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Mónica Gómez de Parada H.
25 de febrero del 2010-
PSICOPATOLOGÍA.
HISTORICAL PERSPECTIVE ON DIAGNOSIS OF CHILDHOOD DISORDERS

• Binet: first psychometric measure of children.

• Kanner’s: description of infantile autism and diagnosis in child psychiatry.

• Findings:

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

Informants.

• 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...
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