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Classification Of
Psychiatric Disorders In
Children And Adolescent
Mona Reda
Classification systems
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DSM : Diagnostic and Statistical Measurement
ICD : International Classification of Disorders.
History of classifications
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Kanner 1935 “ personality difficulties”
Guidelines of diagnosis 1957
DSM-I only 4 categories were identified :
Chronic brain syndrome associated with bran trauma
 Schizophrenia reaction
 Special symptom reaction, LD, enuresis and
somnambulism
 Adjustment reaction
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DSM-II. 1968
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Hyperkinetic reaction of childhood
Withdrawal reaction of childhood
Overanxious reaction of childhood
Runaway reaction of childhood
Unsocialized aggressive reaction of childhood
Group delinquent reaction of childhood
Over reaction of childhood
DSM-III. 1980
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Mental retardation
Attention deficit with or without hyperactivity
Conduct disorder
Anxiety disorder
Other disorders of infancy and childhood
Eating disorders
Stereotypic movement disorder
Other disorders with physical manifestations
Pervasive developmental disorders
DSM-III R. 1987
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Mental retardation
Pervasive developmental disorders
Specific developmental disorders
DSM-IV. 1994
DSM-IV TR. 2000
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The provision of a separate section for
disorders that are usually first diagnosed in
infancy , childhood, or adolescent is for
convenience only and is not meant to suggest
that there is any clear distinction between
childhood and adult disorders for most ( but not
all) DSM-IV disorder, a single criteria set is
provided that applies to children and adults .
Modifications in DSM
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Diagnostic symptoms
Duration of illness
Age of onset
Spectrum
Value Of Classification
Communication:
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Facilitate communication among physicians
Reliability will be greater if system is based on clearly
defined observable phenomena rather than features
Reliability affected by structure of the system
Knowledge of the diagnosis should allow the
professional to make inferences about
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Etiology
Natural history
Expected response to treatment
Other associated conditions
Heuristic
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System is expressed in operational and
reproducible form to promote discovery of
knowledge ( new diagnosis)
Public health and treatment
Ability to develop diagnosis based quality
control criteria such as expected form and
duration of treatment
 Useful for planning and quality control as well
as evidence based education.
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Problems In Diagnostic Issues
Misdiagnosis and labeling
 Comorbidity:
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Presence of similar criteria in different disorders
Presence of one disorder lead to the second.
Etiological relationship between the two disorders
Common environmental or biological antecedents
Diagnostic definition error, disorders commonly occur together
 Revisions
Allow debate and data, with each revision new findings emerge
that have direct implications on the existing diagnosis
Approaches to Classification
Categorical system
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An individual will either meet the criteria and carry the diagnosis
or will not and will be cleared free of the disorder
It represents the way that both the clinician and patient think of
a disorder
However,
Disorders do not always represent them selves in full criteria
Disorders differ in their potential to cause impairment
Symptoms and signs will differ in different age and sex of the
patient
Approaches to Classification
Dimensional system
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Starts with the collection of a large inventory of
symptoms from both clinician and community
samples
Main groups ( internalized and externalized
behaviors)
Common in studies of child psychopathology.
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Disadvantage:
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A case is a deviation from normal rather than impairment in
function
Items in inventory are written in simple way
Factor structure differs across different age and sex groups,
make it difficult to compare.
Information collected on single instrument.
Greater accuracy in reflecting nature, less predictive of
outcome.
Approaches to Classification
Multi-axial approach:
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Axis I: clinical syndrome
Axis II: personality disorder & mental retardation
Axis III: general medical diagnosis
Axis IV: psycho-social and environmental problems
Axis V: degree of impairment that resulted from
psychiatric disorder
Approaches to Classification
Multi-axial approach:
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Axis I: clinical syndrom,personality disorder & mental
retardation ,general medical diagnosis
Axis II: psycho-social and environmental problems
Axis III: degree of impairment that resulted from
psychiatric disorder
To conclude:
Diagnosis of psychiatric disorder is made using a
classification system in order to facilitate
communication and stability of data base to
encourage new diagnosis identification, and
better evidence based quality of service.
Thank You