On a pediatric bone marrow transplant unit, hematologist-oncologists, nurses, social workers, psychiatrists, psychologists, and others on the team deal with children and adolescents whose cancers are either treatable by marrow transplantation or are ultimately fatal. Contrary to original assumptions, many children and families cope well, especially in relatively uncomplicated cases with good outcome. Treatment may include direct psychotherapeutic intervention with the child and family, as well as use of psychopharmacologic agents such as antidepressants or anxiolytics for frank psychiatric disorders. Psychotherapists often have to function adjunctively with other staff members in their interactions with the patient and the family. A stress disorder model appears to best explain child, parent and family reactions to bone marrow transplantation. Given the medical severity and complexity of the conditions treated, and the approximately equal rates of overall success and failure, a supportive consultative approach is usually most helpful for child patients, parents and staff throughout the procedure. A retrospective study of the children treated over seven years in a tertiary pediatric hospital bone marrow transplant unit is presented. The level of child, parent, and family psychopathology was usually mild to moderate, but there were clear differences between patients. Mothers were more supportive than fathers under this extreme type of stress. Prospective longitudinal studies of children and families are needed to establish causal chains and optimal therapeutic interventions.

The purpose of this paper is to compare and contrast the disorders of infancy, childhood and adolescence in the DSM-III-R with those of its predecessor, the DSM-III. Design features of the child psychiatry sections of the DSM-III-R are described, with comparisons of reliability and validity assessments in the two classifications. Categorical and dimensional systems of psychiatric nosology are described; the DSM-III-R has features of both systems. To be most useful for child psychiatrists in ordinary clinical practice, DSM-III-R symptom criteria should be available in a standardized but brief fashion to ensure adequate data gathering from both child and parent. This avoids problems inherent in lengthy standardized interviews are based on DSM-III-R criteria; although these interviews are excellent for research purposes, clinicians tend to avoid them as clinically constraining. The commonly used alternate of clinicians' overall evaluations is of uncertain reliability and validity, since it is unclear whether all symptoms have been asked for. A symptom checklist approach is therefore suggested as a intermediate procedure to ensure that appropriate questions are asked from the parent and child, while allowing fuller exploration by the clinician. This approach also indicates parent-child variance, and allows for rank ordering of diagnoses which may indicate priorities for treatment of child psychiatric disorders. Overall, the DSM-III-R is a positive step towards more adequate diagnosis and treatment for child and adolescent psychiatric disorders, which will lead to further improvement in the future DSM-IV.