DSM-V

Study: Rates of ADHD diagnosis and medication treatment continue to increase substantially

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Begin­ning in about 1990, sub­stan­tial increas­es in the rates of ADHD diag­no­sis and med­ical treat­ment were found in sev­er­al nation­al­ly rep­re­sen­ta­tive sam­ples of US physi­cian office vis­its. For exam­ple, between 1995–96 and 2007-08, the num­ber of office vis­its at which an ADHD diag­no­sis was made increased by over 400% in adults — from 3.1 per 1000 vis­its to 14.5 per 1000 vis­its. And, the per­cent of adult office vis­its includ­ing both ADHD diag­no­sis and med­ica­tion increased from 1.9 to 11.4 per 1000 visits.

Among chil­dren aged 5 to 18, between 1991–92 and 2008-09, rates of ADHD diag­no­sis increased near­ly 4‑fold among boys — from 39.5 to 144.6 per 1000 — and near­ly 6‑fold for girls — from 12.3 and 68.5 per 1000 vis­its. Dur­ing this time, the rate of vis­its that also involved med­ica­tion treat­ment increased by sim­i­lar rates. [Read more…] about Study: Rates of ADHD diag­no­sis and med­ica­tion treat­ment con­tin­ue to increase substantially

Study finds large gaps between research and practice in ADHD diagnosis and treatment

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Most chil­dren with ADHD receive their care from com­mu­ni­ty-based pedi­a­tri­cians. Giv­en the large num­ber of school-age chil­dren who require eval­u­a­tion and treat­ment ser­vices for ADHD, and the adverse impact that poor qual­i­ty care can have on chil­dren’s devel­op­ment, it is impor­tant for chil­dren to rou­tine­ly receive care in the com­mu­ni­ty that is con­sis­tent with best-prac­tice guidelines.

The Amer­i­can Acad­e­my of Pedi­atrics has clear­ly rec­og­nized this and pub­lished guide­lines for [Read more…] about Study finds large gaps between research and prac­tice in ADHD diag­no­sis and treatment

Sensible and perplexing changes in ADHD diagnostic criteria (DSM‑V)

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Taking a Closer Look at ADHD Attention Deficit DisorderThe Amer­i­can Psy­chi­atric Asso­ci­a­tion recent­ly pub­lished DSM‑V, the first major revi­sion to the diag­nos­tic man­u­al for psy­chi­atric dis­or­ders since 1994. In DSM‑V, ADHD is includ­ed in the sec­tion on Neu­rode­vel­op­men­tal Dis­or­ders, rather than being grouped with the dis­rup­tive behav­ior dis­or­ders, i.e., Oppo­si­tion­al Defi­ant Dis­or­der and Con­duct Dis­or­der. This change bet­ter reflects the way ADHD is cur­rent­ly conceptualized.

Below I review changes that have been made to the actu­al diag­nos­tic cri­te­ria for ADHD. [Read more…] about Sen­si­ble and per­plex­ing changes in ADHD diag­nos­tic cri­te­ria (DSM‑V)

Rethinking the Classification of Mental Illness

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The new Diag­nos­tic and Sta­tis­ti­cal Man­u­al of Men­tal Dis­or­ders (DSM-5) is sched­uled to be released in May 2013. This recent Dana Foun­da­tion arti­cle points out the need of a fun­da­men­tal­ly dif­fer­ent approach based on the new ways researchers use to study and under­stand men­tal illness.

The prob­lem with the DSM-IV, our cur­rent shared diag­nos­tic lan­guage, is that a large and grow­ing body of evi­dence demon­strates that it does a poor job of cap­tur­ing either clin­i­cal and bio­log­i­cal real­i­ties. In the clin­ic, the lim­i­ta­tions of the cur­rent DSM-IV approach can be illus­trat­ed in three salient areas: (1) the prob­lem of comor­bid­i­ty, (2) the wide­spread need for “not oth­er­wise spe­cif­ic (NOS)” diag­noses, and (3) the arbi­trari­ness of diag­nos­tic thresholds.

What­ev­er the ulti­mate approach to the DSM‑5, it is crit­i­cal that the sci­en­tif­ic com­mu­ni­ty escape the arti­fi­cial diag­nos­tic silos that con­trol so much research, ulti­mate­ly to our detriment.

Key ques­tions: How can we give the research com­mu­ni­ty not only per­mis­sion but also encour­age­ment to rethink the clas­si­fi­ca­tion of psy­chopathol­o­gy? How can we encour­age sci­en­tif­ic inno­va­tion while ensur­ing that clin­i­cians can still com­mu­ni­cate with patients and families—and also with insur­ance com­pa­nies, schools, and courts?

Shall we question the brand new book of human troubles

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With three years still left until pub­li­ca­tion, the fights over the new ver­sion of the psy­chi­atric diag­nos­tic man­u­al, the DSM‑V, are hot­ting up and The New York Times has a bookcon­cise arti­cle that cov­ers most of the main point of contention.

- “What you have in the end,  Mr. Short­er said, “is this process of sort­ing the deck of symp­toms into syn­dromes, and the out­come all depends on how the cards fall.

- Psy­chi­a­trists involved in prepar­ing the new man­u­al con­tend that it is too ear­ly to say for sure which cards will be added and which dropped.

Although I doubt the DSM com­mit­tee are using that exact metaphor, it cer­tain­ly illus­trates the point that the process requires a cer­tain degree of value-judgement.

It’s inter­est­ing, how­ev­er, that the pub­lic debate is cur­rent­ly focused on whether cer­tain diag­noses should be includ­ed or not, rather than whether diag­no­sis itself is use­ful for psychiatry.

We’ve had psy­cho­met­rics for a good 100 years that allow us to mea­sure dimen­sions of human expe­ri­ence and per­for­mance with a much greater degree of accu­ra­cy than [Read more…] about Shall we ques­tion the brand new book of human troubles