About this blog.

My son was diagnosed with PDD-NOS at 24 months. I created this blog to bring meaning to the often-confusing label. Sometimes I have answers. Other times, just more questions.

Thursday, July 30, 2009

The DSM-V Saga Continues

You can't make this stuff up.

To recap: Certain members of the American Psychiatric Association (the "APA") have proposed sweeping revisions to the DSM-IV, which is used to diagnose, among other things, autism. With respect to autism and other conditions, the proposed DSM-V will include "dimensional ratings" and "subclinical" designations. This is said to represent a paradigm shift. The chair of the DSM-IV task force, Allen Frances, sharply criticized the proposed revisions and the lack of transparency of the process. The APA came out swinging with its rebuttal, in which it accused Frances of bias and financial motivation: the DSM V revisions will render the DSM-IV handbook, which Frances authored, obsolete.


  1. Predictably, Frances took umbrage. Those royalties he'll be forfeiting when DSM V is published? $10,000 per year. Which, for him, is probably nothing. He doesn't write that, because that would be crass, but that's the implication. Frances also challenges the APA to be tranparent and make public the exact wording of the proposed revisions, and the research in support thereof.

  2. One of the members of the Workgroup on Disorders and Childhood and Adolescence has resigned in protest. This is the group that is deliberating over the inclusion of sensory processing disorder in the DSM V. She writes:

    "I am increasingly uncomfortable with the whole underlying principle of rewriting the entire psychiatric taxonomy at one time. I am not aware of any other branch of medicine that does anything like this....There seems to be no good scientific justification for doing this, and certainly none for doing it in 2012."

    So even if SPD were included in the DSM V, who is going to respect it? The process appears to have little integrity.

Related: Bitterness, Compulsive Shopping and Internet Addiction [via Slate]
Secrecy and Made Up Illness: The Latest Fight Over Psychiatric Illness [Via Doublex]


Nyx said...

Yes, it's a mess. Regarding the whole is-Autism-Spectrum-a-thing issue, I recently came across this post at the Eide blog from April which I missed at the time but I thought was pretty interesting. In case you didn't see it: http://eideneurolearningblog.blogspot.com/2009/04/different-mri-findings-in-autism-autism.html. They assert that a recent study demonstrates that the autism label really is encompassing what are in fact a number of very different neurological conditions. It certainly would explain the repeated failure of the medical community to find a biological marker, wouldn't it? Increasingly, I'm thinking that the psychiatric community is just the wrong place to go for a diagnosis. I think I'm taking my son to a neurologist. Can't hurt anything but the old pocketbook. Did some reading the other day about mild cerebral palsy. A lot of it sounded awfully familiar. Oddly, the developmental pediatrician never even mentioned the possibility.

Saja said...

I think Ms. Costello's discomfort is an excellent indicator of the inherent bias and subjectivity in diagnosing mental disorders or conditions. The DSM has made other sweeping changes in the past--throwing out homosexuality as a disorder, for example--which reflect only changing social mores and not objective scientific criteria.

The diagnosis of psychological conditions that don't have a physical basis is inherently subjective, and can only be based on behavioral observables. I can appreciate Ms. Costello's reluctance to make "sweeping changes," but in this case, as in the case with homosexuality, I think the sweeping changes are a definite change for the better. Big steps don't always equal impulsive, irrational decisions--quite often, the opposite is true.

Laura said...

Nyx, I read the Eide post a while ago and found it compelling. On the issue of biological markers, read Frances' first letter to the APA, top of page 2:


And see the APA response, second Q&A


There is an awareness among psychiatrists of the progression from syndrome classificaton (psychiatry) to domains of pathology (neurology). The problem for the here and now is that the pathology is very much a work in progress, for autism and all of the other conditions/disorders. As Frances observes, not a single biological test has been perfected for any of the conditions described in DSM V.

Saja, too true. Sometimes evolution is the right path, and other times revolution is called for.

Kris said...

Ugghh...I am tired of trying to figure out my son's symptoms in the context of a diagnosis. Especially since it seems there isn't even a consensus among experts about how to classify these types of diagoses. He for sure has ADHD and SPD (which isn't even a "real" dx), beyond that is less clear. He is an enigma. When I read info about another "new" dx, Sluggish Cognitive Tempo (ever heard of that??), I can see a lot of Alec in that description - except for the times he is hyper and sensory seeking - there is always an "except" with him.

My husband thinks he is slightly brain damgaged, plain and simple. I had placenta previa when pregnant with him, he was "trapped" in a corner of my uterus and was born with one side of his head flattened and facial asymetry. Also had torticollis.
Some posts to a torticollis group confirmed that he is not the only child born this way to experience sensory and other related problems.

Maybe I should be seeking a neurologist as well. The psych people certainly haven't nailed him down.

Doesn't sound like the folks at the APA are any more in agreement than anyone else and I'd be willing to bet each member of this team would give my son a different diagnosis.

I love the Eides. I would love to have them take a crack at Alec.

Kris said...

Oh my - just reading past Eide posts and there is one from May 2005 that talks about what I just said - how mild birth injury can look like ASD/ ADHD and how checklists stink. Hmm...a neurologist is sounding better and better.
Thanks for the thought Nyx!

Laura said...

*hands Kris a cookie* No, I had never heard of sluggish cognitive tempo, but damn, that sounds like Brad. Too bad there isn't one label that's unifying - that encompasses attention, speech, working memory, motor and social. Maybe one day.

Yeah, I had read about the birth injury link in Out of Sync Child and Mislabeled Child. Also: maternal bleeding is one of the risk factors for SPD, and that would describe my labor and delivery.

Trekga said...

Just found your blog. As a mom of 2 children on the "spectrum" albeit high end (Aspergers & PDD-nos)I can relate. Both my boys do not receive any school related therapy for their sensory issues. In my experience it the most dominating factor in their lives. It would be wonderful if our school district stepped up to help not only my 2 boys but others function even easier in the inclusive setting.Thus, a dx that is recognized would be so beneficial.

Laura said...

Trekga - hi, and thanks for the note. Well, we'll have to see where the chips land. I know the sensory processing disorder foundation has not thrown in the towel, so maybe they'll pull it off. I just wonder if the whole process is tainted at this point.