I. Diagnostic and Classification Systems with Children
A. Historical Overview: First classification system came into existence in the mid-1800s...children not included until the 20th century
1. DSM-I was established:
Why? How were childhood disorders represented?
2. DSM-II: New category-
"Behavior disorders of Childhood and Adolescence" was added.
3. DSM-III: more
emphasis on observable behavior, 4x as many categories for children, multiaxial
classification system.
4. DSM-III-R: more
sensitive to child psychopathology, new section- "Disorders Usually Diagnosed
in Infancy, Childhood, or Adolescence"
B. The current system: DSM-IV
DSM-IV: Diagnostic and Statistical Manual
of the American Psychiatric Association.
- The most common language in the U.S. of mental
health clinicians and researchers for communication about the disorders
for which they have professional responsibility.
1. Multiaxial approach
Axis I - Clinical Syndromes
- Patterns of abnormal behavior that impair functioning and are stressful
to the person
acute - have a beginning
and an end
episodic - repeated
Axis II - Personality
Disorders - only personality disorders and mental retardation
Deeply ingrained, maladaptive
ways of perceiving others and behavior that are stressful to the individual
or those who relate to the individual
**People may receive Axis I or Axis II diagnoses, or a combination of the two
Also multiple diagnoses within axes
Axis III - General Medical Conditions - Chronic and acute illnesses, injuries, allergies, etc., that affect functioning and treatment
Axis IV - Psychosocial and Environmental Problems - Stressors that occurred during the past year
Axis V - Global Assessment of Functioning - Overall judgment of current functioning and the highest level of functioning in the past year according to psychological, social, and occupational criteria
II. General Issues in the Classification and Diagnosis of Childhood Syndromes
A. Mentally Ill vs "Normal"
1.Rosenhan's study
2. Spitzer's criticism
B. Reliability: consistent results
under the same circumstances
1. Inter-rater reliability:
agreement between psychologists on a particular diagnosis
2. Reliability of the
DSM-IV- Pros and Cons
C. Labeling
1. Nomothetic vs Idiographic
approach- Nomothetic-putting individuals into categories based upon
many shared characteristics
Idiographic- attempting
to understand the uniqueness of the individual
2. Support for classification
(labels)-
a. Research
b. Provides a common language
c. Limitations reflect the current level of knowledge about psychopathology
d. A Label is functional if it can provide additional, important information
beyond the label itself
3. Objections to classification
a. Labels can shape all perceptions of people
b. Labels can cause prejudicial treatment
c. Labels can foster self-fulfilling prophecies
III. Issues in the Classification of Childhood Syndromes
A. Validity: test measures what it is supposed
to measure or a diagnostic category diagnoses what it is supposed
to diagnose.
1. Construct - a
hypothesized characteristic of an individual that cannot be directly observed
2. Construct Validity-
determining whether or not a diagnostic category successfully assesses
a construct (psychiatric diagnoses).
3. A valid diagnostic
label provides the following information about the individual:
a. Performance on tests/measures
b. Course & Outcome
c. Family history of psychiatric syndromes
d. Differentiation from other syndromes
e. Response to treatment
B. Categorical vs Dimensional Approaches
1. Categorical - Kraepelin
2. Dimensional
C. Correlations Among Different Syndromes
1. Correlation does not
necessarily mean that two syndromes (diagnoses) are linked
2. What correlation among
diagnoses may mean:
a. they have common causes
b. the 2 may have similar appearances at different points in development
c. they may have similar surface indicators
d. they are minor variations of the same thing
D. Which Childhood Syndromes Have Been Identified?
1. Externalizing- hyperactivity,
impulsivity, distractibility, aggression, delinquency, antisocial
2. Internalizing- anxiety,
depression, social withdrawal, somatic complaints, inattention-passivity
E. Are Children Classified Correctly?
1. Sensitivity- The percent
of children with the disorder who are correctly classified as having the
disorder. (True positives)
2. Specificity- The percent
of "normal" correctly classified as "normal". (true negatives)