Diagnosis and Labeling

A label is simply a word or phrase used to describe or classify a person or group. Classification of individuals into categories by psychologists and psychiatrists is a form of labeling referred to as diagnosis. Psychologists and psychiatrists have a long tradition of labeling people into diagnostic categories as a means to classify and organize psychopathology and to communicate efficiently with other mental health professionals. Diagnosis may be an efficient way to initially provide general information to different professionals who work with the same client. Many times diagnoses are needed to make clients eligible to access educational and mental health services. Diagnoses are also often required so that payment can be received for services that are rendered to clients. Even though all diagnostic systems have some drawbacks, the ones in current use have allowed for advancement of knowledge and understanding of psychological and educational problems (Merrell, 2003).

Modern psychological and psychiatric diagnosis and labeling can be traced to the written recording of case studies and detailed observations of patients in hospital settings. As a result, it has its foundations in the medical model. Study of case records allowed early clinicians to classify on the basis of symptom clusters, an already established technique used by botanical and zoological taxonomists (Millon, 1969). The central idea of this method was that because certain groups of symptoms or behaviors often occurred together, clinicians could use symptom clusters to identify particular disorders.

In 1883, Emil Kraepelin wrote a compendium that linked symptom pictures, patterns of onset, course, and outcomes for mental disorders. Kraepelin's nosology was the framework for the structure that would become the prototype for the most widely used diagnostic system of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fourth edition. School psychologists use two major classification systems, the psychiatrically oriented DSM system and a classification system based on federal special education law, the Individuals With Disabilities Education Act (IDEA).

Another diagnostic approach is the empirically based behavioral dimensions taxonomy, but this method is not as commonly used as the DSM and IDEA models (Achenbach, 1993, 2002; McDermott, 1993; McDermott & Weiss, 1995; Quay, 1975, 1977; Quay & Peterson, 1967, 1987). This approach has identified dimensions of psychopathology through the use of multivariate statistical methods such as factor analysis (e.g., internalizing-overcontrolled, externalizing-undercontrolled, etc.). One advantage to this method is that because diagnoses are based on norm-referenced scales, clinicians can determine where an individual child falls in relation to others in the population. This can allow for estimates of severity of particular disorders. Although the dimensions have been identified by various independent researchers and appear to be robust, each set of researchers has used different names for the same constructs, which has led to some confusion. Nonetheless, the empirically based behavioral dimensions system shows promise for extending research and practice in the area of diagnosis and psychopathology in children and youths. Psychologists might use the empirically derived diagnostic information to aid in making a DSM or IDEA diagnosis. Ultimately, an IDEA diagnosis is required before the child can be determined eligible for special education services in the schools and/or a DSM diagnosis is often desired in nonschool settings.

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