Paediatrics: Classification, categories, and dimensions

Classification, categories, and dimensions

As is the case in general medicine and paediatrics diagnosis is used in child and adolescent psychiatry to;

·Collect and organize information collected at assessment.

·To guide treatment planning.

·To inform about prognosis.

Classification systems assist with the standardization of the diagnostic process and the use of a reliable and effective classificatory system can serve several important functions;

·Their use results in a greater precision in planning treatment at both the individual and population levels.

·They are a prerequisite for the conduct of many types of clinical research and facilitate the communication of research findings.

·They allow for the collection of epidemiological data a process which is central to health-care planning at international, national, and local levels.

The two most influential diagnostic systems are the World Health Organization’s International Classification of Diseases (ICD) and the American Psychiatric Association’s Diagnostic and statistical manual (DSM) system. Current versions are ICD-10 and DSM-V, although revisions are underway for both. Both are categorical systems. They both include sec-tions describing disorders first diagnosed in childhood and adolescence, but also allow children and adolescents to meet criteria for most ‘adult’ mental health disorders. A key requirement of both systems is that they insist that both symptoms and associated impairments be present in order for a diagnosis to be made.

Notwithstanding these clear benefits there has been some resistance to the introduction of standardized diagnostic systems into routine clinical practice in child and adolescent mental health. Some clinicians believe this categorical approach is overly restrictive and propose that a dimensional approach whereby ‘cases’ represent the extreme end of a continuum is more appropriate. Supporters of the dimensional view suggest it is less stigmatizing for children, evoke a more holistic management strategy than a limited medical model, and, for some presentations, has more predictive validity than the categorical/diagnostic model. Drawbacks of the dimen-sional approach include difficulties deciding when to treat and an over reli-ance on symptoms at the expense of impairment. Unfortunately debates over ‘categorical’ versus ‘dimensional’ often become unnecessarily polar-ized and it is important to remember that they are not mutually exclusive from each other.