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Classification slides

Classification slides - Classification Classification • A...

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Unformatted text preview: Classification: Classification: • A system for representing the major categories or dimensions of child psychopathology, and the boundaries and relations among them Why have a system of Why have a system of classification? • Communication • Means of summarizing/condensing large amounts of information • Identify treatment strategies that will be more likely to work • Facilitate research • Information about etiology/prognosis Problems with classification: Problems with classification: • Can overlook features that are not • • • • common to a particular disorder Focus on weaknesses, not strengths Can lose information by collapsing over categories Tendency to automatically label any child brought to a clinic Labels can be stigmatizing and a self­ fulfilling prophecy Self­fulfilling prophecy: Self­fulfilling prophecy: • Labels viewed as negative can have adverse effects – Others may treat the child differently – Can impact how the child feels Two approaches to classification: Two approaches to classification: Empirical (generally dimensional) • Relies on the statistical analysis of large amounts of data to determine the symptoms that make up a diagnostic category • No initial assumptions are made about which symptoms go together • No assumptions are made about which diagnostic categories exist • Data are allowed to speak for themselves General findings using the General findings using the empirical approach: • Two broad or global categories that – Externalizing – Internalizing encompass most childhood behavioral problems • There is good reliability and validity evidence for these 2 factors General findings (cont.): General findings (cont.): • Narrow band factors—refers to the specific behavioral syndromes that make up the broad band dimensions – Are often specific to age, gender, setting – Some debate about whether these can be reliably identified and whether distinctions are valid Strengths of empirical Strengths of empirical classification: • Avoids bias in judgment that is associated with the clinical approach • Quantitative approach to decision­making; can use objective rules to define inclusion and exclusion criteria for disorders Limitations of empirical approach: Limitations of empirical approach: • Implementation—factors derived from factor analysis is NOT the same as a diagnosis, although they are often used this way • Limitations of data going into factor analysis – Most relies on parent and teacher report, which may be biased – Leaves out clinician ratings Clinical approach to classification Clinical approach to classification (often categorical): • Usually generated by a panel of experts who identify the diagnostic categories and the specific symptoms that categorize each disorder • Experts rely on clinical observations and readings of the literature • Involves some compromise • Classification of adults has relied on this system (e.g., the DSM) Ex. DSM systems: Strengths Ex. DSM systems: Strengths • Last few editions have included many • • • • more child categories Greater breadth of coverage including intellectual, behavioral, emotional, physical, and developmental problems Uses operational criteria Includes exclusionary criteria No attempts to identify causes DSM systems: Weaknesses DSM systems: Weaknesses • Poor operational definitions—terms like “often” and “easy” are used without guidance • Somewhat biased in what symptoms go together • Lacks a developmental framework DSM­IV: DSM­IV: • Attempt to integrate empirical and clinical approaches • Did not rely exclusively on the consensus of a committee of experts; also used empirical data • Steps used included: – Literature reviews (double reviewed) – Field trials ...
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