Clinical Assessment of Child and Adolescent Personality and ...

CHAPTER 3 CLASSIFICATION AND DEVELOPMENTAL PSYCHOPATHOLOGY49in a child and adolescent are pathologicaland need treatment and (2) determiningthe types of pathology that may be present.Alternatively, according to Achenbach(1982) “assessment and classificationare two facets of what should be a singleprocess: assessment aims to identify thedistinguishing features of individual cases;taxonomy (classification) is the grouping ofcases according to their distinguishing features”(p. 1). Therefore, understanding theissues involved in classification is essentialto clinical assessment.The first issue involves acknowledgingthat any classification system of psychologicalfunctioning will be imperfect. Psychologicalphenomena do not fall into specificcategories of normal and abnormal, or intoclear, non-overlapping dysfunction types.This seems to be especially true with children;there is often no clear demarcationof when a dimension of behavior should beconsidered normal and when it should beconsidered pathological. Further, there isoften a high degree of overlap among thevarious forms of psychopathology in children.Finally, any classification system isonly as good as the research used to createit. As the research advances, so should theclassification system.Therefore, any system of classification isbound to be imperfect. Due to this imperfection,many experts have argued againstthe need for any formal classification system.Instead, they argue that psychological functioningshould be assessed and describedidiosyncratically for each individual person.That is, each person is a unique individualwhose psychological functioning shouldsimply be described in ways that maintainthis uniqueness without comparing it withthat of other individuals or fitting it intoartificial categories. This argument has anintuitive appeal given the complexity ofhuman nature. However, there are severalcompelling arguments for the need for goodclassification systems, in spite of the factthat even the best system will be imperfect.The Need for ClassificationSystemsCommunicationThe main purpose of classification systemsis to enhance communication among professionals(Blashfield, 1984; Quay, 1986).A classification system defines the rules bywhich psychological constructs are defined.In the absence of such a system, psychologicalconstructs are defined by idiosyncraticrules developed by each professional, andone cannot understand the terminology usedby a professional unless the rules employedin defining the terms is understood. Forexample, the term depression is a psychologicalconstruct that has several meaningsin the psychological literature on children.It can refer to Major Depressive Episodes,as defined by the Diagnostic and StatisticalManual of Mental Disorders, FourthEdition-Text Revision (DSM-IV-TR; APA,2000). In contrast, it can also refer to elevationson a rating scale of depression (Curry& Craighead, 1993), or to a set of responseson a projective technique (Exner & Weiner,1982). The concept of masked depression isused to describe the belief that many childhoodproblems (e.g., hyperactivity, enuresis,learning disabilities) are the result ofan underlying depressive state (Cytryn &McKnew, 1974). Not surprisingly, each ofthese definitions identifies a different groupof children.Thus, simply saying that a child exhibitsdepression does not communicate much toanother professional unless there is furtherexplanation on how this classification wasmade. On the contrary, if one states that thechild meets the criteria for Major Depressionaccording to the DSM-IV-TR system,then a classification is said to be madeusing a system with clearly defined rules.Also, another professional will then havea clear idea of how depression is defined,even if he or she does not agree with theDSM-IV-TR system. However, this communicationrequires precision in the use