Assessing mental disability in minors

Forensic psychiatry devotes a great deal of attention to the "imprecise" and "insufficiently scientific" nature of psychiatric disability assessment, and, for this reason, it is vitally important to establish a reliable method of assessing different levels of disability. The assessment of mental disability in minors is unique in that it involves developmental aspects, which affect the formation and outcome of the disability. The relationship between disability and development is reciprocal: disability can affect development, thereby intensifying the degree of disability, while development affects integration of the disability into the personality and self-image, thereby preventing or reducing the transformation of disability into handicap. Only an understanding of both the psychopathological structure and its interaction with developmental elements can lead to an accurate assessment of the degree of disability. Such an understanding is vital to the proper practice of forensic psychiatry. We hereby propose a new formula for disability quantification which provides an arithmetical means for the calculation of disability percentages in minors, and we recommend its use in the assessment of demands for National Insurance benefits and compensation claims. The relationship between this new formula and the existing Children's Global Assessment Scale (CGAS) functional scale, when tested retrospectively on 50 clinical reports composed by the writers of this article, showed a good correlation in the results obtained independently by each writer. Two case studies are presented here. A further evaluation by objective evaluators is necessary in order to construct a model for a final objective evaluation of disability in children and adolescents.