Some 25 years ago, a World Health Organization seminar produced
findings that argued for a multiaxial approach to the classification of
child psychiatric disorder (1). At that time three axes were proposed:
clinical psychiatric syndromes, level of intellectual function and associated or etiological factors (physical or environmental). Subsequently, the
suggestions included dividing this third axis into its two parts. In 1975,
WHO published a report of trials of these four axes, the first three of
which were taken from the Eighth Edition of the International
Classification of Diseases ICD-8 (2). These trials indicated the increased
reliability associated with the use of the axes. Later in 1975 a multiaxial
schema was introduced in the United Kingdom adding yet one further
axis for specific developmental disorders, which had previously been
included with 'biological factors'. This schema was based on the newly
introduced ICD-9, with a relatively simple list of associated psychosocial situations. Subsequent studies indicated that the reliability of the
psychosocial axis was unacceptably low, and with the prospects that a
new edition of the ICD would be appearing in the 1990s, a working
group was set up to redraft the psychosocial axis, following the same
principles used for the psychiatric disorders in ICD-10. This means that
this axis includes a much more detailed specification of the criteria to be
used for coding each of the separately identified psychosocial stressor