1. Chapter 5 Classification, Assessment, and Intervention Bilge Yağmurlu
PSYC 330
Developmental Psychopathology

2. Terminology Sign: feature that are observable by others
Symptom: feature that can be reported only by the individuals themselves
Syndrome: a set of signs and symptoms that covary across individuals
Classification: system for delineating the major categories or dimensions of syndromes
Diagnosis: the process of assigning individuals to the categories generated by a classification system

3. Terminology
Etiology  (aetiology, aitiology): the cause(s) of a disorder
Prognosis: denotes prediction of how a patient's disorder will progress, and whether there is chance of recovery
Comorbidity: presence of more than one mental disorder occurring in an individual at the same time
Epidemiology: the study of the patterns of disease in human populations... to estimate the prevalence of disorders and to identify their correlates and causes

4. Conceptual Framework Value of assessment:
Ability to identify characteristics important for decision making
Different procedures and sources of data:
Projective tests
Tabulations of overt behaviors
Personality inventories
Interviews

5. Taxonomic Targets for Assessment
Which characteristics will be assessed?
What are the targets for assessment?

6. Taxonomic Targets for Assessment
Error of Measurement
Variability in a measure’s results over brief intervals

7. Approaches to Conceptualize Child Psychopathology
Types of Problem Behaviors
Enumerates symptoms
Dimensions
Symptom clusters
Categories
Diagnostic criteria

8. Empirically Based Paradigm
“Bottom up”
Test correlates of syndromes
Quantitative aspects
Cross-Informant Syndrome Constructs
Constructs: Aggressive beh, anxious/depressed, attention problems, delinquent beh, social problems, somatic complaints, thought problems, & withdrawn

9. Empirical Classifications
Child behavior checklist (CBCL) given to large groups of youngsters, factor analysis conducted
Table 5-3 has symptoms associated with internalizing and externalizing disorders –Achenbach & Rescorla, 2001
Parent, teacher and youth self report.
Figure 5-1 example in book

10. Empirically Based Paradigm
“Syndromes” or symptom clusters
Undercontrolled
Overcontrolled
Common dimensions
Withdrawn
Social problems
Delinquent behavior
Aggressive behavior
Somatic complaints
Thought problems
Attention problems
Anxious/depressed

11. Empirically Based Paradigm
Norm-referenced profiles
Labelling

12. DSM Approach Explicit criteria Assessment procedures
Diagnostic interviews
How are criteria derived?

13. DSM Diagnostic Interviews
Diagnostic Interview Schedule for Children-Child Version (DISC-C)
DISC-P
Test-retest attenuation effects
Problem of threshold
DSM-IV diagnosis of ADHD: 6 out of 9 cireteria
Difficulty in understanding
Breton et al. (1995): 9 year-olds 16% for depression
11 year-olds 31%

14. Structured Diagnostic Interviews
Child & Adolescent Psychiatric Assessment (CAPA)

15. Diagnostic Efficiency
Determining indicators
which maximize our diagnostic “hits”
Which minimize our diagnostic “misses”
true positive
false positive
true negative
false negative

16. Classification Systems
ICD; WHO
DSM; APA
DC: 0-3; National Center for Clinical Infant Programs

17. DSM Approach

18. Categories of Child Psychopathology
DSM-IV
Developmental and learning disorders first diagnosed in infancy, childhood, or adolescence
Other disorders usually first diagnosed in infancy, childhood, or adolescence
Disorders of childhood or adolescence that are not listed separately as those usually first diagnosed in infancy, childhood, or adolescence
Other conditions that may be a focus of clinical attention during childhood or adolescence, but are not defined as mental disorders

19. DSM Approach

20. Categories of Child Psychopathology
Developmental and learning disorders first diagnosed in infancy, childhood, or adolescence
Mental retardation
Learning disorders
Motor skills disorder
Communication disorders
Pervasive developmental disorders

21. Categories of Child Psychopathology
Other disorders usually first diagnosed in infancy, childhood, or adolescence
Attention-deficit and disruptive behavior disorders
Feeding & eating disorders
Tic disorders
Elimination disorders

22. Categories of Child Psychopathology
Disorders of childhood or adolescence
that are not listed separately as those usually first diagnosed in infancy, childhood, or adolescence
Mood disorders
Anxiety disorders
Gender identity disorders
Schizophrenia
Sleep disorders

23. Categories of Child Psychopathology
Other conditions that may be a focus of clinical attention during childhood or adolescence,
but are not defined as mental disorders
Relational problems
Problems related to abuse or neglect
Bereavement
Borderline intellectual functioning
Antisocial behavior
Identity problem

24. Multiaxial Classification
Axis I: Clinical Syndromes
Axis II: Personality Disorders
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental Problems
Axis V: Global Assessment of Functioning

25. Multiaxial Classification
Axis I: Clinical Syndromes
Major Depressive Disorder
Axis II: Personality Disorders
No diagnosis
Axis III: General Medical Conditions
Hypothyroidism
Axis IV: Psychosocial and Environmental Problems
Parent-child problem
Axis V: Global Assessment of Functioning
GAF = 35

26. Axis IV: Psychosocial and Environmental Problems
Problems with Primary Support Group
Problems Related to the Social Environment
Educational Problems
Occupational Problems
Housing Problems
Economic Problems
Problems with Access to Health Care Services
Problems Related to Interaction with the Legal System/Crime
Other Psychosocial Problems

27. Axis V: Global Assessment of Functioning
100 Superior functioning. No symptoms 91
Symptoms are present, transient, expectable 71
Moderate symptoms 51
Some impairments in reality or communication 31
Some danger of hurting 11
Persistent danger of hurting 1

28. DSM Approach Problems Poor interrater reliability Too many diagnoses
Validity of diagnoses has been questioned
Some question the categorical structure
High levels of comorbidity
May not appropriately consider culture

29. DSM-V Will be published in May 2013 Changes:
The single, isolated chapter for Childhood and Adolescent Psychiatric Disorders was deleted in favor of a more developmental approach which integrates these disorders into relevant chapters across the entire DSM.
All of the chapters are organized in a developmental lifespan fashion (i.e., disorders typically diagnosed in childhood are listed first.)

30. DSM-V Added to DSM-V: Eliminated (from DSM-IV): Language Impairment
Late Language Emergence
Specific Language Impairment
Social Communication Disorder
Voice Disorder
Eliminated (from DSM-IV):
Expressive Language Disorder
Mixed Receptive-Expressive Language Disorder
Communication Disorder Not Otherwise Specified (now diagnosable under Language Impairment umbrella category)

31. DSM-V Name changes: Some changes in diagnosis:
Previously used term Mental Retardation / Intellectual Disability will be replaced by Intellectual Developmental Disorder
Some changes in diagnosis:
Asperger syndrome will not be viewed as a separate disorder, it will be merged under ASD.
ADHD diagnostic criteria for the time symptoms become present will change. The criterion that “symptoms need to be present before age 7” will be changed to age 12.

32. DSM-V Some changes in diagnosis:
More stringent criteria for the diagnosis of bipolar disorder in children will be used.
Grief following death of a loved one will be considered as a symptom of depression.
Shyness in childhood will be considered as a symptom.
For ODD, the frequency of symptoms were separated by the age of the child. Before age 5, the symptoms need to occur nearly every day for a period of 6months. After age 5 they need to occur at least once per week during past 6 months.

33. Criticisms to DSM-V
More than 11,000 health professionals suggested that DSM-V should not be published.
There is still weak evidence for the disorders suggested in DSM-V and their symptomology.
Too many labels
Some symptoms include behaviors within normal range or just mildly eccentric (e.g., shyness)
More referral to psychiatric drugs will be made

34. Criticisms to DSM-V
There is still comorbidity and it is not easy to differentiate separate disorders
Rape would be labeled as a disorder. Serial rapists and sexual abusers would also be regarded as having a medical condition, which would allow them an excuse for their behaviors and they might not be imprisoned because that behavior is a medical condition.

35. Criticisms to DSM-V Quotes:
“DSM V will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones.” – Prof. Allen Frances (Duke University)
“The proposals in DSM V are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness.”- Prof. Til Wykes (University of Westminster)
“DSM-V as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation.  If this occurs, it means these individuals will be labeled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.” – Prof. David Elkins (Pepperdine University, LA)

36. Intervention Prevention Treatment
Figure 5-3 demonstrates how intervention overlaps

37. Treatment Individual Alterations according to developmental level
Group
Play
Psychodynamic and client-centered
Family therapy/Parenting interventions
Context-related
Pharmacological