Oppositional defiant disorder with onset in preschool years: Longitudinal stability and pathways to other disorders

Objective: To examine the stability and change in oppositional defiant diso rder (ODD) with onset among preschool children in a pediatric sample. Metho d: A total of 510 children aged 2-5 years were enrolled initially in 1989-1 990 (mean age 3.42 years); 280 participated in five waves of data collectio n over a period of 48 to 72 months (mean wave 5 age, 8.35 years). Test batt eries varied by age, but they included the Child Behavior Checklist, develo pmental evaluation, Rochester Adaptive Behavior Inventory, and a play sessi on (before age 7 years) and a structured interview (Diagnostic Interview fo r Children and Adolescents, parent and child versions) at ages 7+ years. Co nsensus diagnoses were assigned by using best-estimate procedures. Results: Wave 1 single-diagnosis ODD showed a significant relationship with both si ngle-diagnosis ODD and single-diagnosis attention-deficit hyperactivity dis order (ADHD) at subsequent waves, but not with single-diagnosis anxiety or mood disorders. Single-diagnosis ODD at wave 1 was associated with later co morbidity of ODD/ADHD, ODD/anxiety, and ODD/mood disorders. Stability acros s waves 2 through 5 was moderate to high for comorbid ODD/anxiety and ODD/A DHD; low to moderate stability for single-diagnosis ODD and single-diagnosi s mood disorder; and low for mood disorder, single-diagnosis ADHD, and sing le-diagnosis anxiety disorder. Conclusions: Preschool children with ODD are likely to continue to exhibit disorder, with increasing comorbidity with A DHD, anxiety, or mood disorders.