Will Newer Mental Health Language Lead to More Medicated Children?

In 1980, and later in 2000, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (current edition abbreviated as DSM-IV-TR) categorically organized mental illnesses/disorders with operational criteria which then was considered an advancement in the mental health field, but some professionals now argue that new proposed revisions are not scientifically sound. Clinicians complain that the current manual’s system poorly reflects clinical realities. Researchers are skeptical that the existing manual’s categories represent a valid basis for scientific investigations, and accumulating evidence supports this skepticism.

There is an insurgency against the newly proposed, currently unpublished manual, DSM-5 (the APA has decided to rid the Roman numerals) that is now spreading. Several divisions of the American Psychological Association (APA) have written an open letter and offers a petition highly critical of the proposed DSM-5. Now, other professional associations (e.g. American Counseling Association and The Association for Women in Psychology) are starting to chime in.

This is especially relevant when it comes to proposed revisions of childhood disorders. The last publication of the DSM had been accused of causing an epidemic of bipolar diagnoses in children over the past decade. Shortly after the manual came out, doctors began to diagnose bipolar in children even if they had never had a manic episode and were too young to have shown the pattern of mood change associated with the disease. Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these children were put on antipsychotic drugs, whose effects on the developing brain are poorly understood, but which are now known to cause obesity and diabetes.

In 2007, a series of investigative reports revealed that Harvard University’s Dr. Joseph Biederman, an influential advocate for diagnosing bipolar disorder in children, failed to disclose money received from the makers of the drug Risperdal (risperidone), used to treat bipolar. The author of the DSM at the time, Dr. Allen “Al” Francis, said he wished they had anticipated the future fad and put a warning against it.

The current proposed reclassification of Attention Deficit/Hyperactivity Disorder (ADHD) from “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” to the new grouping “Neurodevelopmental Disorders” seems to suggests that ADHD has a definitive neurological basis. This change, in combination with the proposal to lower the diagnostic threshold for this category, poses high risk of over-medicalization and over-diagnosis of this disorder category, argues it’s APA opponents.

And then there’s the proposal to reduce the number of criteria necessary for the diagnosis of Attention Deficit Disorder (ADD), a diagnosis that is already subject to epidemiological inflation.

In the newest proposal to revise Gender Identity Disorder (GID), which generally onsets in childhood, often resolving by adulthood, is now conceptualized as reflecting a “marked incongruence between one’s experienced/expressed gender and assigned gender” leading to the recommendation that the name Gender Incongruence (GI) replace GID. While GI seemingly rids the stigma of being a “disorder” per se, medical interventions such as child hormone blocking pharmaceuticals could never-the-less be justified. A case-in-point is a lesbian couple in California who say their 11-year-old son wants to be a girl and have decided to give the child hormone blockers to delay the onset of puberty — so that he can have more time to decide if he wants to change his gender. But, this is controversial because critics say 11-year-olds are not old enough to make life-altering decisions about changing their gender, and parents should not be encouraging them.

Finally, perhaps many of these childhood reclassifications may, as Dr. Francis has once suggested, continue a fad leading to rapidly diagnosing children in need of amelioration, in other words a fix, and in modern psychiatry this often means medication. To pharmaceutical companies, this means profit.

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