The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountains Study.

BACKGROUND We examine models of the relationship between oppositional defiant disorder (ODD) and conduct disorder (CD) in a community sample. Particular attention is paid to the generalisability of findings based on clinic-referred boys. METHODS The analyses were based on four waves of data from the Great Smoky Mountains Study covering children in the community aged 9-16 years. Child and parent reports of DSM-IV symptoms, diagnoses, and a range of family and environmental adversities were collected using the Child and Adolescent Psychiatric Assessment. RESULTS Cross-sectional analyses indicated that CD and ODD largely shared similar correlates, although some aspects of parenting appeared more related to CD than ODD. This pattern was broadly similar in boys and girls. Longitudinal analyses confirmed that ODD was a strong risk factor for CD in boys and there was a suggestion that ODD was a stronger risk factor for CD than for other common disorders. Atypical family structure was an important factor in the transition between ODD and CD in boys. In girls ODD provided no increased risk for later CD but was associated with increased risk for continued ODD, depression, and anxiety. CONCLUSIONS These results are more consistent with a developmental relationship between ODD and CD in boys than girls.