Falling through the cracks children with social impairment but no diagnosis

Diagnostic systems have to be practically useful above all. If they are overinclusive, the risk is that there are too many categories, which have poor reliability and high overlap. If on the other hand they are too exclusive, the risk is that there will be many individuals suffering from problems which are not encompassed by the scheme. In the Bird et alS-B survey, 6.2 per cent of the population had moderate impairment but no DSM-III diagnosis. In a different survey using DSM-IIIR criteria, Angold et al.(32 found 9.4 per cent had no diagnosis but significant impairment. Across a variety of 'caseness' measures, the individuals were as disturbed as those with a diagnosis. Many of the difficulties were around relationships with parents and siblings, and Angold et al. argue that children who have symptoms associated with psychosocial impairment should be regarded as suffering from a psychiatric disorder.

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