Assessing Child Impairment in Functioning in Different Contexts: Implications for Use of Services and the Classification of Psychiatric Disorders

Context: Functional impairment is a necessary criterion for most DSM IV disorders, for determining need for services, for evaluating the effectiveness of treatment and for reimbursement of mental health services. It is also an important predictor of mental health service utilization in children. Presently the diagnosis of impairment on axis V of DSM IV makes it difficult to disentangle symptoms and functioning. Furthermore, clinicians are required to consider familial and contextual issues in assessing child impairment, but no specific guidance or guidelines to accomplish this are offered. Conclusions: Given these limitations, a new conceptualization of impairment in functioning based on a modification of the International Classification of Functional Disability and Health for Children and Youth (ICF-CY) is recommended. A new instrument, the Child WHODAS, which is being considered for inclusion in the new edition of DSM 5, is described. This instrument is a disability measure based on the ICF-CY for ascertaining disability in functioning.