Child Psychopathology

1
Child Psychopathology

• Diagnosis
• Treatment
• Reading for today Chapter 4

2
Classification and diagnosis
3
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

4
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?

5
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.
6
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
7
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

8
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

9
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

10
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

11
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

12
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