DSM-IV and disorders of childhood and adolescence: can structural criteria be functional?

The structural, descriptive basis of the diagnostic categories outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) is contrasted to a system of functional analysis, with regard to (a) clinical diagnosis, (b) target behavior identification, (c) treatment design, (d) treatment evaluation, and (e) clinical research. It is noted that structural classification is a useful starting point for these activities but that functional analysis has greater utility for target behavior identification and treatment design by giving consideration to antecedent and consequent events, skills repertoires, response interrelations, and support systems. Examples of melding structural classification and functional analytic systems are provided with reference to certain childhood disorders: mental retardation, disruptive behavior disorders, and anxiety disorders. Recommendations are made for an elaboration of the DSM axes to include (a) psychosocial and environmental resources and deficits, and (b) idiographic case analysis. It is suggested that these axes will assist in systematizing functional analysis and making it more accessible to all clinicians and researchers.