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Impaired but undiagnosed

A Angold1, E J Costello, E M Farmer

  • 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.

Journal of the American Academy of Child and Adolescent Psychiatry
|February 10, 1999
PubMed
Summary

Many children and adolescents experience psychosocial impairment without meeting criteria for specific disorders. These cases, often labeled "not otherwise specified" (NOS), indicate significant distress and warrant psychiatric consideration.

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Area of Science:

  • Child and Adolescent Psychiatry
  • Mental Health Diagnostics
  • Psychosocial Impairment

Background:

  • Investigating the prevalence and outcomes of psychosocial impairment in youth.
  • Focusing on individuals not meeting criteria for specific disorders (DSM-III-R).
  • Addressing the need for operational definitions for Not Otherwise Specified (NOS) diagnoses and V codes.

Purpose of the Study:

  • Determine the prevalence of psychosocial impairment in youth.
  • Examine the outcomes associated with such impairment.
  • Propose definitions for NOS diagnoses and V codes in child psychiatry.

Main Methods:

  • Utilized two-stage general population sampling for the Great Smoky Mountains Study.
  • Interviewed 1,015 youths aged 9, 11, and 13 in the initial wave.

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  • Conducted follow-up interviews one year later using the Child and Adolescent Psychiatric Assessment.

    • Main Results:

    • Weighted prevalence: sibling relational problems (1.4%), parent-child relational problems (3.6%), relational problems NOS (0.6%).
    • Overall symptomatic impairment rate was 9.4%.
    • Individuals with symptomatic impairment showed significant disturbance, comparable to those with diagnosed disorders.

    Conclusions:

    • Youth exhibiting psychosocial impairment, even without meeting criteria for defined disorders, should be considered psychiatrically impaired.
    • Recommends adopting a broader definition for NOS diagnoses in the DSM.
    • Advocates for the implementation of this definition in research diagnostic algorithms.