The recent tragedy at Sandy Hook Elementary School has spurred many political and social debates, among them, the reform of mental health diagnoses and treatment. Just a few weeks prior to the shooting, the American Psychiatric Association established and approved the final criteria for diagnosing psychiatric disorders, which will be found in the fifth edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5), scheduled to be published in May of 2013. The experts who evaluated the previously published diagnostic criteria adopted a more conservative approach when defining and approving the current criteria, which resulted in approximately the same number of mental disorders included in DSM-4. This is contrary to the tendencies observed in other fields of medicine, where the number of defined disorders and syndromes grows every few years. Several new disorders appear in DSM-5, while others have been excluded. These changes have implications for many children and adults, as well as healthcare delivery because diagnoses often determine one’s qualification for certain programs, treatments, and mental health care.
Here are the main changes and adaptations that were made in the fifth edition of DSM-5.
* The diagnoses of Asperger’s disorder, autistic disorder, childhood disintegrative disorder and pervasive developmental disorder have been included into the diagnostic criteria for “Autism Spectrum Disorder”. This integration is aimed at improving the accuracy and consistency in the diagnosis of children suffering from autism, however some parents fear it might omit children currently diagnosed with Autism Spectrum Disorder, thereby making it more difficult for them to receive certain services.
* “Disruptive mood dysregulation disorder” is a new classification included in DSM-5, which is defined to help diagnose those children that display irritability and outbursts of erratic behavior occurring more than three times per week for more than a year. The inclusion of this disorder in DSM-5 aims to prevent the over-diagnosis of and unnecessary treatment for bipolar disorder in children.
* “Hoarding disorder” is also a novelty of DSM-5. It has been defined to diagnose individuals who persistently experience difficulty in discarding or parting with objects they own, even if these don’t have a significant value or utility.
* “Excoriation disorder” has been introduced in DSM-5 in the chapter presenting Obsessive Compulsive and Related Disorders. It will be used to diagnose individuals who exhibit persistent skin picking.
And finally, amongst the major changes in the new edition of the manual;
* Gender Identity Disorder will be replaced by the term “Gender Dysphoria” which impacts the lives of children who struggle with gender issues.
Several other less prominent changes have been made, such as refining the diagnostic criteria for posttraumatic stress disorder and substance abuse, all designed to address inconsistencies and inaccuracies that may occur when trying to establish precise diagnoses in individuals who exhibit complex symptoms.
As we all know, it is vital for individuals with psychiatric disorders to receive appropriate treatment. While it is still unclear as to what exactly motivated the young man responsible for the murders in Sandy Hook, it is likely that he suffered from some mental health issues. Will the new changes to this diagnosis manual help or hinder the reform of mental health care? Only time will tell. For now, help protect your rights and entitlements, as well as those of your children and students by staying informed.
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The child who is ‘left behind’ most is the one who leaves school without transition readiness.
Dr. James Stanfield, Ed.D.