The following letter was sent to Psychiatric News, an official publication of the American Psychiatric Association:
I would like to address some of the issues included in a report on the DSM-V development, so nicely written by Joan Arehart-Treichel. By reading it I realized the APA is facing the most important crossroad of its history but, at the same time, the sad possibility of missing the opportunity to bring drastic changes to the way we diagnose mental illnesses.
I dread the perpetuation of several fallacies that are ruining thousands of lives hurt by wrong diagnoses and treatments. For example, most experts believe that ADHD can have many comorbidities and one of them is quoted in Ms. Arehart-Treichel's chronicle as saying that irritability could be a sign of depression. Assertions like this one go undisputed even though experts also concur that ADHD does not have a mood component.
By the same token, prominent professors ignore DSM-IV-TR's guidelines and teach that ADHD can co-occur with Autism. Ironically, my office's receptionist knows that autistic children do not pay attention to people and their failure to look at the teacher does not make them ADHD. What she does not know is what I see: rituals, obsessions and aggressive behaviors gone out of control when these children are given psychostimulants.
Finally I take issue with the phrase "similarities of symptoms" because it is a misperception of what should be called "overlapping of symptoms." Case in point, impaired attention could be the manifestation of manic racing thoughts, nervous agitation of social anxiety, thought blocking of active psychosis, intrusive thoughts of OCD, flashbacks of PTSD, "brief disconnections" of Absence Seizures and, by exclusion, ADHD.
This is the real problem. Clinicians have subverted DSM's guidelines and give ADHD the benefit of diagnosis of first choice, instead of been "what it is left after all possible causes of inattention have been ruled out."
I hope DSM-V will bring solutions instead of more confusion because we already have the experience of DSM-III, which created the Oppositional-Defiant diagnosis to appease the psychoanalytic establishment. We should remember that 40 years ago children "could not have depression or bipolar disorder and we would not think of OCD or social anxiety in the pediatric population". Consequently, children with manic defiance or fear of going to school, to mention just two situations, were called oppositional-defiant, without a search for etiology, as we do in any other medical specialties.
Manuel Mota-Castillo, M.D.
Assistant Professor of Psychiatry at St. Matthews University Medical School and UCF.
The child who drew this picture had been diagnosed with ADHD because she could not concentrate in class. Sadly, she also was labeled oppositional-defiant because she was refusing to attend school....nobody took the time to find out how scared she was or to considering that her father is treated for bipolar disorder.
A QUESTION THAT CAN LAST 100 YEARS:
Why is it that Psychiatry is the only medical specialty that alllows non-physicians to formulate medical diagnoses?
Can you imagine receiving a note from school like this one:
"I evaluate Johnny and concluded that he has a peptic ulcer. Please, take him to his pediatrician and get a prescription of Zantac."
Replace the word Zantac with Ritalin, Concerta, Adderall or Vyvanse and you will get the picture.