Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD‐11 with ICD‐10 and DSM‐5
Background Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’...
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| Published in: | Journal of child psychology and psychiatry Vol. 62; no. 3; pp. 303 - 312 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Blackwell Publishing Ltd
01.03.2021
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| ISSN: | 0021-9630, 1469-7610, 1469-7610 |
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| Abstract | Background
Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’s (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD‐10’s (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD‐11 classification of chronic irritability and oppositionality as compared to the ICD‐10 and DSM‐5 approaches.
Methods
Clinicians (N = 196) from 48 countries participated in an Internet‐based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.
Results
Compared to ICD‐10 and DSM‐5, ICD‐11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM‐5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.
Conclusions
The formulation of irritability and oppositionality put forth in ICD‐11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability. |
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| AbstractList | Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches.BACKGROUNDSevere irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches.Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.METHODSClinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.RESULTSCompared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.CONCLUSIONSThe formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability. Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches. Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability. Background Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’s (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD‐10’s (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD‐11 classification of chronic irritability and oppositionality as compared to the ICD‐10 and DSM‐5 approaches. Methods Clinicians (N = 196) from 48 countries participated in an Internet‐based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. Results Compared to ICD‐10 and DSM‐5, ICD‐11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM‐5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. Conclusions The formulation of irritability and oppositionality put forth in ICD‐11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability. BackgroundSevere irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD‐11, a solution markedly different from DSM‐5’s (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD‐10’s (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD‐11 classification of chronic irritability and oppositionality as compared to the ICD‐10 and DSM‐5 approaches.MethodsClinicians (N = 196) from 48 countries participated in an Internet‐based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability.ResultsCompared to ICD‐10 and DSM‐5, ICD‐11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM‐5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability.ConclusionsThe formulation of irritability and oppositionality put forth in ICD‐11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability. |
| Author | Ezpeleta, Lourdes Khoury, Brigitte Burke, Jeffrey D. Matsumoto, Chihiro Andrews, Howard F. Youngstrom, Eric A. Robles, Rebeca Zhao, Min Roberts, Michael C. Evans, Spencer C. Peña, Francisco Lochman, John E. Keeley, Jared W. Rebello, Tahilia J. Elena Medina‐Mora, María Ayuso‐Mateos, José L. Sharan, Pratap Kulygina, Mayya Fite, Paula J. Matthys, Walter Reed, Geoffrey M. |
| AuthorAffiliation | 4 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA 5 Behavioral Health Services and Policy Research, Research Foundation for Mental Hygiene, New York, NY, USA 12 Japanese Society of Psychiatry and Neurology, Tokyo, Japan 16 Alekseev Mental Health Clinic №1, Moscow, Russian Federation 19 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland 15 Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon 8 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA 18 Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China 2 Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA 3 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA 11 Department of Psychology, University of North Carolina, Chapel Hill, NC, USA 17 Department of Psychiatry, ll India Institute of Medical Sciences |
| AuthorAffiliation_xml | – name: 15 Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon – name: 1 Department of Psychology, Harvard University, Cambridge, MA, USA – name: 10 Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands – name: 13 Columbia University Medical Center, New York, NY, USA – name: 8 Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA – name: 19 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland – name: 7 Department of Psychology, University of Alabama, Tuscaloosa, AL, USA – name: 9 Research Group Epidemiology and Diagnosis in Developmental Psychopathology, Autonomous University of Barcelona, Barcelona, Spain – name: 17 Department of Psychiatry, ll India Institute of Medical Sciences, New Delhi, India – name: 3 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA – name: 18 Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China – name: 4 Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA – name: 6 National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico – name: 2 Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA – name: 5 Behavioral Health Services and Policy Research, Research Foundation for Mental Hygiene, New York, NY, USA – name: 14 Department of Psychiatry, Autonomous University of Madrid, Madrid, Spain – name: 16 Alekseev Mental Health Clinic №1, Moscow, Russian Federation – name: 11 Department of Psychology, University of North Carolina, Chapel Hill, NC, USA – name: 12 Japanese Society of Psychiatry and Neurology, Tokyo, Japan |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32396664$$D View this record in MEDLINE/PubMed |
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| Keywords | child and adolescent mental health oppositional defiant disorder irritability International Classification of Diseases (ICD-11) mood dysregulation |
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| Notes | Read the Commentary on this article at doi https://doi.org/10.1111/jcpp.13354 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Spencer Evans is now affiliated with the Department of Psychology at the University of Miami, FL, USA |
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Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health... Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations,... BackgroundSevere irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health... |
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| SubjectTerms | Adolescent Attention Deficit and Disruptive Behavior Disorders Bipolar disorder Child Child & adolescent mental health Child & adolescent psychiatry child and adolescent mental health Childhood Classification Conduct disorder Diagnostic and Statistical Manual of Mental Disorders Diagnostic systems Differentiation Disorders Emotions Field study Fieldwork Humans Individualized Instruction International Classification of Diseases International Classification of Diseases (ICD‐11) Internet Irritability Irritable Mood Japanese language Manipulation Medical diagnosis Medical personnel Mental health Mental health professionals Mental health services Mood Disorders mood dysregulation Multilingualism Oppositional defiant disorder Psychopathology Public health Spanish language Vignettes |
| Title | Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD‐11 with ICD‐10 and DSM‐5 |
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