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Chapter 5

Chapter 5 - ONLINE

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Western University
Psychology 2042A/B
Richard Brown

Psych 2042A Chapter 5: Classication, Assessment and Intervention Classication and taxonomy are the delineation of major categories or dimensions of behavioural disorders, done for either clinical or scientic purposes Diagnosis usually refers to assigning a category of a classication system to an individual Assessment refers to evaluating youngsters, in part to assist the processes of classication and diagnosis and in part to direct intervention Classication and Diagnosis: Classication systems are employed to systematically describe a phenomenon. these systems describe categories or dimensions of problems behaviours, emotions, and/or cognitions. a category is a discrete grouping (i.e. anxiety disorders) in which an individual is t or not t the term dimension means that an attribute is continuous and can occur to various degrees. (i.e. high, low, or moderate levels of anxiety) features of the category and a dimension must occur together regularly, in one or more situations or as measured by one or more methods Interrater reliability refers to whether different diagnosticians use the same category to describe a persons behaviour. i.e. is Marias behaviour rated as separation anxiety by 2 or more diagnosticians? Test-retest reliability asks whether the use of a category is stable over some reasonable period of time i.e. is Marias behaviour rated as separation anxiety the rst time she goes for a test and the second time she goes for another test later on? validity of diagnostic systems: to be valid, a diagnosis should provide us with more information than we had when we originally dened the category. another important aspect of validity whether our description of a disorder is accurate. clinical utility of a classication system is judged by how complete and useful it is The DSM Approach the most widely used classication system in the United States is the APAs Diagnostic and Statistical Manual of Mental Disorders (DSM) The 10th revision of the International Classication of Diseases (ICD) developed by the WHO (1992) is an alternative system that is widely used Diagnostic Classication of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC: 0-3) is a system developed to classify mental disorders of very young children DSM system is a clinically derived classication system clinically derived classication systems are based on the consensus of clinicians that certain characteristics occur together. DSM system is also a categorical approach to classication - person either meets or does not meet the criteria for diagnosis Historically, the classication of abnormal behaviour was focused on adult disorders and there was no extensive classication scheme for child and adolescent disorders The multiaxial system in the DSM-IV-TR, disorders are classied into one or two major groups (axes) Axis 1: any existing clinical disorder or other condition that may be a focus of treatment (i.e. an academic problem) Axis 2: Mental retardation or a Personality Disorder Axis 3: Medical conditions that are related to treatment Axis 4: Psychosocial or Environmental Problems that may affect treatment Axis 5: allows the clinician to make a numerical judgement (0 to 100) of the childs overall level of adaptive functioning (Global Assessment of Functioning - GAF) 100: superior functioning 70: generally good functioning; some difculty in school/social settings 50: serious impairment in school/social settings 30: serious impairment in communication/judgement or inability to function in almost all areas. The diagnostic categories DSM-IV-TR outlines some diagnostic categories described as usually rst diagnosed in early childhood/adolescence) i.e. Mental retardation, learning disorders, motor skills disorders, communication disorders, ADHD/ disruptive behaviours, eating disorders, substance abuse, schizophrenia, sleep disorders Comorbidity this term is used when children meet the criteria for more than one disorder some people use the term co-occurrence comorbidity may be because many disorders have mixed patterns of symptoms another explanation may be because that there are shared risk factors for many disorders. some of the same risk factors lead to the problems used to dene both disroders the presence of one disorder created an increased risk for developing the other disorder. Evaluating the DSM improvements have been made in an attempt to include more comprehensive coverage of child and adolescent disorders greater attention has been placed into the positive development of children we might have broadly dened childrens behaviour as deviant - i.e. when a child shows common misbehaviours or various problems in academic learning, they can be easily classied as mental retardation. reliability of the DSM system has been one main concern over the years there had been disagreements between clinicians in the earlier versions - needed to improve interrater reliability reliability still varies and may depend on the specic disorder, the nature and source of information available, other characteristics of the child such as gender, ethnicity, or characteristics of the clinician DSM also has to have a clear and accurate representation of the nature of disorders validity of the DSM system: validity is indicated if research discovered treatments or etiologies that were specic to particular syndromes i.e. many medications have been effective in treating various DSM disorders DSM promotes a disease/medical model that emphasizes biological treatment for children/adolescents rather than emphasizing the interaction of the child and the environment resulting to the disorder DSM-IV-TR includes a set of diagnostic criteria in a section on Specic Culture, Age, and Gender Features that alerts clinicians to variations associated with culture, developmental level, and gender. nevertheless, diagnostic criteria are largely the same for both genders and for all ages and cultures. disorders may appear to have prevalence rates that vary within age and gender i.e. ADHD is more frequent in males nondeviant boys exhibit higher rates of behavioural characteristics that are associated with ADHD - this may be the result of the higher rates of males with ADHD the practice of d
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