The release of DSM-5 occasioned a renewed interest in how to evaluate a person in mental distress for the presence of a mental disorder (e.g., American Psychiatric Association 2015; Lieberman 2015; Phillips et al. 2012a, 2012b, 2012c). Such an evaluation can seem impossible. After all, when you are determining whether a person is experiencing a mental disorder, you consider many aspects of a person, including his or her culture, ethnicity, faith, family history, gender, medical history, sexual orientation, and temperament. When making those determinations in children and adolescents, your evaluation is often even more complex. You must know both a person’s age and his or her developmental age. You must know both a person’s temperament and the temperament of his or her parents. You must know the health of a person and the health of his or her family.
By design, DSM-5 is a manual for the diagnosis of mental illness in a particular person, so using it in children and adolescents, whose health is inevitably bound up in the communities and families in which they are situated, requires an act of translation. This manual is, itself, a pragmatic translation of DSM-5. This book is not a replacement for DSM-5 itself or the many pediatric psychiatric interview textbooks (e.g., Cepeda 2010; Mash and Barkley 2007) but a way to use the DSM-5 criteria as part of a diagnostic interview to guide treatment planning.
Every day we interview patients with students, trainees, and fellow practitioners, so we wrote the book for interviewers at all levels of experience. The first section of the book introduces the diagnostic interview, its goals, and how to structure an interview according to how much time you have with a person. The second section operationalizes the DSM-5 diagnostic criteria for clinical practice. The third section includes additional information, tables, and tools. Taken as a whole, this book helps you accurately diagnose mental disorders in a child or an adolescent while establishing a therapeutic alliance, which remains the goal of any psychiatric encounter.
Before we begin, a few words about the language we use in this book. When possible, we use neutral gender for the person and the interviewer, but when doing so is grammatically awkward, we alternate between the universal feminine viiiin odd-numbered chapters and the universal masculine in the even-numbered chapters.
Wherever possible, we emphasize the agency, the ability of a child or an adolescent to act in the world. To signal this emphasis, we use the word person to describe the object of mental health evaluation. We acknowledge that a robust debate exists about whether the object of medical care is best construed as an ill patient under the care of a health professional or as an autonomous consumer of that professional’s services (cf. Emanuel and Emanuel 1992), but because personhood precedes illness or consumption, we prefer person. However, when we write about a person who has entered psychiatric treatment, we use the term patient because it acknowledges both the vulnerability of the person in treatment and the responsibilities assumed by professionals when they care for patients (cf. Radden and Sadler 2010). We use the term patient not to endorse medical paternalism but to emphasize that the particular and protected relationships that develop in clinical encounters are better described as therapeutic relationships rather than as therapeutic contracts.
Because children and adolescents often depend on a variety of adults—parents, extended family members, adult friends, teachers, faith leaders, coaches, and more—for their needs, we use the term caregiver to describe an adult who cares for a child or an adolescent outside of medical relationships.
Finally, we are both physicians, but children and adolescents receive care within medical relationships from persons trained in a variety of helping professions. To acknowledge this variety, we use the term practitioner to describe a medical professional who cares for children and adolescents. Although provider is the more common euphemism, we prefer practitioner because it emphasizes the ways a professional who meets children and adolescents as patients is constantly practicing and refining his or her craft.
We thank the teachers and students with whom we learned (and still learn) how to care for children and adolescents in mental distress, our respective academic and clinical homes for encouraging this work, and our own families for tolerating our efforts.
The authors have no competing interests or conflicts to declare.