An Item Response Theory Analysis of DSM-IV Conduct Disorder

Objective: We examined DSM-IV conduct disorder (CD) symptom criteria in a community sample of male and female adolescents to evaluate the extent to which DSM-IV criteria characterize the range of severity of adolescent antisocial behavior within and across sex. Method: Interviews were conducted with 3,208 adolescents between the ages of 11 and 18 years using the Diagnostic Interview Schedule for Children. Item response theory analyses were performed to obtain severity and discrimination parameters for each of the lifetime DSM-IV CD symptom criteria. In addition, item response theory-based differential item functioning analyses were conducted to examine the extent to which the symptom criteria function similarly across sex. Results: The DSM-IV CD symptom criteria are useful and meaningful indicators of severe adolescent antisocial behavior. A single item (Steal without Confrontation) was a poor indicator of severe antisocial behavior. The CD symptom criteria function similarly across sex; however, three items had significantly different severity parameters. Conclusions: The DSM-IV CD criteria are informative as categorical and continuous measures of severe adolescent antisocial behaviors however, some CD criteria display sex bias. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(1):42-50.