MENTAL ILLNESS IN CHILDREN: DIAGNOSING OUTSIDE THE BOX

Hans Steiner, M.D., 401 Quarry Road, Room 1136, Stanford, CA 94305-5340

Background: Children and adolescents have two characteristics that make ordinary diagnostic practices problematic: They are extremely context dependent. The social context strongly influences their behavior, mentation, and symptoms; and they are evolving organisms that change at a rapid rate. This can lead to varied manifestations of symptoms. The DSM-IV diagnostic criteria themselves are also somewhat problematic, having been defined in adults.
Method: Summarizing findings from recent prevalence studies of psychopathology in youth, we will discuss the importance of high levels of comorbidity and non-isomorphic manifestations of adult disorder. The example of bipolar offspring is given.
Results: The findings suggest that in order to diagnose children accurately and validly, we always need to consider social context, developmental phase, and trajectories of functioning. The example of the continuum from ODD to CD to APD is given.
Conclusion: If we are to understand longitudinal outcomes of psychopathology better we need to be prepared to modify our diagnostic practices.