Child Psychopathology

Citation

Georgina Louise Warner (2015), "Child Psychopathology", Journal of Children's Services, Vol. 10 No. 1, pp. 92-93. https://doi.org/10.1108/JCS-12-2014-0049

A field such as Child Psychopathology, so ameliorable in nature, is difficult to capture and reflect in a contemporary manner. Mash and Barkley acknowledge the enormity of the task (p. xi) but tackle it well in this latest edition of Child Psychopathology, with the revolutions of the recently published Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013) evident from the outset. The severance of Obsessive-Compulsive Spectrum Disorders from Anxiety Disorders in the structuring of the chapters, for example, provides a clear indication that the latest scientific thinking, instrumental in the development of DSM-5, has also taken precedence here. In fact, the various contributing authors have given significant attention to DSM-5 and relevant insertions from the manual can be found throughout the book, making it a valuable resource for students, researchers and clinicians alike.

DSM-5 includes a host of significant changes and has been a contentious topic over the last 18 months. Given that two decades had passed since the last revisions to the DSM, and the vastness of scientific advancement in that period alongside the development of new conceptual frameworks, it is not surprising that a number of changes were made. A revision that has received considerable attention is the aggregation of pervasive developmental disorders into the single diagnosis of autism spectrum disorder (ASD). The evolution of “autism” has seen various diagnostic classifications, and the title of the disorder has been controversial from inception given its prior association with Schizophrenia; however, this recent reconsideration has been viewed as “a step backwards” by many and there is concern that some individuals with milder symptoms and sound intellectual functioning will be denied beneficial services as a result of the change. Grofer-Klinger et al. concisely present the polemic rationalisation for the change in the ASD chapter of the third edition of Child Psychopathology. On balance, the authors see the benefit of the change, noting that the new criteria should reduce the likelihood that individuals without ASD will be inappropriately given an ASD diagnosis.

The changes within DSM-5 that impact on the field of Child Psychopathology are not all disorder-specific as in the case of ASD; two broader alterations have been made to the manual. First, a general life-span approach has been taken. While previous editions collated all the disorders typically identified in infancy, childhood or adolescence in an isolated chapter, the new manual disperses the disorders throughout the chapters. In other words, the new manual is arranged by disorder with developmental stage as a second order. An example is Separation anxiety, which now sits within the “Anxiety disorders” chapter of the manual. Accordingly, the third edition of Child Psychopathology adopts the life-span approach and, as one would now expect, the description of Separation Anxiety accompanies those of other anxiety disorders in a dedicated chapter (Higa-McMillan et al.). The rationale for the change was to aid understanding of how age and development can affect a diagnosis. The structural change is helpful as it allows the reader to see how the clinical expression of a diagnosis can change across the life-span rather than focus exclusively on the early expression of the disorder.

The second comprehensive change seen in DSM-5 is the cessation of multi-axial classification. There is no longer a specific requirement for clinicians to consider a mental health disorder in the context of a child’s intellectual level, medical conditions, psychosocial situation and overall level of functioning, as previously prescribed by the “axes”. The importance of psychosocial and contextual factors is, quite rightly, not negated; in place of the axial classification, separate notations on extraneous influences appear in DSM-5. There is a danger that divorcing extraneous influences from the diagnostic process in this manner will lessen the extent to which clinicians consider the possible impact of contextual factors such as the child’s relationships, quality of care and any history of abuse on development. The third edition of Child Psychopathology remedies this by commencing in Chapter 1 with a strong emphasis on “[…] the role of developmental processes, the importance of context and the influence of multiple and interacting events and processes in shaping adaptive and maladaptive development” (p. 3). A number of epidemiological considerations are presented and discussed by Hayden and Mash in this opening chapter, including: age, socioeconomic status, sex, rural vs urban location, ethnicity and culture.

It would be difficult to dispute that the third edition of Child Psychopathy provides an up-to-date overview of mental disorders prevalent in infancy, childhood and adolescence. The range of disorders covered in the book is an achievement in itself, with chapters on intellectual disability (Witwer et al.) through to adolescent substance misuse disorders (Chassin et al.) plus many more. Overall, this book serves as an excellent resource for anyone with an interest in Child Psychopathology.