Psychiatric Assessment, Diagnosis, and Classification in Children and Adolescents
Psychiatric assessment, diagnosis, and classification
Assessment is multi-informant and multi-method: developmental history, parent and teacher reports, child interview and observation, rating scales, and records. Diagnosis requires DSM-5/ICD criteria, symptom duration, developmental appropriateness, and functional impairment-not just a high checklist score. Comorbidity is the rule, so the candidate must sequence differentials: ADHD versus anxiety, depression versus irritability, trauma versus psychosis, and medical mimics. Cultural formulation, language, hearing, and school context shape reporting. Standardized interviews improve reliability, while rating scales quantify severity and track change. Safety, sleep, substance use, and abuse/neglect screening belong in every evaluation.
Traps: diagnosing from a single informant; treating parent-teacher discrepancy as "masking" without exploring setting demands; equating a scale cutoff with a disorder; ignoring impairment; and anchoring on a prior label. Questions often present conflicting reports-the best response is to gather collateral and observe functioning rather than average the ratings. Also remember consent/assent and confidentiality limits.
Worked example/rule of thumb: A parent reports severe ADHD symptoms, but the teacher reports typical attention and no academic impairment. Before diagnosing ADHD, assess home-only triggers (sleep, anxiety, parent-child conflict, screens) and cross-situational impairment. Rule: no disorder without developmentally inappropriate symptoms plus impairment in more than one setting, unless the syndrome is setting-specific by definition.