DSM-IV Basics: A Primer for School Psychologists

Ken Merrell, Ph.D.

School Psychology Program, The University of Iowa
December, 2000

WHY BOTHER WITH THE DSM-IV?

Many school psychologists, particular those who are more behaviorally-oriented, contend that the DSM-
IV should be avoided because of a variety of problems: modest reliability, questionable treatment validity,
and lack of a focus on identifying problems in a functional manner. Although there is some merit to these
concerns, school psychologists should become at least familiar with the DSM-IV for the following
reasons:
• it is not going away–DSM has become a permanent fixture in American mental health care
• reliability has improved substantially from previous editions
• empirical validity focus has improved substantially in most cases
• outside of school settings, a DSM-IV diagnosis may be necessary for helping to secure third-party
payment for services; thus, familiarity with DSM is important for school psychologists who wish to
work in non-traditional settings
• DSM diagnoses, although not perfect, can provide a common framework for communication among
professionals regarding specific client concerns and background
• the DSM is part of a continuing step toward developing a scientific taxonomy of psychological and
psychiatric disorders

HISTORY OF DSM

• The first edition was published by American Psychiatric Association in 1952, and was a variant on
the World Health Organization’s International Classification of Diseases-6.
• The latest revision (DSM-IV) was 1994. A more recent “text revision” has also been published.
• Categories of disorders have evolved over time based on emerging data and political forces; the
medical model of disease has historically been the basis for much of the DSM system, although that is
changing somewhat over time.

WHO CAN MAKE DSM-IV DIAGNOSES?

• The DSM-IV can be used for diagnostic purposes by any mental health professional with adequate
training in diagnosis. Some school psychologists mistakenly believe that one must be a clinical
psychologist or psychiatrist to use the DSM-IV. The issue is training a competence rather than
professional title.
• Some school districts or state departments of education specifically prohibit the use of DSM by
school psychologists within special education assessment processes.

CODING AND REPORTING PROCEDURES WITHIN DSM-IV

• diagnostic codes
• severity and course specifiers
• recurrence
• principal diagnosis/reason for visit
• provisional diagnosis specifier
• other: use of V codes, deferred diagnosis on Axis I or Axis II

TYPES OF INFORMATION IN DSM-IV TEXT

• diagnostic features
• subtypes and/or specifiers
• recording procedures
• associated features and disorders
• specific culture, age, and gender features
• prevalence
• course
• familial pattern
• differential diagnosis

DSM-IV MULTIAXIAL CLASSIFICATION SYSTEM

Axis I Clinical Disorders (p. 26)

Other Conditions That May Be a Focus of Clinical Attention (pp. 675-687)
Axis II Personality Disorders (p. 27)
Mental Retardation
Axis III General Medical Conditions (p. 28)
Axis IV Psychosocial and Environmental Problems (pp. 29-30)
Axis V Global Assessment of Functioning (rated 0-100; see pp. 758-761)

DSM-IV CATEGORIES OF DISORDERS CONSIDERED TO USUALLY BE FIRST EVIDENT

IN INFANCY, CHILDHOOD, AND ADOLESCENCE

MENTAL RETARDATION: Mild, Moderate, Severe, and Profound Mental Retardation

LEARNING DISORDERS: Reading Disorder, Mathematics Disorder, Disorder of Written Expression, Learning Disorder Not Otherwise
Specified

MOTOR SKILLS DISORDER: including Developmental Coordination Disorder

COMMUNICATION DISORDERS: Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, Phonological
Disorder, Stuttering, Communication Disorder Not Otherwise Specified

PERVASIVE DEVELOPMENTAL DISORDERS: Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s
Disorder, Pervasive Developmental Disorder Not Otherwise Specified

ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR DISORDERS: Attention-Deficit/Hyperactivity Disorder (3 types), Conduct

Disorder, Oppositional-Defiant Disorder, Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified, Disruptive Behavior
Disorder Not Otherwise Specified

FEEDING AND EATING DISORDERS OF INFANCY OR EARLY CHILDHOOD: Pica, Rumination Disorder, Feeding Disorder of
Infancy or Early Childhood

TIC DISORDERS: Tourette’s Disorder, Chronic Motor or Vocal Tic Disorder, Transient Tic Disorder, Tic Disorder Not Otherwise
Specified

ELIMINATION DISORDERS: Encopresis, Enuresis

OTHER DISORDERS OF INFANCY, CHILDHOOD, OR ADOLESCENCE: Separation Anxiety Disorder, Selective Mutism, Reactive
Attachment Disorder of Infancy or Early Childhood, Stereotypic Movement Disorder, Disorder of Infancy, Childhood, or Adolescence
Not Otherwise Specified