Decision Trees for Use in Childhood Mental Disorders

The third edition of The Diagnostic and Statistical Manual ofMental Disorders (DSM-III) (1) provides specific diagnostic categories for use in childhood mental disorders, even though these diagnoses are not limited to children. In addition, many of the diagnostic categories used for adults are considered appropriate for use in children. DSM-I II instructs the clinician to diagnose children by first considering the section Disorders First Evident in Infancy, Childhood, or Adolescence before considering the disorders described elsewhere. However, this may lead to problems because some major diagnostic categories such as affective disorders and schizophrenia are not included in the childhood section. This may lead some clinicians to overlook a more accurate diagnosis outside the childhood section, i.e., using Overanxious Disorder in stead of Major Depression. In an attempt to help the clinician to understand the structure of the classification system, DSM-III contains a set of decision trees. Although these trees may be useful for adult diagnosis, they are not quite as useful in diagnosing children. The main problem is that children generally are brought to psychiatrists with behavioral complaints which are related by their parents. Children are more likely than adults to act out their feelings in non-specific ways. For example, a child\u27s verbalization of worries to his parents may be a symptom of Separation Disorder, Major Depression, or Overanxious Disorder. Use of the decision trees in DSM-III would require the clinician to make an initial distinction between anxious mood and depressed mood. This is difficult with children, who often are unable to verbally label their feelings. Another factor complicating diagnosis in children is their greater imagination leading to the assessment of hallucinations or delusions which may not necessarily indicate psychosis. This article proposes an alternate set of decision trees that may be helpful in the diagnosis of mental disorders in children and adolescents under the age of 18 years. Like the DSM-III decision trees, these trees are only approximations of the actual diagnostic criteria. Thus, they are not meant to replace the actual diagnostic criteria in DSM-II I