Psychology 2042A/B Chapter Notes - Chapter 5: Inter-Rater Reliability, Intellectual Disability, Learning Disability
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18 Nov 2011
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Chapter 5: Classification, Assessment and Intervention
•Classification and taxonomy are the delineation of major categories or dimensions
of behavioural disorders, done for either clinical or scientific purposes
•Diagnosis usually refers to assigning a category of a classification system to an
individual
•Assessment refers to evaluating youngsters, in part to assist the processes of
classification and diagnosis and in part to direct intervention
Classification and Diagnosis:
•Classification 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 fit or
not fit
•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 personʼs behaviour.
•i.e. is Mariaʼs 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 Mariaʼs behaviour rated as separation anxiety the first 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 defined the category.
•another important aspect of validity whether our description of a disorder is
accurate.
•clinical utility of a classification system is judged by how complete and useful it is
•The DSM Approach
•the most widely used classification system in the United States is the APAʼs
Diagnostic and Statistical Manual of Mental Disorders (DSM)
•The 10th revision of the International Classification of Diseases (ICD)
developed by the WHO (1992) is an alternative system that is widely used
•Diagnostic Classification 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 classification system
•clinically derived classification systems are based on the consensus of
clinicians that certain characteristics occur together.
•DSM system is also a categorical approach to classification - person either meets
or does not meet the criteria for diagnosis
•Historically, the classification of abnormal behaviour was focused on adult
disorders and there was no extensive classification scheme for child and
adolescent disorders
•The multiaxial system
•in the DSM-IV-TR, disorders are classified 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
childʼs overall level of adaptive functioning (Global Assessment of
Functioning - GAF)
•100: superior functioning
•70: generally good functioning; some difficulty 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 first
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 define 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 defined childrenʼs behaviour as deviant - i.e. when a
child shows common misbehaviours or various problems in academic
learning, they can be easily classified 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 specific 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 specific 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 “Specific
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 dichotomizing continuous symptoms to form a disorder category
and a nondisorder category results in reduced statistical power and may lead to
misleading research outcomes
•the category vs. dimension question will be a central issue as systems of
classification continue to be considered
•classification system is influenced by the general social atmosphere in which it
exists.
•Empirical Approaches to Classification
•empirical approach to classification of behavioural problems is an alternative to
the clinical approach to taxonomy
•based on the use of statistical techniques to identify patterns of behaviour that are
interrelated.
•general procedure is to get the parent or another respondent to indicate the
presence or absence of specific behaviours - responses are quantified
•0- not present; 1- moderate degree of behaviour; 2- behaviour is clearly
present
•groups of characteristics/behaviours usually occur together - these groups are
called syndromes (Table 5-3; p.98) - these are identified by empirical or clinical
judgement procedures
•rather than relying on observation for the most part, clinicians also use
statistical procedures
•two broadband syndromes, or general clusters of behaviours or characteristics
•internalizing syndromes: anxious, shy, withdrawn, and depressed, etc
•externalizing syndromes: fighting, temper tantrums, disobedience, etc