Parent–Child Relational Problem: Field Trial Results, Changes in DSM‐5, and Proposed Changes for ICD‐11

Abstract

Caregiving relationships are significant factors in the development, mediation, or moderation of childhood mental health problems. However, epidemiological and clinical research has been limited by lack of reliable, succinct, and standardized methods of assessing parent-child relationship constructs. The Relational Processes Workgroup (ad hoc to the DSM-5 process) proposed more specific criteria to define a parent-child relational problem (PCRP). These criteria were field tested in one of the DSM-5 Field trial sites, utilizing a similar research design as DSM-5. Participants included 133 symptomatic children (5-17 years) in active treatment for a mental health problem and their primary caregiver (86% mothers). Two separate clinicians, each blinded to the assessment of the other clinician as well as the DSM-5 diagnoses, interviewed the dyads within a 2-week period, utilizing the proposed PCRP criteria. Prior to each interview, parents were asked to write about their relationship with their child, and children (over the age of 10 years) filled out the Parental Bonding Instrument, Brief Current, and the Perceived Criticism Measure. Clinicians were able to read the narratives and see results of the child report measures before assessing the dyad. The weighted prevalence of a PCRP in this sample was 34%. The interclass kappa for overall agreement between clinicians was 0.58 (0.40, 0.72), which indicates good interrater reliability. Further, clinicians found the PCRP diagnostic criteria clinically useful and an improvement over the brief description of PCRP that was presented in DSM-IV. Relationships between children and their primary caregiver can be assessed in a reliable manner, based on clinical interview with the child-caregiver dyad and several self-report measures.

Editorial: Relational Diagnosis—An Idea Whose Time Has Come

“…Furthermore, they note that 35-64% of those who meet criteria for child maltreatment engage in more than one type of maltreatment. Like Wamboldt, Cordaro, & Clarke (2015), they show that the criteria they have developed result in the reliable and valid diagnosis of these problems.…”

“…In their overview article, Wamboldt, Kaslow et al (2015) point to the challenges as well as the strengths of relational diagnosis. Wamboldt, Cordaro et al (2015) elaborate on the difficulties of deconstructing a relational problem from a child problem when, for example, a child is oppositional, regardless of parental behavior. In a related vein, there remain the problems of reliably assessing family difficulties when a family member displays a severe individual psychiatric or health diagnosis that renders usual ways of envisioning optimal family functioning less relevant (Doherty, McDaniel, & Hepworth, 2014;Hernandez, Barrio, & Yamada, 2013;Suro & Weisman de Mamani, 2013;Valdez, Padilla, Moore, & Magaña, 2013;Zhou, Yi, Zhang, & Wang, 2014).…”

Editorial: Emerging Principles of Practice in Couple and Family therapy

“…These methods are, of course, applied within specific treatments in particular ways, but these concepts and methods are also readily exported into the integrative method of the practitioner. And, finally, there is the vast underlying base of knowledge about relational life from which all effective practice draws, including the myriad of empirical findings that we catalog in this journal about family life that is so essential to effective practice [the wide range of such findings includes such diverse information as understanding the impact of partner affairs (Whisman, ), the ways in which resilience occurs (Lietz, Julien‐Chinn, Geiger, & Hayes Piel, ; Walsh, ), the impact of ambiguous loss (Solheim, Zaid, & Ballard, ), the nature of LGBTQ issues in families (Green & Mitchell, ), the impact of various cultural contexts on families (Killoren, Wheeler, Updegraff, Rodríguez de Jésus, & McHale, ; Updegraff & Umaña‐Taylor, ), and relational assessment (Hamilton, Carr, Cahill, Cassells, & Hartnett, ; Heyman, Slep, & Foran, ; Wamboldt, Cordaro, & Clarke, )].…”

Editorial: LGBTQ families in the 21st Century

“…Social science has played an important role in the progress leading to the acceptance of same sex marriage, though it certainly has not been the only force (were public policy about family life primarily governed by the best evidence of social science, many other social issues would be handled much differently than they are presently). First came the debunking of the notions held for centuries about the innate pathology in LGBTQ relationships, which resulted in removing these ways of being in relationships as a psychiatric diagnosis (one irony here is that this was for the first few DSMs their only foray into relational diagnosis, while ignoring what truly are pathological relational problems) (Foran, Whisman, & Beach, ; Heyman, Slep, & Foran, ; Slep, Heyman, & Foran, ; Strong, ; Wamboldt, Cordaro, & Clarke, ; Wamboldt, Kaslow, & Reiss, ). Then came demonstrations that LGBTQ relationships were just as positive and beneficial as heterosexual relationships (Antonelli, Dèttore, Lasagni, Snyder, & Balderrama‐Durbin, ; Green, ; Green & Mitchell, ; Harvey & Stone Fish, ).…”

“…relational diagnosis, while ignoring what truly are pathological relational problems) (Foran, Whisman, & Beach, 2015;Strong, 2015;Wamboldt, Cordaro, & Clarke, 2015;Wamboldt, Kaslow, & Reiss, 2015). Then came demonstrations that LGBTQ relationships were just as positive and beneficial as heterosexual relationships (Antonelli, D ettore, Lasagni, Snyder, & Balderrama-Durbin, 2014;Green, 2007;Green & Mitchell, 2008;Harvey & Stone Fish, 2015).…”