Annual Research Review: Conceptualising functional impairment in children and adolescents
Ronald M. Rapee,1 Susan M. Bogels,2 Cathy M. van der Sluis,2 Michelle G. Craske,3 and Thomas Ollendick4
Centre for Emotional Health, Macquarie University, Sydney, Australia; 2University of Amsterdam, The Netherlands; 3Department of Psychology, University of California, Los Angeles, CA, USA; 4Child Study Center, Virginia Tech, Blacksburg, VA, USA
Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for deﬁning and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the inﬂuence of impairment on diagnostic decisions and prevalence rates. Several factors inﬂuencing impairment in childhood such as culture, development and gender are considered. This article con- cludes with a discussion of the utility of separating judgements of impairment from speciﬁc diagnoses, which is proposed for consideration in the forthcoming DSM-5.
Keywords: Mental health, quality of life.
Annual Research Review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice
John V. Campo
Background: Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. Method: Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disor- ders in community-based and clinical samples of children and adolescents. Results: FSS are consis- tently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. Conclusion: Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal rela- tionships between the various symptoms and conditions.
Keywords: Anxiety, comorbidity, depression, emotion, somatization.
Annual Research Review: Hoarding disorder – potential benefits and pitfalls of a new mental disorder
David Mataix-Cols and Alberto Pertusa
Departments of Psychosis Studies and Psychology, King’s College London, Institute of Psychiatry, London, UK
Background: The inclusion of a new mental disorder in the nomenclature is not a trivial matter. Many have highlighted the risks of an ever-increasing number of mental disorders and of overpathologizing human behaviour. Given the proposed inclusion of a new hoarding disorder (HD) in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, ﬁfth edition), it is pertinent to discuss the potential beneﬁts and pitfalls of such a development. Method: In this article, we examine whether HD ﬁts with the current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and proposed DSM-5 deﬁnitions of ‘mental disorder’. We next discuss the potential beneﬁts and risks of the creation ofthis diagnosis. Finally, we address some additional considerations that may arise when proposing a new disorder for the nomenclature and identify some of the gaps in the knowledge base. Conclusion: HD ﬁts the current DSM-IV and proposed DSM-5 deﬁnitions for a mental disorder. On balance, the potential beneﬁts of creating the new diagnosis (e.g. identiﬁcation of the majority of cases who clearly suffer and need help but are currently missed out by the existing diagnostic categories) outweigh the potential harms (e.g. pathologizing normal behaviour). Whether the criteria will need modiﬁcation for their use in children/adolescents is unclear and more research is needed to address this ques- tion.
Keywords: Hoarding disorder, DSM-IV-TR (Diagnostic and Statistical Manual of Mental Dis- orders, fourth edition, text revision (DSM-IV-TR)), DSM-5, obsessive-compulsive disorder.
- DSM-5 Somatic Symptoms Work Group submissions 2012: Last chance to tell SSD Work Group why it needs to ditch flawed, unsafe and unscientific proposals (dxrevisionwatch.wordpress.com)
- Mental Health Disorders (socialsecurityhome.com)
Annual Research Review: Impact of advances in genetics in understanding developmental psychopathology
Anjene M. Addington and Judith L. Rapoport
Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
It was hoped that diagnostic guidelines for, and treatment of, child psychiatric disorders in DSM-5 would be informed by the wealth of clinical genetic research related to neurodevelopmental disorders. In spite of remarkable advances in genetic technology, this has not been the case. Candidate gene, gen- ome-wide association, and rare copy number variant (CNV) studies have been carried out for attention- deﬁcit/hyperactivity disorder (ADHD), Autism, Tourette’s Syndrome, and schizophrenia, with intriguing results, but environmental factors, incomplete penetrance, pleiotropy, and genetic heterogeneity, underlying any given phenotype have limited clinical translation. One promising approach may be the use of developmental brain imaging measures as more relevant phenotypes. This is particularly impor- tant, as subtle abnormalities in timing and expression of gene pathways underlying brain development may well link these disorders and be the ultimate target of treatments.
Keywords: Developmental psychopathology, genetics, copy number variants, pre-natal diagnosis, nosology, prevention.