A context for classification in child psychiatry.

OBJECTIVE To provide a context for classification in child psychiatry over last 45 years including debate over different approaches. METHOD The context for classification of child psychiatric disorders has changed drastically since the introduction of categorical classification and the multi-axial formulation in the Diagnostic and Statistical Manual (DSM) and the International Classification of Disease (ICD). The authors review some historical factors including the shift in psychiatry to a universal classification system spanning the lifespan. RESULTS The adaptation of categorical and universal diagnosis has resulted in a series of child-adult lifespan continuities and discontinuities about how problems are conceptualized within the categorical, multi-axial system. CONCLUSION There is need for a more flexible classification system to incorporate emerging data from longitudinal and gene-environment (GxE) interaction studies within the framework of attachment, developmental and systems theory.