Impairment in children

For children with mental health problems, impairment results in a diminished ability to perform at developmentally expected levels. Impairment in daily life activities can include dysfunction or an absence of adaptation in social, emotional, psychological, or occupational/academic domains, and it is a core component of nearly all childhood and adolescent mental health disorders. Currently, the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition, Text Revision (DSM-IV-TR, 2000) requires impairment in daily life functioning for the diagnosis of the externalizing (e.g., attention deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]) and internalizing (e.g., anxiety and mood-related) disorders, and impairment in social or academic functioning is a cardinal feature of other disorders of childhood and adolescence (e.g., autism, learning disabilities, substance abuse).