Unlike the DSM-I, the DSM-II contained a section entitled Behavior Disorders of Childhood and Adolescence, which enumerated six specific categories: hyperkinetic reaction, withdrawing reaction, overanxious reaction, runaway reaction, unsocialized aggressive reaction, and group delinquent reaction. This section also included a diagnosis termed "other reaction of childhood," which was designed to include children showing serious behavioral disorders not listed in the previous categories. Each diagnosis was described in one paragraph listing typical symptoms and, for selective categories (e.g., unsocialized aggressive reaction), included information to guide differential diagnosis. In addition, adjustment reactions of infancy, childhood, or adolescence were specific diagnoses that could be coded, along with childhood schizophrenia, with each of these diagnoses having a brief description of distinguishing symptoms. A section of special symptoms included potential child and adolescent diagnoses such as enuresis, feeding disturbance, and specific learning disturbance, but none of these diagnoses had accompanying definitions or related information. Lastly, digits could be added to the diagnostic codes to indicate severity of the dysfunction (i.e., mild, moderate, and severe).

Although the inclusion of these diagnoses was a noteworthy improvement over DSM-I, these child and adolescent diagnostic categories received limited scientific scrutiny, because their brief descriptions and lack of operational criteria did not lend the diagnoses to proper investigation. Indeed, the reliability of the childhood diagnoses of DSM-II were not investigated until after the DSM-III appeared ( Mattison , Cantwell, Russell, & Will, 1979). Furthermore, the state-of-the-art with respect to diagnostic assessment tools and methodology was not well interrelated to DSM-II classification--nor to any classification, for that matter.

The childhood section of DSM-II evolved into the DSM-III section entitled Disorders Usually Evident in Infancy, Childhood, or Adolescence. Based on the limited coverage of child and adolescent psychiatric disorders provided by the DSM-II, the number of possible diagnoses for children and adolescents expanded to 32 categories (excluding atypical diagnoses). Furthermore, the DSM-III featured a multiaxial format, including five specific developmental disorders that could be coded on Axis II.

In addition to the increased number of diagnoses available to child practitioners, the meager information provided to guide diagnosis in DSM-II was enhanced in DSM-III by the inclusion of considerable descriptive information for each diagnosis. For example, specific diagnostic criteria were provided for each category. In addition, standard information was provided for each diagnosis. This included information related to associated features, age at onset, course, impairment, complications, predisposing factors, prevalence, sex ratio, and familial pattern. A discussion of differential diagnosis was included for each diagnostic category. Finally, an appendix of decision trees was proposed, and a glossary of technical terms was also included. As a consequence of the more objective and descriptive nature of the DSM-III, the number of scientific investigations of this psychiatric classification system increased. For example, the DSM-III itself included an appendix of the results for two field trials testing the interrater reliability for 126 cases selected by pairs of raters. Subsequently, other research teams also focused on general reliability studies of the childhood and adolescent categories contained in DSM-III ( Mattison et al., 1979; Mezzich, Mezzich, & Coffman, 1985; Strober, Green, & Carlson, 1981; Werry, Methven, Fitzpatrick, & Dixon, 1983). . .

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