Problems for the Book of Problems? Diagnosing Mental Health Disorders Among Youth.

The present introduction to the Special Issue on “Comorbidity in Children’s Mental Health” does not provide an exhaustive discussion of all of the issues that impact the diagnoses of mental health problems among youth. Rather, these issues are highlighted in the articles included in this Special Issue. Similarly, the present introduction is not the place for a comprehensive and detailed data-based review that could directly inform additional advances in the DSM or the ICD systems. With comorbidity as the theme of the Special Issue, the authors of the accompanying articles provide ample discussion of co-occurring symptoms, limited symptom specificity, and related matters that should be taken into account when diagnosing youth with mental health problems. In this illustrative introduction, we describe and consider a few topics. For example, when striving for an accurate diagnosis of children’s mental health problems, how should divergent reports of symptoms from various sources (e.g., parent, child, clinician, teacher) be weighted? What duration of symptoms (time frame) best reflects disordered functioning, and does the time frame vary across age and developmental periods? Although any discussion of “normal” varies based on the definitions or conceptualizations of developmentally appropriate behaviors, typical development and the many vicissitudes within it, as well as cross-situational consistency of behavior, necessarily bear directly on diagnostics. These topics are among the issues that we consider in the following sections. In another discussion (Drabick & Kendall, 2010), we consider several additional topics relevant to diagnosis among youth from a developmental psychopathology perspective. DSM and ICD are diagnostic systems in the process of review and completion. We, like others, hold that the data should drive the diagnostic system, and that caution should guide changes in diagnostic criteria. We hope that the next needed studies will be informed by the discussions raised in this Special Issue, and further, that the results of these proposed studies will inform the next iteration of diagnostic systems. Before launching into a consideration of sources of concern within the existing diagnostic systems (e.g., DSM-IV-TR; American Psychiatric Association [APA], 2000), it would be remiss not to first mention several worthwhile and meritorious advances that have been made from previous editions. To illustrate, we will use the DSM as an example. For anyone whose first endeavor into psychodiagnostics was with the “mustard manual,” a name reflecting the color of the notably thin, out-line-style Diagnostic and Statistical Manual of Mental Disorders (APA, 1952), the now bulky and descriptive DSM (APA, 2000) has much to be applauded. Once a bulleted list of disorders lacking specifiable criteria, the manual has been transformed to include detailed and specific sets of symptoms required for diagnoses. The poorly named and often single-theory-driven categories of the initial manual have been replaced by aptly labeled disorders that are no longer burdened by theoretical persistence to the neglect of data. In short, the advances in the DSM over the past 40 years are noteworthy, laudable, and move the field in the right direction. However, given our quest for excellence, several important issues are still in need of attention.1