Lahey B B, Loeber R, Quay H C, Frick P J, Grimm J
Department of Psychiatry, University of Miami, FL.
J Am Acad Child Adolesc Psychiatry. 1992 May;31(3):539-46. doi: 10.1097/00004583-199205000-00023.
Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.
对立违抗性障碍（ODD）和品行障碍（CD）在症状的统计共变及起病年龄方面都有显著差异。这两种障碍在与损害及反社会行为家族史的关联方式上相似，但品行障碍的关联比对立违抗性障碍更强。几乎所有青春期前起病的品行障碍临床转诊青少年都保留了早年出现的对立违抗性障碍症状。此外，在一些品行障碍青少年中，一系列严重的反社会行为在较晚年龄出现，这表明品行障碍存在进一步的发展进程。这些发现与将对立违抗性障碍和品行障碍概念化为同一障碍的发展阶段、分层组织的严重程度水平相一致，但有两个发现支持在《精神疾病诊断与统计手册》第四版（DSM-IV）中区分独立的障碍：（1）许多对立违抗性障碍青少年从未发展成品行障碍，（2）青春期首次出现的品行障碍似乎独立于对立违抗性障碍。
