25 de febrero del 2010-
HISTORICAL PERSPECTIVE ON DIAGNOSIS OF CHILDHOOD DISORDERS
• Binet: first psychometric measure of children.
• Kanner’s: description of infantile autism and diagnosis in child psychiatry.
The relative frequency of behavioral disturbance in childhood, the powerful nonspecific association betweenneurological impairments and behavioral disorders, and the association of learning disorders with conduct disorders.
• Assessment tools:
Much effort has gone into validating rating scales and questionnaires and in exploring interview parameters that might predict or reflect stimulant drug effects.
➢ DEFINITION OF DISORDER:
• Most diagnostic categories have been generatedon the basis of what clinicians agree they recognize from clinical descriptions as fitting what they see in their own practice.
• Perception is influenced by their experience.
• Variation degree to which child clinician’s have been trained to be descriptive. Inferential is based on the quality of the clinician’s interaction with the child and his family.
➢ IMPORTANCE OFMULTIPLE DIAGNOSES
• Oppositional deficient disorder if often diagnosed together with attention deficit/ hyperactivity disorder.
• Multiple diagnoses will lead to better categorization.
• A single, highly specific diagnosis does not capture the case.
• Specific symptoms can be accounted for by more than one disorder, the nature of the total symptom picture will determine thediagnosis.
• Diagnostic confusion occurs when children show signs of more than one disorder.
➢ VALIDITY AND RELIABILITY OF DSM IV DIAGNOSES FOR CHILDHOOD DISORDERS.
Validity of axis I and axis II diagnoses.
• Most childhood psychiatric disorders fall under 2 broad categories: behavioral disorders or emotional disorders.
• Work remains to be done in order toclarify differences between hyperactivity and conduct disorders and between anxiety disorders and depression.
➢ Reliability if axis I and axis II diagnoses.
• Problems did indeed focus on axis I disorders, the major problem was differentiating between diagnoses, rather than struggling with detailed criteria as anticipated.
• Differential diagnosis and the handling of mixedcategories were the sources of most discrepancies.
➢ SPECIFIC DIAGNOSTIC ISSUES IN CHILD PSYCHIATRY.
Age specific manifestation of disorder.
• Childhood disorders are uniquely characterized by developmental considerations that are central to many of the diagnostic entities (enuresis at age of 12). Where normal development stops and pathology begins.
• Earl’s work suggestedthat DSM III diagnoses were appropriate even for 3 year old.
➢ ADOLESCENCE AS A DEVELOPMENTAL STAGE.
• Adolescence constitutes a special stage requiring singular diagnostic attention. Much has been written about identity problems in adolescence.
• A substantial proportion of adolescent inpatients previously described as having identity disorder now will probably be consideredto have adjustment, mood, or psychotic disorders.
• The virtue of DSM system is that it provides clear description and definition of disorders so that follow-up, family, and treatment studies can be carried out.
➢ PROBLEMS IN ASSESSMENT
• Children under age 15, are self referred. Presenting complaints usually come from their parents, school, community, orprofessionals. As a result, in addition to evaluating the child, the clinician must simultaneously evaluate the sources of referral. Sources data is often minimal.
• Some disorders, such as depression, the child’s report may reveal more “positive” information that the parents; while other symptoms “externalizing” behaviors, are more accurately reported by the parent’s. subjective states...