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

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ABSTRACT

Objective:

To test the reliability and validity of DSM-IV oppositional defiant and conduct disorders (ODD and CD) and symptoms using the Kiddie Disruptive Behavior Disorders Schedule and generate data on the manifestation of symptoms of ODD and CD in 3- to 5-year-old children.

Method:

One hundred twenty-three consecutive referrals to a child and adolescent psychiatry clinic and 100 children recruited from a pediatric clinic and their biological mothers participated. Mothers were interviewed about current ODD and CD symptoms, and mother and teachers completed measures of impairment. Twenty-five percent of the interviews were randomly selected and coded by a second rater to test interrater reliability. A separate sample of 31 children was recruited for a 1-week test-retest study.

Results:

Overall, reliability of ODD and CD symptoms as measured by interrater and test-retest reliability was moderate to high. Reliability was not affected by age or sex of the child. Validity was demonstrated via associations with impairment and differentiation between referred and nonreferred children.

Conclusions:

Most DSM-IV ODD and CD symptoms can be reliably and validly assessed in preschool children. Some developmental modifications are recommended. The results add to the literature on best methods of assessment of preschool psychopathology.

Section snippets

Diagnostic Validity Study.

Two hundred twenty-three 3- to 5-year-old children were enrolled in the Diagnostic Validity Study. Approximately half of the children (n = 123) were consecutive referrals to Child Psychiatry at the University of Chicago because of aggression, defiance, and/or problems controlling temper. The other half (n = 100) was recruited through the general pediatric clinic and was screened to establish that the caregiver was not seeking an evaluation for disruptive behavior problems. For both referred and

Reliability of ODD and CD Symptoms and Diagnoses

We tested the reliability of ODD and CD symptoms by computing κ statistics for the presence or absence of the symptom within informant and interviewer and across a 1-week time interval (i.e., test-retest reliability), and across interviewers within the same assessment (i.e., interrater reliability). The results are presented in Table 2. Kappa coefficients for 1-week test-retest reliability for ODD symptoms ranged from a low of 0.22 for often spiteful or vindictive to a high of 0.78 for often

DISCUSSION

In this first set of analyses from our current program of research, we aimed to test the reliability and validity of DSM-IV ODD and CD in 3- to 5-year-old children. We examined these issues on a number of levels (i.e., symptom, symptom count, diagnosis) and across methods (i.e., test-retest, interrater, validity) within a clinically referred sample and a demographically matched comparison group. To our knowledge, assessing reliability at the symptom level has not been a standard approach to

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    This project was supported by NIMH grants R01 MH62437 and R01 MH68455. The authors thank the families and staff of the Chicago Preschool Project and Drs. Paul Rathouz and Benjamin Lahey.

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    Copyright © 2007 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.