Jan 15 2013 psy341 psychopathology of childhood.docx

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University of Toronto St. George
Ross Hetherington

Psy 341 Jan 15 2013 Lecture 2 Psychopathology of childhood Classification and assessment (lecture 2) 1. Classification  Categorical approaches oCategorical vs dimensional classification o Caqtegorical classification: assumes every diagnosis has a clear underlying cause and each disorder is fundamentally different (DSM-IV-IR) o Dimensional classification: assumes a numver of different traists or dimensions of behavior all exist that children or adults posses to varying degress (CBCI) oCategorical classification: o Assessment: the process of evaluating the phenomenon: to be classified or diagnosed. Assessment is meaningful to the extent that it leads to effective intervention oCriteria for evaluation of systems: 1. Categories must be clearly defined 2. Defining features must occur together regularly 3. System must be reliable a. Inter-rater reliability b. Test-retest reliability 4. System must be value 5. System must have clinical utility  Covering everything that covers. Would not be useful if every patient comes in with every presentation. Must be a system that allows us to give reasonable and valid evaluation to cases that we see  DSM-IV-IR/ DSM-V oClinically derived classification system o International classification of Diseases (ICD-10)  Maintained by world health organization o Not until DSM-III (1980) has included more categories on children  Clinical descriptions replaced with specific criteria  More child categories  Multiaxial system o DSM-III-R (1987)  Recognized subsets within diagnostic classifications  We see anxiety, ADHD, numbers of categories with sub-categories – multiaxial o DSM-IV (1994)  Greater focus on empirical validation and field trials o DSM-IV-TR  Updated text to include information and findings about prevalence and associated features  Most test of DSM-IV are not revised o DSM-V  Multiaxial system is gone o Criticisms of DSM approach  1. All are multi-determined. We all have mild anxiety for example, this is life  Dimensional approaches – empirically based approach, clinically observation oAims to captures variation on a range of dimensions oMaking use of developmental context oUseful for research oBUT o Dependent on sampling. Age and sex, and informant o Insensitivity to context o Child behavior checklist (CBCL), best known to child psychopathology o  Labeling oProblems: o 1. Labels are for disorders, not children o 2. Information is lost: Neglect of individual o 3. Logical fallacy: label causes bahaviour o 4. Categories ignore reporting biases o Considering the threats of validity oVirtues: o Uniform categories, reduces variability o Diagnosis leads to correct intervention o Prognostic information o Facilitates efficient information exchange  2. Assessment  Interviews oUnstructured vs. structured oVary in how structured they are oSome interviews are highly structured o Highly structured interviews are scheduled for affective disorders and schizophrenia o Semi-structured: general guidelines or topic areas
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