68 Chapter 6
Symptoms and signs
The manifestations change with age. Younger children are more likely to
show the signs of oppositional-defiant disorder (ODD), which is a subtype
of CD in ICD-10 but a separate condition in DSM-IV. The criterion
behaviours for ODD (see Box 6.1) should occur much more often than in
other children or adolescents of the same developmental age. The DSM-IV
criteria for CD (see Box 6.2) are more likely to be met by adolescents, and
are closer to those for adult antisocial personality disorder. This definition
is less likely to include girls than previous definitions since early sexual
experience, early substance abuse and chronic violation of rules have
been dropped.
Box 6.1ICD-10∗criteria for oppositional-defiant disorder (ODD)
At least four of the following eight items have been present for at least six
months:Irritable items
1 Unusually frequent or severe temper outbursts.
2 Often touchy or easily annoyed.
3 Often angry or resentful.Headstrong items
4 Often argues with adults.
5 Often defies adult requests or rules.
6 Often deliberately annoys other people.
7 Often shifts blame to others.Hurtful items
8 Often spiteful or vindictive.
Recent studies suggest that when irritable items are particularly prominent,
there is a high concurrent and future risk of anxiety or depression. Likewise,
headstrong items seem linked to ADHD, and hurtful items to psychopathy.
Note:∗DSM-IV criteria for ODD are similar toThe ICD-10 Classification of
Mental and Behavioural Disorders: Diagnostic Criteria for Research(World Health
Organization, 1993).Associated features
Psychiatric symptoms
1 ADHD features: restlessness, inattentiveness, impulsiveness and general
over-activity often co-exist but are often been under-recognised in the
UK. The combination makes the outcome worse.
2 Low mood: about a third show significant emotional symptoms, most
commonly unhappiness and misery. When present, these symptoms
carry an increased risk for depression and deliberate self-harm in the
teenage years and adulthood.