Rating child psychiatric caseness from detailed case histories

Novel operationalized criteria were used to rate detailed psychiatric case histories on 151 schoolchildren with hemiplegia. Ratings of psychiatric caseness or non-caseness were reliable and valid; the method may be widely applicable. Caseness was defined both narrowly (in terms of social incapacity for the child) and broadly (in terms of disruption to others and distress too). Both definitions could be applied reliably to children of normal intelligence but broadly defined caseness was more reliable for children with low intelligence. Barely half of the psychiatric cases met operationalized criteria for one or more DSM-IV or ICD-10 diagnosis. The others mostly had partial or mixed syndromes that could, with clinical judgement, be assigned to "not otherwise specified' diagnoses. Even with clinical judgement, however, a substantial minority of children with low intelligence had clinically significant but undiagnosable abnormalities in social relatedness.