• Oppositional Defiant Disorder;
  • nosology

Background:  ICD-10 and DSM-IV include similar criterial symptom lists for conduct disorder (CD) and oppositional defiant disorder (ODD), but while DSM-IV treats each list separately, ICD-10 considers them jointly. One consequence is that ICD-10 identifies a group of children with ODD subtype who do not receive a diagnosis under DSM-IV.

Methods:  We examined the characteristics of this group of children using the Great Smoky Mountains Study of children in the community aged 9–16. This study provided child and parent reports of symptoms and psychosocial impairment assessed with standardised diagnostic interviews.

Results:  Children who received an ICD-10 diagnosis but not a DSM-IV diagnosis showed broadly similar levels of psychiatric comorbidity, delinquent activity and psychosocial impairment to those who met DSM-IV criteria in both cross-sectional and longitudinal analyses.

Conclusions:  These results indicate that DSM-IV excludes from diagnosis children who receive an ICD-10 diagnosis of CD (ODD sub-type), and who are substantially disturbed. Methods of redressing this situation are considered.