EMPIRICAL COMPARISON OF ICD-10, DSM-IV, K-SADS, AND IGDA IN CHILD PSYCHIATRY CLINICAL PRACTICE

Abstract

Background: Diagnostic systems and guidelines remain crucial in psychiatric practice regardless of their limitations. However, some models fall short in considering the narrative or idiographic dimension of problems brought by patients, which often deepens the distance between diagnosis and clinical decision-making while also emphasizing the disorder and not the individual. Treatment and intervention are strongly related to values, goals and skills, which are only elicited through a person-centered approach and attention to narratives. This broad context is particularly relevant in child psychiatry, where disorders have a strong developmental dimension, and several sources of information are necessary to formulate a diagnosis properly.  Objectives: To compare diagnostic systems in child psychiatry case formulation, discussing the narrative dimension in the IGDA.  Method: Ten school-aged children and their parents were interviewed in-depth. Each case diagnosis was formulated according to the directives in DSM-IV, ICD-10, K-SADS-PL, and IGDA.  Results: The narrative dimension in IGDA brought up unique characteristics of each case that facilitate decision-making, acknowledging the patient’s positive aspects that may be relevant to treatment and recovery.  Discussion and Conclusions: The narrative dimension of diagnostic formulations, alongside the categorial one, is likely to be helpful in a person-centered psychiatric practice, and child psychiatry may benefit greatly.