMENT
Knowledge about the prevalence and course of DBD is only as good as the available methods of assessment. Readers are referred to reviews of the assessment of DBD in juveniles by Frick and O'Brien, 1995, Dishion et al., 1995, and Hinshaw and Zupan (1997), and to a special section of the Journal of the American Academy of Child and Adolescent Psychiatry (McClellan and Werry, 2000).
EPIDEMIOLOGY
During the past 10 years, efforts to understand variations in the prevalence of ODD and CD according to age, gender, socioeconomic status, neighborhood, and degree of urbanicity have begun (Lahey et al., 1999a). Knowledge of these variations is important both for understanding the nature of these disorders and for the planning and administration of mental and public health services. Table 2 summarizes prevalence data from several population-based studies (excluding studies based on teacher
COMORBIDITY AND DEVELOPMENTAL CHANGES IN COMORBIDITY
The importance of studying target disorders in the context of comorbid disorders has been highlighted in several reviews (Angold et al., 1999, Caron and Rutter, 1991, Loeber and Keenan, 1994, Nottelman and Jensen, 1995). The emergence of comorbid conditions may indicate different levels of seriousness of disorder, with some comorbid conditions resulting in higher degrees of impairment than single conditions (e.g., Paternite et al., 1995). Risk assessment is still in an embryonic state regarding
CONCLUSION
Limited space cannot do justice to the complexity of DBD symptoms and syndromes, their course, and outcomes. Although the past 10 years have seen major development in this area, we identified several important issues to be addressed. While it is clear that oppositional behavior and covert delinquent behavior are distinct syndromes, it is not yet clear whether aggression should be considered to be (1) part of ODD, (2) part of CD (aggressive and covert CD behaviors), or (3) distinct from both ODD
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This series of 10-year updates in child and adolescent psychiatry began in July 1996. Topics are selected in consultation with the AACAP Committee on Recertification, both for the importance of new research and its clinical or developmental significance. The authors have been asked to place an asterisk before the 5 or 6 most seminal references.
This article was supported in part by NIMH grant MH 42529 to Dr. Loeber and Dr. Lahey, and NIMH grant MH 50778 to Dr. Loeber. The authors are grateful to Erica Spokart for editorial assistance.