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Childhood Mental Disorders and Illnesses
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Diagnostic Criteria for Childhood Disorders

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Whatever the nature of children's disorders or illnesses, one basic rule applies to what to do about helping them: It is best to seek professional treatment at the EARLIEST POSSIBLE TIME. Early treatment and intervention for children's symptoms helps reduce the impact of those symptoms on further development. Untreated symptoms can snowball and lead to the development of sometimes severe secondary problems such as social, academic and occupational difficulties, addictions, poor self-esteem, suicide attempts, self-harm (cutting or burning oneself) and the like. Secondary problems can be prevented or minimized when children's symptoms are brought under control. Unfortunately, only 1 out of 5 children with symptoms of mental illness obtain proper early assessment and treatment. If you are concerned about your child, it is essential to his or her well-being (as well as your entire family's) that you seek proper help now.

list with boxes checkedIn order to obtain treatment, it is important that children are appropriately and accurately diagnosed. Diagnosis is the term used to describe the process that a professional goes through when figuring out whether children have a particular disorder. Professionals make diagnoses by comparing observations and measurements of children's behavior against published criteria that must be present in order for a diagnosis to be made.

In the United States, diagnostic criteria for mental disorders are published in the Diagnostic and Statistical Manual of Mental Disorders (or DSM), an important tool that clinicians use to diagnose both child and adult psychological disorders. The most current volume, (the DSM IV-TR; fourth edition, text revision, published in 2000), provides comprehensive diagnostic criteria based on the best available clinical and research literature findings regarding mental illness (as of the publication date). It is a standard way of measuring and classifying mental disorders, and is used extensively by psychologists, psychiatrists, social workers, mental health counselors and other mental health professionals.

An important organizing principle of the DSM is the fact that individuals are assessed across five separate "axes" (dimensions) in order to develop a more complete understanding of their functioning. Each axis describes a different aspect of functioning. Axes I and II are used to describe mental disorders, per se, with Axis II specifically devoted to describing developmental disorders (which by definition occur from a young age). Importantly, not all child disorders are classified as developmental disorders. Instead, many are categorized as Axis I disorders, which can be any disorder that is not developmental in nature, a disorder that is primarily a medical problem (in which case it would be described on Axis III), or a social problem (in which case it would be described on Axis IV). Most of the disorders discussed in this paper are Axis I disorders, except for Mental Retardation, which is classified as an Axis II disorder.

The DSM is mostly concerned with adult mental problems. Child mental problems are described and contained within a single large chapter, and considered separately from adult disorders, even when adult disorders exist, which are similar in nature. For instance, childhood feeding disorders are not discussed within the eating disorders chapter of the DSM, but instead within the "ghetto" of the child disorders chapter. While there are good conceptual reasons for thinking about childhood feeding disorders in separate terms from "adult" eating disorders like anorexia (which typically have their onset in adolescence), the extent of separation between child and adult disorders seems arbitrary to us, and appears to be due more to the politics which have shaped DSM's structure than based on actual scientific evidence. As the division between child and adult disorders is necessarily ambiguous in many ways (it is easy to differentiate between an infant and an adult, how easy is it to differentiate between a late adolescent and an adult?), perhaps future revisions of this centrally important work will come to be organized differently.

For the time being, childhood disorders occupy a separate space within DSM. Within the childhood disorders chapter of the DSM, problems are further subdivided based on similarities of dysfunction. You may notice that this is also how we have chosen to organize this article. Disorders that share qualities in common have been grouped together under their broader heading, as is the case in DSM.