1. Developmental Psychopathology
Assessment of Psychopathology

2. Terminology Sign: feature that are observable by others
Symptom: feature that can be reported 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 for ideographic portraits
Tabulations of overt behaviors
Inventories
Interviews
Structured vs. unstructured diagnostic interviews

5. Taxonomic Targets for Assessment
Which characteristics will be assessed?
Reliably assessable
Valid indices
What are the targets for assessment?
Taxonomic groupings (needed to organize relevant information)

6. Diagnostic Efficiency
Determining which indicators will maximize our diagnostic “hits” and which will minimize our diagnostic “misses” is important
Presence vs. absence of of a single disorder and a single indicator
true positive
false positive
true negative
false negative

7. Taxonomic Targets for Assessment
Error of Measurement
Test-retest unreliability: Variability in a measure’s results over brief intervals
Different informants (different standards of judgment, perceptions and memories)
Different assessment procedures may target different variables (personal experiences, signs)
Targeted time intervals (frequency of behaviors in the last 6 months vs. present)
Solution?

8. Taxonomic Targets for Assessment
Error of Measurement
Solution is aggregating data from different procedures
Be alert!
Information for consistency and continuity across settings is an important.

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

10. Empirically Based Paradigm
“Bottom up” approach is taken to derive syndromes
Problems are rated according to frequency and intensity
Quantitative approach deals more effectively with measurement error
Degree of problem vs. presence or absence
Uses norm-referenced profiles: seperate norms for each gender within each developmental level

11. Cross-Informant Syndrome Constructs (symptom clusters)
Example: Parents (CBCL), teachers (TRF) and child (YSR)
Undercontrolled (Other-directed)
Overcontrolled (Inner-directed)
Common dimensions
Somatic complaints
Thought problems
Attention problems
Anxious/depressed

12. Categorical Approach The DSM Paradigm
Classifies problems according to diagnostic categories.
Each category reflects a taxonomic construct and involves explicit criteria
Top-down approach: categories and criteria were negotiated among the committees
Field trials affected some cutpoints in latest versions

13. Classification Systems
International Classification of Diseases (ICD); WHO
DSM; APA
Diagnostic Classification (DC): 0-3 ages; National Center for Clinical Infant Programs

14. Categories of Child Psychopathology
DSM-IV
Developmental & 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

15. Categories of Child Psychopathology
Developmental & learning disorders first diagnosed in infancy, childhood, or adolescence
Mental retardation
Learning disorders
Mathematics
Motor skills disorder
Coordination
Communication disorders
Stuttering
Pervasive developmental disorders
Disintegrative

16. Categories of Child Psychopathology
Other disorders usually first diagnosed in infancy, childhood, or adolescence
Attention-deficit and disruptive behavior disorders
Conduct
Feeding and eating disorders
Pica
Tic disorders
Tourette’s
Elimination disorders

17. 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

18. 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

19. Multiaxial Classification
Diagnosis is systemized in 5 axes:
Axis I: Clinical Syndromes
Major mental disorders, developmental disorders and learning disabilities
Axis II: Personality Disorders
Underlying pervasive or personality conditions
Axis III: General Medical Conditions
Nonpsychiatric somatic conditions
Axis IV: Psychosocial & Environmental Problems
Axis V: Global Assessment of Functioning

20. Axis IV: Psychosocial & 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
The Global Assessment of Functioning, or GAF scale, is a numeric scale (1 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. Children and adolescents under the age of 18 are evaluated on the Children’s Global Assessment Scale, or C-GAS.

21. 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
Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning Serious symptoms OR any serious impairment in social, occupational, or school functioning Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. 0 Not enough information available to provide GAF.

22. Axis V: Global Assessment of Functioning
Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning Serious symptoms OR any serious impairment in social, occupational, or school functioning Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. 0 Not enough information available to provide GAF.

23. Multiaxial Classification
Axis I: Clinical Syndromes
Major Depressive Disorder
Axis II: Personality Disorders
No diagnosis
Axis III: General Medical Conditions
Hypothyroidism
Axis IV: Psychosocial & Environmental Problems
Parent-child problem
Axis V: Global Assessment of Functioning
GAF = 35 (serious impairment in school, family relations, judgment and thinking)

24. DSM Diagnostic Interviews
DSM does not provide formal assessment procedures
Diagnostic Interview Schedule for Children-Child Version (DISC-C)
DISC-P
Uses a highly structured DSM-based protocol

25. Other Structured Diagnostic Interviews
Child & Adolescent Psychiatric Assessment (CAPA)
Interviewer based: interviewer has to ensure that the respondent understands the questions
Requires more training and sophistication
Requires extensive coding: each symptom at a level of severity is specified in the glossary

26. Assessment according to categorical criteria
Test-retest attenuation effect: major declines in symptoms from initial interviews to repeat interviews
Sources of error:
Problem of threshold
Example:
6 out of 9 criteria must be met for DSM-IV diagnosis of ADHD

27. Inattention: 6 or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities.
Is often easily distracted.
Is often forgetful in daily activities.

28. DSM Diagnostic Interviews
Other potential sources of error:
Difficulty in understanding questions
16% of 9 yo can understand DISC questions for depression
11 yo -> 31%
Some disorders have criteria which require multiple symptoms: “5 of the following must be present in the same 2-week period”
increases low agreement rates and test-retest attenuaton effect

29. Problems with Classification Systems
Social stigmatization
Labels stick and follow people around.
Labels remain even after clinical improvement has been made
Self-fulfilling prophecy: diagnostic labels remove responsibility from the patient

30. Problems with the DSM System
Proliferation of categories and “overdefined” pathology
Increasing addition of everyday problems:
e.g., caffeine-induced sleep disorder, disorder of written expression

31. Problems with the DSM System
Inattention to culture, gender and developmental level
Diagnostic criteria are the same for all groups. There is a section that alerts clinicians to possible variations.