Transcript J22 4053X1 diagnosis

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
Why will there be a DSM-V?
• Research is ongoing, and we continue to learn
about categories
• Society and cultural standards of behavior may
change
• New disorders may be discovered, or old ones
may be reclustered
• Treatment research informs us about the
appropriateness of diagnosis
• Clinical practice informs diagnosis revision
“Generic Diagnoses”
You have discovered a new child mental
health problem. What kinds of
diagnostic criteria are there?
• Objective listing of potential symptoms,
especially those that are unique
• The symptoms are causing problems
• Age of onset
• Duration/ intensity
• Rule out other disorders or medical
conditions
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
– Third party consent, competence to consent
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