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Research Review: Child psychiatric diagnosis and classification: concepts, findings, challenges and potential

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  • Conflict of interest statement: I have been involved in WHO activities with respect to ICD diagnosis and classification since the mid-1960s. I was also on the APA’s child and adolescent psychiatry working party for DSM-IV and on the joint committee between DSM and ICD for harmonization between the two classification systems. Currently, I chair the WHO child and adolescent psychiatry Working Party for ICD-11. I have also recently been appointed by the APA as Member of the Board of Trustees’ DSM-5 Scientific Working Group. However, this essay is written entirely as an individual; accordingly, the views expressed are mine and not those of the Working Party, WHO or the APA: including the views, policies, or other official positions of the APA and World Health Organization or its Advisory Group or any of its Working Parties. Nevertheless, I wish to express my deep gratitude to both the ICD-11 Working Party and to its DSM-V counterpart for the clear thinking, creative ideas and empirical evidence that they provided and which I have used to underpin this essay.

Abstract

The conceptual issues are briefly noted with respect to the distinctions between classification and diagnosis; the question of whether mental disorders can be considered to be ‘diseases’; and whether descriptive psychiatry is outmoded. The criteria for diagnosis are reviewed, with the conclusion that, at present, there are far too many diagnoses, and a ridiculously high rate of supposed comorbidity. It is concluded that a separate grouping of disorders with an onset specific to childhood should be deleted, the various specific disorders being placed in appropriate places, and the addition for all diagnoses of the ways in which manifestations vary by age. A new group should be formed of disorders that are known to occur but for which further testing for validity is needed. The overall number of diagnoses should be drastically reduced. Categorical and dimensional approaches to diagnosis should be combined. The requirement of impairment should be removed from all diagnoses. Research and clinical classifications should be kept separate. Finally, there is a need to develop a primary care classification for causes of referral to both medical and non-medical primary care.

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