Axis and GAF(diagnosis report)

Sorry for bombarding you with this mess and posting so many questions. With only a few days to prepare for this meeting on the 12th, I am a bit frazzled to say the least! (Suz....I'll keep my IEP questions on Martie's forum from now on....sorry about that)

The school seemed a bit hesitant to even believe me when I say Andrew was diagnosed with ODD/CD because they have not received any sort of report from the psychiatrist yet about it. So I called the psychiatrist and asked that he fax me some sort of brief report stating the disorders he has diagnosed Andrew with. (for me to copy for the school) I received it within an hour. Now I have questions about the report. I need to understand it so I can help the school understand it!

Here is what it says as far as the diagnosis:

Axis I
Oppositonal Defiant Disorder with Conduct Disorder traits.
ADHD - not otherwise specified (not otherwise specified)
Rule out mood disorder (not otherwise specified)
Rule out Anxiety Disorder (not otherwise specified)

Axis II
No diagnosis

Axis III
Status post heart surgery

Axis IV
School and peers are Andrew's biggest problem

Axis V
I am not sure, but it says either SS or 55

Now for my never ending questions............

What does the "Axis" mean?
What does "not otherwise specified" mean?
And what does he mean by "rule out"?


Dolly, I can help with the "not otherwise specified" and the "rule out" but the Axis stuff has left me temporarily. The "not otherwise specified" refers to the diagnosis being a general diagnosis and not specific to a certain type of ADHD, anxiety disorder, etc. It is not significant most of the time when "not otherwise specified" is mentioned other than for insurance purposes. "Rule out" is used whenever a diagnosis may exist but more time, evaluation., testing, etc. is needed to make a the diagnosis for the person. If your child may have anxiety disorders, the doctor will check it out (rule it out) before making the diagnosis certain. Hope that helps. fig

Wow, I finally get to offer some info based on my relentless research of ODD. Some of the below is standard language found on several articles about DMS, some is my opinion/observations.

DSM System (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition™ )

The DSM-IV, represents the standard diagnostic classification system and coding reference for mental disorders.

It is a manual that physicians, psychiatrist, psychologists, therapists, and social workers use in order to diagnose mental illness in a common format and language.

A multiaxial system involves an assessment on several axes, each of which refers to a different category of information that may help plan treatment and predict outcome for each individual being assessed.

Axis I: Clinical Disorders

Axis I is used to report all the various disorders or conditions in DSM-IV except for the Personality Disorders and Mental Retardation (which are reported on Axis II).

So Axis I is the "normal" area where primary conditions are listed, such as ODD, ADD, ADHD, etc.

Axis II: Personality Disorders

Personality Disorders and Mental Retardation are reported on Axis II. Additionally, this axis is used to report €œprominent maladaptive personality features and defense mechanisms”.

So this is area where what I consider to be either diagnosis that are more severe than Axis I items or in addition to Axis I items.

Axis III: General Medical Conditions

Current general medical conditions are reported on Axis III. Only those conditions that have relevance to Axis I conditions are reported. The purpose of delineating Axis III is to encourage thoroughness in evaluation and to enhance communication among rehabilitation professionals.

This is where biological/chemical items or other medical issues are placed, such as problems with thyroid, etc. This Axis seems to be here to ensure behavior caused by medical (vs. psychiatric - hmmm how can they be separated) conditions are not overlooked.

Axis IV: Psychosocial and Environmental Problems

Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis or care of an individual. These may include, for example, problems getting or holding a job, housing, abuse, or neglect.

Axis V: Global Assessment of Functioning

The individual’s overall level of functioning is reported on Axis V. The reporting of overall functioning on Axis V is based on clinical judgement using the Global Assessment of Functioning (GAF) Scale.

In your case it was 55 (which is about where my ODD daughter was when released from hospitalization after being admitted at around 35 < very bad):

60-51 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school function (e.g., few friends, conflicts with peers or co-workers).

Also, rule out or rule out means that it has not yet been ruled out, and is still under consideration, and that further testing and observation, and sometimes medication trial, will need to be carried out before it is ruled (note the d) out. It is suspected as a possibility, therefore it is classified as rule out until proven not possible.

Ask your own psychiatrist if any of this doesn't make sense, this is my understanding from my research. I hope it helps.

Best success to you!


Hi Dolly,
Don't be sorry for all the questions. We're all here to share knowledge and experience.
ConcernedFather is right on with the description of the Axis codes.
You already know the symptoms of ODD. The main thing to realize is that no matter what the diagnosis, it's the GAF or General Adapative Function that, in my opinion, really means the most. It is basically how the person functions despite all the other four Axes. Someone can function better than someone else even though they have similar diagnoses and stressors.
You seem to be gathering all the info needed for the meeting.
Good luck


Former desparate mom
I am going to archive this for future reference. Thanks concerned dad for typing this all out.

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