Objectives. The main purpose of the paper was to discuss dilemmas concerning the use of contemporary classifications of mental disorders in children and adolescents. The ICD-10 and DSM-IV classification systems are aimed at unification of diagnoses and diagnostic criteria. While the systems have many scientific, practical and teaching merits, their weak points include their over-embedding in current socio-cultural contexts, difficulty in diagnosing multiple disorders, and a low stability of diagnoses in children and adolescents. Another purpose of the paper was to outline the history of classifying and diagnosing mental disorders in children and adolescents in Poland.
Review. The authors analysed the literature concerning classification systems, the history of classification of mental disorders in children and adolescents, and the effect of environmental, social and cultural factors on diagnosing developmental mental disorders. The analysis of developmental mental disorders classification in Poland from the historical perspective was based on major textbooks of psychiatry and chapters published in Poland since the early 1900s. The classification of child and adolescent mental disorders underwent many changes and transformation in many aspects over the past century. While initially classifications of developmental mental disorders were very similar to those in adults, an increasing awareness of the specificity of mental disorders in children and adolescents, as well as gradual differentiation of diagnostic criteria can be seen with years. Early classifications were usually based on therapeutic pedagogy experiences and on theoretical approaches such as psychoanalysis. The number of diagnoses was gradually increasing, theoretical models were abandoned in favour of phenomenological descriptions on which diagnoses were based, the significance of the context of mental disorders was more and more widely appreciated, and it was more and more often taken into account in classifications. Increasingly clearer diagnostic criteria were specified. On the other hand, stability of diagnoses, especially in younger children, is still low. Besides, a very high prevalence of co-morbid conditions is reported in the research literature. A careful interview with the child and his/her parents/caregivers, as well as family diagnosis taking into account the achievements of family therapy seem to be essential for good diagnostic practice.
Conclusions. Classification and diagnoses of mental disorders in children and adolescents changed significantly in the 20th century. This transformation of views on developmentalpsychopathology was strongly influenced by social and cultural factors. Changes in the classification of mental disorders in children and adolescents in Poland reflect these in Western Europe and the US.