DSM-IV diagnosis of conduct disorder and oppositional defiant disorder: Implications and guidelines for school mental health teams

The DSM-IV criteria for conduct disorder (CD) and oppositional defiant disorder (ODD) are reviewed. These diagnoses are compared with their counterparts in DSM-III-R, and the rationale and empirical support for changes in criteria are described. Generally, DSM-IV criteria appear better operationalized and more closely conform to empirical studies than do prior criteria. However, results from DSM-IV field trials indicate that interrater and test-retest reliability were only marginally improved compared to prior criteria and remained moderately low by psychometric standards. Studies confirming the importance of subtyping CD on age of onset are reviewed, and empirical evidence for the relationship between ODD and early-onset CD is described. These criteria highlight the importance of alerting clinicians to early intervention, especially for symptoms of ODD that are typically easier to modify than ones of CD. Although overlooked in DSM-IV criteria, community factors, gender differences, and academic functioning are important considerations in school-based assessments and interventions.