DSM-5: A Controversy in the Mental Health Community

A very important controversy related to children is flying under the radar of most educators. It's a controversy in which educator voices could play a highly constructive role.

Some background first. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It's used by mental health professionals, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers. There have been a number of revisions since it was first published in 1952, and each revision has included more mental disorders.

ADHD Reclassified

There is some controversy related to the latest revision, the DSM-5, scheduled for release in May 2013. Drafted by a Task Force of the American Psychiatric Association, the revision would change the diagnosis of "mental disorders" in a number of major categories, including Attention Deficit Hyperactivity Disorder (ADHD). The concern on the part of many members of the mental health community is that more individuals whose behaviors and experiences are well within the norm of human variation will be labeled with a "mental disorder" and treated with psychiatric drugs. Children diagnosed with ADHD, as you probably know, also present a challenge for many teachers.

While the proposed new criteria would apparently decrease the likelihood of diagnosis of some disorders, I'm only focusing here on ADHD, where the proposed revisions would have the opposite effect. Specifically, under the new proposed DSM-5, fewer symptoms would be needed to diagnose a child with ADHD. The proposed DSM-5 places the bar so low that thousands of children who didn't have ADHD according to DSM-IV would meet the "test" according to DSM-5. The rationale of the Task Force is that there are individuals who do not meet the criteria but are still impaired, and decreasing the diagnostic criteria would make them entitled to insurance benefits. But the bottom line is that this lowering of the bar will increase the number of children diagnosed and treated with drugs. We already have a well-documented problem with the overzealous prescribing of psychiatric drugs in this country, and many teachers and parents have voiced specific concern about over-diagnosing and medicating kids for signs of ADHD.

Of course there are many children who should be diagnosed with ADHD yet never even get to see a psychologist or psychiatrist because parents and teachers don't recognize the symptoms and/or don't have medical insurance. But that important challenge lies outside the present controversy.

Although psychologists and psychiatrists often work in effective and complementary ways, there has long been a concern on the part of psychologists that many psychiatrists prescribe drugs too quickly as the first line of treatment. The pharmaceutical industry plays a role in this as well.

Educating the Public

Concerns regarding revisions to the DSM are perhaps best reflected in the response of the Society for Humanistic Psychology, a division of the American Psychological Association, that has mounted a campaign to have the Task Force rescind its proposed changes in diagnostic criteria for ADHD as well as other changes that are of concern.

Specifically, a petition launched by the Society now has well over 10,000 signatures, including those from mental health professionals and mental health related organizations worldwide. Additionally, the Society, under the leadership of Dr. David Elkins, a Professor Emeritus of Psychology at Pepperdine University, has begun a major media campaign to educate the public regarding the potential dangers of some of the proposed revisions. Recently, the Society sent a letter to the DSM-5 Task Force calling for an outside, independent review of the controversial proposal.

Dr. Elkins writes: "I hope educators, counselors, psychologists and everyone who works with children will sign the petition and speak out. Many very young children are being placed on powerful psychiatric drugs...and it's time for all of us who care about kids to take a stand." I agree. I think it's important that educators consider adding their voices to those asking the Task Force to reconsider its changes.

Since the DSM-5 Task Force will finalize its work by May, the window of opportunity to do this is fairly small.

A Call to Action

What can you do? Most importantly, become better informed. Please check out this website, which provides a description of the problems with the proposed DSM-5 as well as the petition and a place to sign, if you support it: http://www.ipetitions.com/petition/dsm5/#sign_petition. You can also write directly to the American Psychiatric Association (not to be confused with the American Psychological Association!) either through an e-mail to apa@psych.org or to their office address: American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209, Attn: DSM-5 Revision.

There are no guarantees that any of this will bring about a change by the DSM-5 Task Force, but the Task Force has invited feedback, so this does provide an opportunity for our voices to be heard. Certainly, without additional input from both professionals and the lay public, the present draft could become the finalized DSM-5. Children, teachers and parents will feel the impact for many years.