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Dimensional classification assumes that disorders fall along a continuum of severity ranging from mild to severe. It involves describing the severity of the individual’s distress and/or disability on this continuum. One advantage of dimensional classification is that it conveys more information than simple categorical or prototypical classification. For example, rather than merely diagnosing a child with autism, a clinician can describe the child as having mild impairment in social communication but severe behavioral impairment (e.g., repetitive actions and difficulty adjusting to changes in routine). A second advantage of the dimensional approach to classification is that it allows clinicians to monitor changes in children’s functioning across time. For example, a child may continue to meet diagnostic criteria for autism after several years of behavior therapy; however, his repetitive behavior might improve from “severe” to “mild.”

Previous versions of the DSM were criticized for their exclusive reliance on the categorical and prototypical approaches to classification. Consequently, the developers of DSM-5 attempted to incorporate aspects of dimensional classification into the newest edition of the manual. Dimensional classification is most easily seen in the DSM-5 Cross-Cutting Symptom Measure, a rating scale that can be used to evaluate the severity of children’s signs and symptoms. The rating scale allows dimensional classification on 10 broad domains including physical symptoms and sleep problems, anxiety and depression, anger and irritability, and mania and psychotic symptoms. Children’s severity on each domain can be described on a 5-point continuum ranging from “none or not at all” to “severe or nearly every day.”

Table 1.1 shows a clinician’s ratings of an adolescent using the Cross-Cutting Symptom Measure. These ratings show that the adolescent is experiencing moderate to severe problems with depressed mood and irritability but fewer difficulties with anxiety and worry. The ratings provide additional data, above and beyond the adolescent’s diagnosis, and can be used as a baseline from which to assess the youth’s progress in treatment.

Some DSM-5 disorders also allow clinicians to provide additional information about their clients using specifiers. A diagnostic specifier is a label that describes a relatively homogeneous subgroup of individuals with the same disorder. Usually, specifiers are created based on the person’s signs and symptoms. For example, some children with ADHD are primarily hyperactive and impulsive but listen to their parents and teachers, whereas other children with ADHD daydream in class but remain quiet and still. Although all of these children are diagnosed with ADHD, clinicians might assign the specifier “predominantly hyperactive–impulsive presentation” or “predominantly inattentive presentation” to children in the first and second groups, respectively. These specifiers provide a more precise description of children’s behavior than the diagnostic label alone.

Table 1.1

Review

 DSM-5 uses a categorical approach to classification because it requires children to meet specific criteria to be diagnosed with a disorder. Youths who do not meet all criteria are not diagnosed with the disorder.

 DSM-5 also uses a prototypical approach to classification for many disorders. Children can show a subset of possible signs and symptoms that reflect a typical child with the disorder.

 DSM-5 uses a dimensional approach to classification for several disorders. Clinicians can indicate the severity of children’s disability or distress on a continuum ranging from mild to severe.