Psychopathology in Children

The DSM-IV Approach

Child psychopathology is currently viewed from a variety of perspectives. One important perspective is embodied in the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which defines child psychopathology in terms of categories of disorders. For example, the DSM-IV defines attention deficit hyperactivity disorder (ADHD), predominantly inattentive type, by nine symptom criteria such as “often has difficulty organizing tasks and activities” [Page 414]and “is often forgetful in daily activities.” A child who is deemed to display at least six of the nine symptoms and who also meets criteria for age of onset, duration of the symptoms, and impairment is diagnosed as having ADHD, predominantly inattentive type. The criteria are the same for both genders, all ages, and all sources of information.

The most common DSM-IV diagnoses for children include ADHD, conduct disorder, oppositional defiant disorder, separation anxiety disorder, generalized anxiety disorder, dysthymia, major depressive disorder, and adjustment disorder. The DSM-IV approach implies that there are categorical differences between mental health and each type of disorder. If a child meets criteria for a disorder and is judged to be impaired by the disorder, then the child is not mentally healthy.

The Empirically Based Approach

A second important perspective is embodied in the empirically based approach. Rather than defining disorders by the same criteria for both genders, all ages, and all sources of data, the empirically based approach uses statistical methods to identify patterns of problems that are actually reported for children of each gender at different ages according to multiple sources of data. The sources of data can include parents, teachers, interviewers, observers, and the children themselves. The empirically identified patterns of problems are designated as syndromes, in the sense of “problems that tend to occur together.”

To reflect variations in the frequency and intensity of children's problems, the problems are assessed quantitatively by having parents, teachers, and others rate each problem using scales such as 0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true of the child. A child's score on a syndrome is the sum of the child's scores on all items comprising the syndrome.

To help users judge the degree of deviance indicated by each syndrome score, the syndromes are displayed on profiles that compare syndrome scores with norms for the child's age and gender. Thus, for example, if a teacher rates 13-year-old Jason, the teacher's ratings of problems comprising the attention problems syndrome are summed to obtain Jason's score for attention problems. Figure 1 illustrates how scores for each syndrome are compared with scores for a national sample of boys who were rated by their teachers. Another page of the profile (not shown in Figure 1) displays Jason's scores on subscales of the attention problems syndrome designated as inattention and hyperactivity-impulsivity.

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