Although in different times there have been various proposals regarding the classification of mental disorders of the so-called developmental age spectrum, the most widely adopted and used ones are those proposed by the American Psychiatric Association (DSM), and by the WHO (ICD). However, essential questions on both the pertinence and adequacy of these general classifications for children and adolescents are permanently raised, since for some of the principal mental disorders descriptions and diagnostic criteria are common with those proposed for adult patients. The authors present an outline of the history and development of concepts in matter of nosography and classification in child psychiatry, and address the modern general classifications' shortcomings in meeting clinicians' needs. In this context, they present the French Classification of Child and Adolescent Mental Disorders (CFTMEA), first appeared in the late '80s, and with its 4th revision (CFTMEA R-2000) presented in 2002. Developed within the French psychiatric tradition, it is a psychodynamically oriented classification, incorporating at the same time some of the main contributions from other approaches, such as the neurosciences and cognitivism. CFTMEA is a bi axial classification, with an introductory chapter including its overall presentation, and a guide of utilisation, followed by a glossary with brief descriptions of clinical categories and subcategories, as well as inclusion and exclusion criteria. Axe I includes clinical categories and the recently added infant (0-3) section, while Axe II includes both physical and environmental conditions. The clinician is called to decide first on the clinical categories to be noted, with distinction made between principal and complementary ones. Physical and environmental factors are recorded in a second time, within a perspective of multi-factorial interrelations and not of simplifying etiological explanations. Instead of imposing a strict methodology, CFTMEA leaves the work of diagnosis to the clinician's judgement. Specifically conceived to cover the whole range of clinical conditions met within child and adolescent psychiatry, it takes into account their developmental character; as a consequence, CFTMEA presents many differences compared to the general classifications, both in its structure and content (the diagnostic categories). From a general point of view, the authors of CFTMEA reject the "a theoretical" or "objective" model based on a merely descriptive approach, adopted in DSM and ICD. Finally, an interesting feature is that it is open to "communication" with the ICD 10 by establishing correspondences between the two systems' diagnostic categories. In conclusion CFTMEA should be seen not as an alternative, but a first- choice classification for clinicians working in child and adolescent psychiatry. Contrary to the general classifications, it offers a comprehensive view of the disorders appearing in this age group, taking into account the specific nature of psychopathology in different developmental stages. It is an easy-to-use instrument, having acquired a wide audience, not only in France and the French-speaking countries, but also in many parts of the world, through its translation in different languages, the Greek included.
Keywords: classification, child and adolescent psychiatry, French Classification of Child and Adolescent Mental Disorders.
H. Lazaratou, N. Zilikis (page 49) - Full article (Greek)