Classes of Oppositional Defiant Disorder in Adolescence: Prediction to Later Conduct Disorder

Introduction: Recent revisions to the diagnostic criteria for oppositional defiant disorder (ODD) in the DSM 5 conceptualize the symptoms of this disorder within three separate but related dimensions (i.e., irritable mood, defiant behavior, vindictiveness). However, discrepant findings regarding the validity of these dimensions have limited their clinical utility. Person-centered approaches examining heterogeneity in behavior may be particularly helpful in understanding the structure of ODD. Previous studies utilizing this methodology (Burke, 2012; Kuny et al., 2013) are limited in that they largely examined ODD at one point in time during childhood. The current study aimed to address this limitation by examining the structure of ODD in adolescence (i.e., Grades 6-9). Additionally, given that the behavioral aspects of ODD have been linked to externalizing behaviors (Lavigne et al., 2014; Stringaris & Goodman, 2009), we examined the predictive validity of classes of ODD to later conduct disorder (CD). 

Methods: Data were collected from 521 adolescents (51.9% male; 48.7% White, 28.2% Black) as part of an epidemiological cohort study. Diagnostic information regarding ODD and CD was collected annually from adolescents and parents using the Diagnostic Interview Schedule for Children-IV (Shaffer et al., 2000). Latent classes of adolescents’ oppositional behavior were based on 11 past-year ODD symptom prevalence items.

Results: According to both reporters and across all four grades, a three class solution provided the most parsimonious fit to the data. Class 1 was high on all items (high), Class 2 was high on affective but low on behavioral items (moody), and Class 3 was low on all items (low). Log likelihood tests indicated that the classes were largely invariant across time. Wald chi-square tests examined the predictive validity of the ODD classes to later mean symptom counts of CD, over and above baseline (i.e., 6^th grade) symptom counts. Across all grades and reporters, adolescents in the high and moody classes generally reported more symptoms of CD as compared to those in the low class. Adolescents in the high class also generally reported more symptoms of CD than those in the moody class. 

Conclusions: While we did not find evidence of separate behavioral and affective classes in the current study, our findings highlight the distinct nature of the irritability symptoms of ODD. Both the affective and behavioral aspects of ODD were predictive of later CD, with the high class showing the most problematic pattern of behavioral dysregulation. These findings suggest that interventions targeting behavior problems may be effective for adolescents displaying both the full range of symptoms as well as those displaying primarily the moody aspects of ODD.