Psychosocial impairment is significant in young referred children with and without psychiatric diagnoses and cognitive delays - Applicability and reliability of diagnoses in face of co-morbidity

Subthreshold psychiatric symptoms with clinically significant psychosocial impairment are a diagnostic problem. They may reduce the reliability of classifications and the communicative value of diagnostic descriptions when specific diagnostic categories cannot be applied. This study was undertaken in order to test the reliability and applicability of psychiatric diagnoses and psychosocial functioning scores as well as differences in psychosocial impairment in children referred to a neuropsychiatric outpatient unit. Two hundred and nineteen young children were diagnosed on all ICD-10 axes, except Axis V First, reliability was tested with moderate to good results for psychiatric diagnoses (K-W = 0.55 and 0.73) and psychosocial impairment (ICC 1.1 = 0.71). Additional specification of the criteria for some of the Axis I diagnoses reduced the number of children with "subthreshold" conditions without a psychiatric diagnosis. Second, the severity of psychosocial impairment differed significantly between five psychiatric groups. Children with "subthreshold" conditions were as impaired psychosocially as those with hyperkinetic disorder and more so than children with emotional, social, and emotional and behavioural disorders. High chronological age, low IQ, low level of social skills, and psychiatric group (PDD) predicted psychosocial impairment. Third, the "subthreshold" group often had language problems (14 out of 18 children) unless they were mentally retarded.