Content area
Full Text
There are many aims which underlie the exercise of psychiatric assessment. Like most other aspects of clinical practice, assessment is much improved if these aims are clear and well thought out at the beginning. This introduction will clarify some of these aims and outline some strategies and tactics available to both clinician and investigator. Often the methods used by the researcher are contrasted with those used in clinical practice. The researcher must be able to show that his or her techniques are reliable, valid and repeatable (even though his or her practice may be free of the scrutiny of the scientific world). If child psychiatry is to avoid the status of quackery, then it is as important for clinical practice as for research that an assessment is of acknowledged validity, and that the conclusions drawn are not merely the individual clinician's idiosyncratic response to the findings.
DIAGNOSIS AS AN AIM
The most commonly recognized function of assessment is diagnostic. Diagnosis has come to play an increasingly important part in child psychiatry, despite a widespread awareness that many child psychiatric diagnoses have as yet relatively few implications for the etiology, treatment or prognosis of the condition. Until recently it was generally the case that the choice of treatment was influenced very heavily by the psychiatrist's training and theoretical orientation, and very little by the characteristics of the patient or the family.1 Some specificity of treatment to diagnosis has begun to emerge in the last few years, but child psychiatric classifications still do not have as many implications for treatment as desirable. Though some system to describe and classify abnormal behavior is needed for communication with our colleagues, our ability to discriminate different symptom patterns has outstripped our ability to find specific remedies, and even these discriminations have poor reliability.2
One possible explanation of this unsatisfactory state of affairs lies at the heart of our concepts of child psychopathology. In all psychiatric disorders, whatever the age of the patient, psychopathology can be divided between that which is personal, or intrapsychic, and that which is interpersonal. Every disorder displays some specific phenomena in each of these divisions, but adult disorders, and the criteria used in their diagnosis, tend to rest more heavily on the personal aspects of psychopathology....