Diagnoses

The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition-Text Revision), or DSM-IV-TR, is published by the American Psychiatric Association for the purpose of providing a common language for professionals to use when discussing mental disorders. The manual defines disorders found in infancy, childhood, adolescence, and adulthood by describing specific behaviors that must be present for the mental health professional to diagnose that particular disorder. A similar manual used by mental health professionals is the International Classification of Diseases (Ninth Edition), often referred to as ICD-9 CM. Although parents often do not like their child to be "labeled," a diagnosis is necessary for Medical Assistance or a private insurance carrier to pay for your child's treatment.

A diagnosis determines the treatment that will be prescribed for your child and therefore has serious implications. If the diagnosis is incorrect, the consequences for your child can be grave. Other parents suggest that you get two or three opinions if you are concerned that your child may have been misdiagnosed.

There is a space for diagnosis on all forms submitted to insurance carriers. The professional treating your child must complete this blank with a standardized diagnosis taken from either the DSM-IV or the ICM-9 CM. "Adjustment Disorders" and "Relationship Disorders" are two common diagnoses of children and adolescents. Listed below are some other common diagnoses of children and adolescents, classified according to the main area of disturbance.

Intellectual Disorders

Mental Retardation: If a child's intellectual functioning is significantly below average, the primary diagnosis would be mental retardation. If a child is also having emotional problems, this would be considered the secondary diagnosis. This diagnosis is established by individually administered, nationally standardized psychological tests.

Behavior Disorders

When a child's behavior is the main problem, they may be diagnosed as having one of the following three disorders:

Substance Use Disorder: Young people who persistently abuse or become addicted to drugs or alcohol often have other mental health problems.

Conduct Disorder: A Conduct Disorder involves persistent violations of the customs of society, often with harm to others. This may be accompanied by aggressive or non-aggressive behaviors. Behavior may include repeated rules breaking, stealing, running away from home, fighting, vandalism, truancy, etc. Oppositional Defiant Disorder is another disruptive behavior disorder that is similar to Conduct Disorder, but the behaviors involved are not as serious.

Attention Deficit Disorder (ADD): Children with this disorder are often but not always hyperactive. The child with ADHD is impulsive and unable to pay attention in class or at home, despite good intentions. If hyperactivity is involved, there is restless and fidgety behavior. There also may be excessive running and jumping.

Emotional Disorders

Depression: Depression is more than a low mood that lasts for a short time; it is a state of mind that limits all activity. Things that were once fun will bring little joy to the child who is depressed. He or she may withdraw from activities he or she used to enjoy. This is often accompanied by changes in or disturbances of sleep, appetite, and school performance. In some cases, depression may lead to suicide, which is the second leading cause of death among teenagers. Adolescents may also be afflicted by manic-depressive illness (also known as bipolar disorder). Bipolar disorder involves having times when an adolescent has excessive energy, has little time for sleep, may spend a lot of money, or is very preoccupied with sex. These problems last for weeks rather than days and will alternate with depressive episodes.

Anxiety Disorder: A child with this disorder is very fearful and avoids certain situations, such as spending time apart from parents, going to school, making friends, or new situations. The child may also be very worried or self-conscious. Obsessive Compulsive Disorder is a type of anxiety disorder that often shows itself in using some behaviors over and over again-for example, hand washing even when there is no good reason to do this.

Adjustment Reaction: A mild or brief disorder usually produced by a stressful situation such as the death of a family member, divorce, a family move, or separation from parents.

Relationship Problems: A disorder characterized by problems with significant others such as parents, teachers, or siblings.

Physical Disorders

Some emotional problems in young children involve a physical problem as well.

Enuresis or Encopresis: Bedwetting or soiling would not be diagnosed as mental illness, but may indeed be a problem for a child after a certain age and indicates that he or she needs professional help.

Stereotyped Movement Disorders: This includes sudden, repetitive movements or tics beyond the child's control, such as head banging. Tourette's Disorder is a combination of muscle tics and vocal tics such as saying words or coughing repeatedly.

Eating Disorders: These include anorexia nervosa (a refusal to eat leading to a drastic loss of weight) and bulimia (binge-eating followed by self-induced vomiting or the use of laxatives). The disorders usually affect teenage girls, although the occurrence among teenage boys is rising.

Developmental Disorders

A developmental disorder may be diagnosed when a child's psychological development is affected by biological or non-biological factors. There is either a delay or a distortion in the child's emotional growth.

Learning Disorders: A learning disorder is usually defined as one aspect of development - often reading, language, or math skills - differing from the normal path of development - also called "learning disabilities." The Pennsylvania State Standards on Learning Disabilities defines them as "a deficiency in the acquisition of basic learning skills, including, but not limited to, the ability to reason, think, read, write, or spell or do mathematical calculations as identified by an educational and psychological evaluation." In DSM-IV-TR, there are two further diagnostic criteria. First, the child must have a discrepancy between his or her IQ and his or her academic performance and, second, he or she must have had adequate opportunity to have acquired academic skills. We do not often know why children have these disabilities, but we believe that there may be some biological base.

Pervasive Developmental Disorder: This is defined as having severe problems in development in several areas. One example is autistic disorder. Babies with autism do not respond to others, cuddle, or look at their caregiver. These children may never learn to talk or else may use peculiar speech patterns. Autistic children also find it very difficult to cope with change. This disorder typically manifests itself in the first 36 months of life.

Schizophrenia: This disorder is characterized by a profound disturbance in social relations and multiple oddities of behavior, including delusions (absurd beliefs not based in fact), hallucinations (most frequently hearing voices), and extremely disorganized thoughts. Onset is typically between 15 and 30 years of age.

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