Toward a New Diagnostic System for Child Psychopathology

Course Outline

This important volume brings together leading child psychiatry researchers to critically review the current diagnostic system and work toward new, more clinically useful ways of understanding childhood problems. The authors examine how existing diagnostic categories as embodied in the DSM-IV do not adequately account for the interplay between maladaptive behavior on the one hand, and children’s environmental contexts, relationships, and developmental needs on the other. Drawing on the latest findings from neurobiological and evolutionary research, the book offers fresh perspectives on the nature, causes, assessment, and treatment of a range of prevalent disorders. The concluding chapter offers specific, cogent suggestions for improving the forthcoming DSM-V.

When a child is struggling with emotional, behavioral, or developmental problems, how much does a DSM-IV diagnosis really tell us about what is going on? How could the current nomenclature be improved to facilitate more effective treatment and prevention? This important volume brings together leading child psychiatrists to critically evaluate the DSM-IV and work toward new, more clinically useful ways to understanding childhood problems. The result is a timely and authoritative work that should be read by any forward-thinking clinician or researchers in the field.

The book argues that, as skilled clinicians know, may disorders of childhood reflect problems in adaptation, the impact of adverse experiences, or mismatch between the child’s developmental needs and the resources available in the environmental needs and the resources available in the environment. Yet the existing diagnostic system, rooted in adult disorders, is static – it fails to account for the ways children shape and are shaped by their changing contexts and relationships. Chapters take a fresh look at frequently encountered problems: anxiety, depression, attention-deficit/hyperactivity disorder, conduct disorder, stress disorders, and autism spectrum disorders. For each, authors draw on state-of-the-art neurobiological knowledge and evolutionary models to explore the processes by which symptoms develop, the role of early experiences, why some children are more vulnerable than others, and whether the DSM successfully encapsulates salient features of the condition. Implications for assessment and intervention are also considered.

The concluding chapter offers cogent suggestions for improving the forthcoming DSM-V.

Theoretically sophisticated yet concise and accessible, this book aims to bridge the gap between what is known about child psychopathology and how mental health services are actually conceptualized and delivered. It will be read with interest by child and adolescent psychiatrists, clinical and abnormal child psychology researchers, and advanced students in these areas.

About Authors

Peter S. Jensen, MD, is Director of the Center for the Advancement of Children’s Mental Health, Ruane Professor of Child Psychiatry at Columbia University, and Research Psychiatrist with the New York State Office of Mental Health. Previously, he was Associate Director of Child and Adolescent Research at the National Institute of Mental Health. He serves on many editorial and scientific advisory boards and has published over 200 scientific articles and book chapters and 13 books.

Penny Knapp, MD, is Medical Director at the State of California Department of Mental Health. She recently retired from the University of California, Davis, where she served as Chief of the Division of Child, Adolescent, and Family Psychiatry. A member or fellow of such national organizations as the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics, she has several dozen refereed publications and is a journal or book reviewer for several pediatric and child psychiatry journals.

David A. Mrazek, MD, is Chair of the Department of Psychiatry and Psychology at Mayo Clinic Rochester and Professor of Psychiatry and Pediatrics at Mayo Clinic College of Medicine. He currently serves as Director of the S. C. Johnson Genomics of Addictions Program and Director of the American Board of Psychiatry and Neurology. Previously, he served as Chair of the Department of Psychiatry and Behavioral Science at George Washington University, and as the Leon Yochelson Professor of Psychiatry. He has authored over 200 publications and is actively involved in psychiatric pharmacogenomic research.

Learning Objectives

After completing this course you’ll be able to:

  1. Discuss the biological systems theory.
  2. List several mechanisms which explain the presence and persistence of “psychopathology.”
  3. List the six susceptibility factors.
  4. Discuss the research of Angold and colleagues (1999) on impairment.
  5. Discuss quantitative and qualitative distinctions for a mental disorder.
  6. Compare the dimensional approach and categorical diagnostic approach.
  7. Discuss the role of culture when determining symptoms, impairment, and cases that need treatment.
  8. Discuss the schematic 2.1 regarding a clinician’s initial treatment decision making.
  9. State the two oldest developmental organizations.
  10. Describe emotional self-regulation.
  11. Discuss joint attention.
  12. Compare systems related to cue-specific conditioned fear and systems related to unconditioned fear.
  13. Discuss plasticity.
  14. Compare social phobia and panic disorder.
  15. List the cognitive features of depression.
  16. State the symptoms of depression in children who have lost a parent or are raised by mothers who are unable to provide consistent parenting. (Bowlby, 1982)
  17. Discuss the research of Post. (1992)
  18. State the evolutionary explanation why some individuals exhibit depression.
  19. Discuss the symptoms of ADHD.
  20. Compare “response-ready” and “problem-solving.”
  21. Discuss the research of Levy et al., 1997: Rasmussen et al., 2002, regarding why some children are at risk for ADHD.
  22. State the most common symptom associated with antisocial personality disorder according to the Epidemiologic Catchment Area Project.
  23. Compare predatory and affective aggression.
  24. Discuss effects of excessive stress and early trauma in the child.
  25. Compare the “externalizing” and “internalizing” symptoms of PTSD.
  26. Discuss the three levels of abuse to a child or adolescent. (Table 8.1)
  27. Describe the four models of treatment according to Table 8.2.
  28. Compare the major features of autism and the triad of subtypes as proposed by Wing(1997).
  29. Describe the Autism Diagnostic Interview and the Autism Diagnostic Observation Scale.
  30. Describe the future DSM.

Course Contents

  1. Introduction
  2. Research and Clinical Perspectives in Defining and Assessing Mental Disorders in Children and Adolescents
  3. Understanding Early Development and Temperament from the Vantage Point of Evolutionary Therory
  4. A Developmental Evolutionary Perspective on Two Anxiety Disorders
  5. An Evolutionary Perspective on Childhood Depression
  6. Application of Evolutionary Models on Attention-Deficit/Hyperactivity Disorder
  7. Conduct Disorder and Evolutionary Biology
  8. Evolutionary Biology of Stress Disorder
  9. Autism and Pervasive Developmental Disorder
  10. Recommendations for DSM-V


Customer Comments

“This is a thought-provoking volume that will be of interest to practitioners and researchers in the field of child and adolescent mental health. It should spark some interesting discussions in the field. The book could be used in an upper-level seminar for doctoral students or with interns and post docs.”

– APA Psycritiques

“If DSM-V is to be a real advance over DSM-IV (as everyone hopes), what is needed is more than tinkering with the diagnostic criteria. What is needed are some new ideas about the conceptual basis of psychiatric diagnosis. This book does exactly that by showing how evolutionary psychology and developmental knowledge are essential for understanding child psychopathology….The developers of DSM-V would be well advised to study the last chapter, which offers suggestions for the new manual.”

– Robert L. Spitzer, MD,
New York State Psychiatric Institute

“This book grapples with the fundamental question, ‘What is a disorder?’ The everyday concerns of the clinician and researcher in differentiating disorder from non-disorder are linked with the latest theoretical understanding of human mental processes and their functions and dysfunctions. The promise of the DSM has always been to use symptom syndromes as an initial step from which to bootstrap to deeper theories of the nature and etiology of disorders. This timely and provocative volume initiates the process of rethinking DSM’s syndromal categories from an evolutionary perspective. The reviews are succinct and lucid. This book will be invaluable for introducing clinical and research students to the evolutionary approach to mental disorder in a clinician-friendly way. It should prove useful and stimulating not only to scholars and clinicians, but also to students in graduate seminars and advanced undergraduate survey courses in psychiatry, psychology, and social work.”

– Jerome C. Wakefield, DSW, PhD,
School of Social Work, New York University