Comparing Conventional vs. Systemic Assessment of Childhood Issues
The number of mental health visits by children and adolescents to office-based physicians in the United States between 1995-1998 and 2007-2010 virtually doubled (Olfson et al., 2015). Mental health impairment denotes the intensity at which psychiatric symptoms hinder one’s ability to perform various significant activities of daily living (Rapee et al., 2012). The federal government necessitates that a mental disorder must result “in a functional impairment, which substantially interferes with or limits the child’s role or functioning in family, school, or community activities to satisfy requirements for the determination of mental health disability and of the need for special education placement, requires” (Leone, 1993, p. 29423).
According to Leone (1993), the etiology of mental health disorders is based on a medical model in which “serious emotional disturbances and serious mental illnesses are brain diseases with a neurological basis (p. 29423).” The medical model defines a severe mental illness as “only those diagnoses whose etiology have been proven to be neurobiological (p. 29423).” This suggests that illnesses such as schizophrenia have a neurobiological component that would meet the medical model requirements. However, depression, which could be situational, such as marital discord, bullying, contextual disparities, or ADHD, which has no substantiated etiology, would not.
In addition, the medical model treatment of a childhood disorder would view mental illness as all physical illnesses. A provider would treat them by diagnosing their symptoms and telling the patient what to do, such as adjusting or limiting the physical cause and treating the somatic symptoms (Sori, 2015a).
The diagnosis of most disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) entails that disorders trigger clinically significant distress or impairment in social, occupational, or other important areas of functioning (American Psychiatric Association, 2013). In contrast, the systemic view of treating child and adolescent disorders considers the interactions and relationships between the child and their system, including their parents, step-parents, foster parents, and other family members. This lens allows the child, viewed as a significant subsystem component, to provide a wealth of information concerning the relationship (Sori, 2015b). In this lens, the diagnosis is not particularly relevant; instead, working to achieve homeostasis is.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
Leone, J. R. (1993). Substance and Mental Health Services Administration: Center for Mental Health Services. Federal Register, 58(96), 29422–29426.
Olfson, M., Druss, B. G., & Marcus, S. C. (2015). Trends in mental health care among children and adolescents. The New England Journal of Medicine, 372(21), 2029–2038. https://doi.org/10.1056/NEJMsa1413512
Rapee, R. M., Bőgels, S. M., van der Sluis, C. M., Craske, M. G., & Ollendick, T. (2012). Annual Research Review: Conceptualizing functional impairment in children and adolescents. Journal of Child Psychology and Psychiatry, 53(5), 454–468. https://doi.org/10.1111/j.1469-7610.2011.02479.x
Sori, C. F. (2015a). Filial Therapy: An Interview with Rise VanFleet. In C. F. Sori (Ed.), Engaging Children in Family Therapy: Creative Approaches to Integrating Theory and Research in Clinical Practice (pp. 91–116). Routledge.
Sori, C. F. (2015b). On Counseling Families and Children: Recommendations from the Exports. In C. F. Sori (Ed.), Engaging Children in Family Therapy: Creative Approaches to Integrating Theory and Research in Clinical Practice (pp. 3–20). Routledge.