Nosology and measurement in child and adolescent psychiatry
Nosology and measurement in child and adolescent psychiatry
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DOI：
10.1111/j.1469-7610.2008.01981.x
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发表时间：
2009-01-01
影响因子：
7.6
通讯作者：
Costello, E. Jane
中科院分区：
文献类型：
--
作者：
Angold, Adrian;Costello, E. Jane
在过去的50年里，儿童和青少年精神疾病的测量和分类取得了巨大的进步。关于我们是否应该继续依赖分类疾病分类的争论仍在继续，但我们认为，尽管精神疾病和正常之间没有明确的分界线，诊断合并症无处不在，目前的官方方法，疾病分类服务儿童和青少年精神病学研究令人惊讶的好。特别是，我们指出，非发展诊断标准的工具，发现发展对精神病理学的影响的效用。我们还认为，寻求疾病之间更清晰的界限是根本错误的。然而，官方疾病分类学倾向于优先考虑诊断访谈中收集的信息，并将观察和其他方法排除在外，这些方法不容易符合其标准的格式。我们认为，现在是纠正这种情况的时候了。ICD-10和DSM-IV对两岁以下的儿童毫无用处，而DC：0-3等替代品则严重缺乏经验支持。我们建议通过整合气质和精神病理学研究的方法向前迈进。最后，我们对标准化评估技术未能更深入地渗透到日常临床评估中感到遗憾。
The last 50 years have witnessed enormous strides in the measurement and classification of child and adolescent psychiatric disorders. Debates about whether we should continue to depend upon a categorical nosology still continue, but we argue that, despite the absence of clear dividing lines between psychiatric disorders and normality and ubiquity of diagnostic comorbidity, the current official approach to nosology has served child and adolescent psychiatric research surprisingly well. In particular we point to the utility of non-developmental diagnostic criteria as tools for discovering developmental effects on psychopathology. We also maintain that the search for sharper boundaries between disorders is fundamentally mistaken. However, official nosologies have tended to privilege information collected in diagnostic interviews and to sideline observational and other methods that cannot easily be made to conform to the format of their criteria. We suggest that it is time to remedy this situation. The ICD-10 and DSM-IV are useless for children under the age of about two, while alternatives, such as the DC:0-3, suffer from a profound lack of empirical support. We suggest a way forward through the integration of methods from temperament and psychopathology research. Finally, we deplore the failure of standardized assessment techniques to have penetrated more deeply into everyday clinical assessment.