Diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-10 alcohol diagnoses in adolescents

Objective: Little is known about the validity of diagnostic criteria for al cohol use disorders (AUDs) when applied to adolescents. This study examined the diagnostic concordance of DSM-III, DSM-III-R, DSM-IV and ICD-IO AUDs i n a sample of adolescents with a broad range of alcohol problem severity. M ethod: Participants were 413 adolescents (250 male), ages 13 to 19, drawn f rom clinical and community sources. AUDs were assessed using the Structured Clinical Interview for the DSM (SCID), modified to make diagnoses in the f our nosological systems. Diagnostic agreement for lifetime diagnoses was qu antified with the kappa statistic. Results: Agreement was fair to high acro ss the three categories of alcohol dependence, alcohol abuse and no alcohol diagnosis (kappa = 0.51 to 0.76); for alcohol dependence (kappa = 0.51 to 0.83); and for the categories of any AUD versus no AUD (kappa = 0.55 to 0.9 6). Concordance was very tow for alcohol abuse diagnoses (kappa = 0.10 to 0 .23), with the exception of DSM-III-R and DSM-IV (kappa = 0.62). Dependence was superior to abuse in the degree of temporal overlap in diagnostic agre ements. Conclusions: Similar to findings with adults, diagnostic concordanc e among adolescents tended to be fair to high for alcohol dependence and ve ry low for alcohol abuse. The data highlight the inconsistency across nosol ogical systems in the conceptual framework and definition of the alcohol ab use category.