title: Toward DSM-V: an item response theory analysis of the diagnostic process for DSM-IV alcohol abuse and dependence in adolescents.
abstract: OBJECTIVE
  Item response theory analyses were used to examine alcohol abuse and dependence symptoms and diagnoses in adolescents. Previous research suggests that the DSM-IV alcohol use disorder (AUD) symptoms in adolescents may be characterized by a single dimension. The present study extends prior research with a larger and more comprehensive sample and an examination of an alternative diagnostic algorithm for AUDs.
  
  
  METHODS
  Approximately 5,587 adolescents between the ages of 12 and 18 years from adjudicated, clinical, and community samples were administered structured clinical interviews. Analyses were conducted to examine the severity of alcohol abuse and dependence symptoms and the severity of alcohol use problems (AUDs) within the diagnostic categories created by the DSM-IV.
  
  
  RESULTS
  Although the DSM-IV diagnostic categories differ in severity of AUDs, there is substantial overlap and inconsistency in AUD severity of persons across these categories. Item Response Theory-based AUD severity estimates suggest that many persons diagnosed with abuse have AUD severity greater than persons with dependence. Similarly, many persons who endorse some symptoms but do not qualify for a diagnosis (i.e., diagnostic orphans) have more severe AUDs than persons with an abuse diagnosis. Additionally, two dependence items, "tolerance" and "larger/longer," show differences in severity between samples.
  
  
  CONCLUSIONS
  The distinction between DSM-IV abuse and dependence based on severity can be improved using an alternative diagnostic algorithm that considers all of the alcohol abuse and dependence symptoms conjointly.
authors.affiliation: School of Medicine at the University of Colorado at Denver, CO, USA. Heather.Gelhorn@UCHSC.edu
authors.forename: Heather
authors.initials: H
authors.lastname: Gelhorn
authors.forename: Christie
authors.initials: C
authors.lastname: Hartman
authors.forename: Joseph
authors.initials: J
authors.lastname: Sakai
authors.forename: Michael
authors.initials: M
authors.lastname: Stallings
authors.forename: Susan
authors.initials: S
authors.lastname: Young
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Rhee
authors.forename: Robin
authors.initials: R
authors.lastname: Corley
authors.forename: John
authors.initials: J
authors.lastname: Hewitt
authors.forename: Christian
authors.initials: C
authors.lastname: Hopfer
authors.forename: Thomas
authors.initials: T
authors.lastname: Crowley
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000145:classification* / Q000175:diagnosis* / Q000534:rehabilitation; D000465:Algorithms; D000987:Antisocial Personality Disorder / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation; D002648:Child; D003120:Colorado; D019955:Conduct Disorder / Q000145:classification / Q000175:diagnosis / Q000534:rehabilitation; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007604:Juvenile Delinquency / Q000331:legislation & jurisprudence / Q000523:psychology; D008297:Male; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity