I support the statements of several of the previous commentators which include my good friend and mentor, Dr. Ronald Pies but, please, do not forget the children. Despite its many flaws, I endorse the usefulness of DSM as a facilitator of communication among mental health professionals around the world. In a simplistic view, I would say that it is better to have a difficult language, i.e. Chinese, than not having one at all.
On the other hand, I have been a consistent critic of the American Psychiatric Association’s (APA) absence of interest in updating diagnoses that made sense in the 80s and before, when the psychoanalytic establishment ruled that “children lack enough ego development to experience depression.” When the DSM-III was created, diagnoses such as Oppositional-Defiant Disorder (ODD), Disruptive Disorder NOS and Conduct Disorder (CD) were incorporated as a way of explaining behaviors (rapid mood changes, explosive anger, elevated mood expressed as defiance, etc.) because psychiatrists were not allowed to give “adult” labels to children. 1,2,3
For some reason that I can’t understand, psychoanalysts from previous centuries decided that children were shielded from mental illness while nothing could save them from receiving a life-threatening disease such as a brain tumor or leukemia. Many years later those that can change such a misconception have done nothing to correct it.
When the APA made available the first DSM5-related website I immediately posted a request to take a look at the validity of ODD and CD. My impression that keeping alive those pseudo diagnoses was a danger to children that were missing treatment for their real conditions and helping the insurance companies to deny needed hospitalizations because, for example, a manic and suicidal adolescent also carries the Dx of ODD or CD.
Other voices like doctors Charlie Huffine and Andy Pumariega have tried to get the APA’s attention to this issue but not to avail. On a daily basis, I see children of parents with serious mental illness misdiagnosed as having a combination of Attention-Deficit Hyperactivity Disorder (ADHD) and ODD that get worse with medications like amphetamines while the APA and the American Academic of Child and Adolescent Psychiatry behave as if this serious issue is not part of their responsibilities. When a person with an elevated mood, social anxiety, panic attacks, obsessive thoughts and compulsions, to mention just a few situations, is given methamphetamine or methylphenidate (the famous Ritalin) his or her symptoms increase, the blame goes to the patient “because he or she is not improving despite adequate treatment” and such refusal to improve “most be because of ODD.”
Furthermore, the APA has never investigated why is it that 99% of the patients of a given doctor have the same diagnosis: ADHD. I am not talking of the case of a diabetologist (that only treats diabetics) or a neurologist that specializes in migraine, but of a general psychiatrist that evaluated children that come in search of a diagnosis.4
For that the APA and I are at war and this conflict will last until its leaders assume the responsible obligation they have with millions of children on this planet.
Manuel Mota-Castillo, M.D.
Assistant Clinical Professor at UCF and FSU
Is It Really ODD?, Mota-Castillo, M., Psychiatric Times, Feb 2004.
Childhood Conduct Disorder and Oppositional-Defiant Disorder Are Common Manifestation of Bipolar Disorder; “Pro and Con”, Mota-Castillo, M. and Steiner, H.,The Journal of Bipolar Disorders Reviews & Commentaries; Dec. 2004.
Eliminate Conduct Disorder & ODD…This is the Right Time!; Mota-Castillo, M., Psychline, Nov. 2004.
The Crisis of Overdiagnosed ADHD in Children, Mota-Castillo, M.; Psychiatric Times, July 2007.