Unfortunately, as Benedict Carey points out, the book often is used for purposes other than those for which it is intended, which can lead to unintended consequences. It remains to be seen what these will be.
I'm just going to make some quick, admittedly superficial comments.
First, I wince at the new category for autism: Autism Spectrum Disorder:
Must meet criteria 1, 2, and 3:
1. Clinically significant, persistent deficits in social communication and interactions, as manifest by all of the following:
a. Marked deficits in nonverbal and verbal communication used for social interaction:
b. Lack of social reciprocity;
c. Failure to develop and maintain peer relationships appropriate to developmental level
2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following:
a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors
b. Excessive adherence to routines and ritualized patterns of behavior
c. Restricted, fixated interests
3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
I have no objection to the criteria. What bothers me is the formal enshrinement of the term "spectrum." Granted, it merely denotes a trend in modern thought, but it is a trend that ought to remain in the informal domain for now.
Next, Posttraumatic Stress Disorder in Preschool Children. The text is long enough that I'm not going to copy it here. This is important because we've known for a long time that the features are different in kids, but there hasn't been any formal way to handle this.
Finally, Temper Dysregulation Disorder with Dysphoria. This is bound to cause a few tantrums. I'll guess that some will criticize this for unnecessarily pathologizing normal childhood behavior. But the intention is quite the opposite. Currently, there are kids who are being labeled as having bipolar disorder, when it really is not clear that they have bipolar disorder. So the idea is to lessen the overuse of the more severe category. This is to be considered a disorder of childhood and adolescence. However, there is no rigid upper age limit. Still, I think this label is less likely to follow a person into adulthood, whereas the bipolar disorder label is likely to do so.
Overall, my impression is that there is more good than bad in the proposed changes.
Brain & Behavior
Comments
Of the three proposed changes that you highlight, I think that by far the most important is "Temper Dysregulation with Dysphoria". It is high time that the APA dispense with the peremptory and facile diagnosis of Bipolar Disorder in children. I have personally witnessed, on too many occasions, the assignment of this diagnosis by psychiatrists either too lazy or ignorant to acknowledge that the problems seen in many of these kids are behavioral, or psychosocial, in nature, and not due to Bipolar Disorder. The diagnosis of Bipolar Disorder in these children does, as you say, unfortunately follow them into adulthood, but, since these individuals never met the criteria for the diagnosis of Bipolar Disorder in the first place, the impact of their situation promotes and informs a logical tautology, in which the proper and appropriate understanding of true Bipolar Disorder (in adulthood) becomes distorted by the presentation of these "false" Bipolar patients. In my current practice, I routinely run across patients labeled with some variant of Bipolar Disorder (eg, "rapid-cycling Bipolar Type II") by, typically, hospital psychiatrists who see the patient only during a brief clinical snapshot, without sufficient time or background information to justify diagnostic confidence. Frequently it turns out that these patients meet criteria for Borderline, Narcissistic or Histrionic Personality Disorder, or for PTSD or a primary substance problem. Sheer laziness on the part of our colleagues.
Posted by: stumpy | February 10, 2010 10:31 PM
When I was in high school, my younger sister was handed a diagnosis of bipolar II. As I have progressed through my undergrad, a sneaking suspicion has been growing that she is not bipolar. I suppose I could consider her to be an example of one of these misdiagnoses. I'm glad something is being done, either way.
Posted by: andrew | February 11, 2010 7:13 PM
If children are being misdiagnosed with bipolar disorder, why not clarify the criteria for bipolar disorder to specifically exclude the children that don't belong there?
Posted by: S | February 16, 2010 11:09 AM
the criteria are already pretty clear. take a look at the current criteria in DSM-IV-TR, and you'll see.
Posted by: stumpy | February 17, 2010 1:12 PM