Sonuga-Barke E J
Department of Psychology, University of Southampton, U.K.
J Child Psychol Psychiatry. 1998 Jan;39(1):115-33.
In this review we explore the clinical and scientific status of categorical models of childhood disorder. Three themes are developed. First, the practical origins of standardised category-based diagnostic schemes are examined along with their contemporary philosophical and psychological significance. Next, the impact that these systems have had on the science of child psychopathology is explored. We look at their link to the medical model and the assumption that childhood disorders are categorical, endogenous, and dysfunctional in nature. We argue that these assumptions underpin the dominant paradigm in child psychopathology and so constrain empirical study and theory development. In the final section, the different ways in which researchers have responded to this link and its impact on science are presented. We present the sort of scientific realism associated with Meehl (1995) as the most appropriate basis for a philosophically respectable child psychopathology. Following this approach means unpacking the paradigmatic assumptions, including the assumption of the categorical structure of disorder, into hypotheses that are then put to empirical test. The sorts of data that would allow us to test the categorical hypothesis are identified. We conclude by discussing the results from three recent studies using behaviour genetic analysis of twin data that, in fact, lead us toward a rejection of this hypothesis. The implications for diagnostic and clinical practice of such a rejection are discussed.
在本综述中，我们探讨了儿童期障碍分类模型的临床和科学现状。提出了三个主题。首先，研究了基于标准化类别的诊断方案的实际起源及其当代哲学和心理学意义。其次，探讨了这些系统对儿童精神病理学科学的影响。我们考察了它们与医学模型的联系，以及儿童期障碍本质上是分类的、内生的和功能失调的这一假设。我们认为，这些假设支撑着儿童精神病理学的主导范式，因此限制了实证研究和理论发展。在最后一部分，介绍了研究人员对这种联系及其对科学的影响所做出的不同反应方式。我们提出与米尔（1995）相关的那种科学实在论，作为一种在哲学上值得尊重的儿童精神病理学的最合适基础。遵循这种方法意味着将范式假设，包括障碍的分类结构假设，拆解为可进行实证检验的假设。确定了能够让我们检验分类假设的各类数据。我们通过讨论最近三项使用双胞胎数据进行行为遗传学分析的研究结果来得出结论，这些研究结果实际上导致我们拒绝这一假设。讨论了这种拒绝对于诊断和临床实践的意义。
