CommentaryFraming childhood mental disorders within the context of disability
Section snippets
Disproportionate rise in disability related to child mental disorders
The threats to the health and well-being of children in the United States have changed dramatically over the past century.15 Widespread public health measures and medical advances have shifted the management of children's health from control of acute infectious diseases to the treatment of chronic conditions many of which are associated with limitations in how children function in their daily lives.15, 16 The epidemiology of chronic conditions of childhood has shifted substantially with a rise
Clinical approach
Despite these advances in the conceptualization of disability, most mental health professionals rely solely on impairment-related diagnostic criterion in the DSM-5 to clinically judge the extent functional impairment is attributable to a child psychiatric diagnosis. This criterion is significant because it is often used as the clinical threshold to differentiate normal and pathological symptom expressions.31 In contrast to the ICF, the DSM-5 is a classification system that provides consensus
Discussion
Data on childhood disability suggest that the proportion of children experiencing disability is steadily increasing regardless of the definition used, and that the conditions underlying those disabilities is shifting from a dominant mix of traditional medical conditions and orthopedic impairments to a preponderance of mental and neurodevelopmental conditions.7, 15 How much of this increase in prevalence is “real” and what proportion results from changes in recognition, diagnosis, availability
Funding
Dr. Zima was supported by the Behavioral Health Centers of Excellence for California (SB852). All of the authors have no financial relationships relevant to this article to disclose.
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