Diagnosis and classification in child and adolescent psychiatry: the case of unipolar affective disorder

Child and adolescent psychiatric classification is a broad domain in which the consideration of a developmental and longitudinal approach is essential. Some of the key issues involved are reviewed in this paper by focusing attention on childhood affective disorders, which are important both clinically and epidemiologically. It has been argued and demonstrated by Kovacs that in contrast to adults, children may not be capable of experiencing or reporting the symptoms thought to be representative of major depressive disorder. Nor may they be able to give an account of their duration. Hence, the pattern of manifested depressive symptoms is likely to vary according to age and stage of development of the child and young adolescent, and this is probably related to concept and language development. Further, distress and negative affect may be expressed by externalising symptomatology, especially in the pre-school years. The complexity of multiple depressive disorders, their coexistence and comorbidity with anxiety disorders needs to be studied further, employing whenever possible a developmental perspective and a longitudinal design.