Child Psychopathology Diagnosis Treatment Reading for today: Chapter 4

Classification and diagnosis

What is classification and diagnosis What are “taxa” in biology? Taxonomy? Categorical approach appropriate for clinical purposes Dimensional approach empirically based and more appropriate for research purposes Cutoff scores can be used to convert a quantitative measure into a qualitative distinction, e.g., CDI score of 19 or greater becomes “depressed”

History of childhood classification 1840: U.S. Census data of “idiocy/insanity” 1880: Dementia, dipsomania, mania, melancholia, monomania, paresis 1948: WHO includes categories in ICD DSMI in 1952, DSMII in 1968, DSMIII in 1980, DSMIII-R in 1987, DSMIV in 1994 Why will there be a DSM-V?

DSM-IV Axes Axis I: Major Disorders Any mental disorder listed in the manual is indicated here, except for those on Axis II. In the case of more than one disorder, the primary disorder is listed first. Axis II: Personality Disorders and Mental Retardation Axis III: General Medical Conditions Any medical problems relevant to treatment of the patient. Axis IV: Psychosocial or Environmental Problems Any type of stressful events or problems with relationships, chronic or acute. Axis V: Global Assessment of Functioning A rating from 1 to 100, 1 indicating severe impairment in everyday functioning, and 100 being perfectly functional.

DSM-I Listed as "Homosexuality",Characterized as "ill primarily in terms of society and of conformity with the prevailing cultural milieu.” DSM-II Listed as "Homosexuality", Characterized as an "other non-psychotic mental disorder". DSM-III Listed as "Ego-Dystonic Homosexuality", for individuals experiencing distress over conflict between wishing to be heterosexual, but having homosexual tendencies. DSM-III-R & DSM-IV Not Included

What are the pros and cons of diagnostic labels? Summarizes and orders observations facilitates communication essential to etiology research epidemiology leads to treatment Stigmatisation Negative perceptions and reactions of others Negative view of self and behavior Can remove impetus to change or improve

Special considerations when treating children Treatment focuses on helping children adapt to their social environment in addition to problem behavior or subjective distress Treatment includes prevention, early identification, traditional treatment, and continuing care components Parental consent and involvement in treatment is essential Figure 4.7 shows range of interventions

Treatment models Behavioral: aberrant learning processes, operant/ classical Cognitive: cognitive deficits and distortions, faulty cognitions must be changed Cognitive-behavioral: how children think and react to their environment Client-centred: Unconditional positive regard will allow child to sort out social circumstances imposed on them Family models: Family structure and function impacts child Medical model: Biological basis of child psychopathology; drug-based interventions

Pros and cons of treatment effectiveness Therapy works for children in most cases Both for internalizing and externalizing disorders Specific problems are easier to treat Cognitive and behavioral treatments are most effective Structured therapy in research studies has demonstrated effects, but what about actual community treatment? Empirically-based interventions not always used Misdiagnoses lead to problems

Child Behavior Checklist is a commonly-used behavioral rating scale. What similarities and differences of parent, teacher, and self-versions? All rate child behavior in different areas: academic, physical, peers, social Parallel structure: size, items, 0/1/2 format Opportunity for open- ended responses Perspective differs Age range –CBCL 4-16, YSR , TRF school age Problem focus for CBCL, TRF; not for YSR Time frame –CBCL and YSR is 6 months; TRF is 2 months