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Posted at 03:00 AM ET, 02/13/2012

An ADHD controversy in the mental health community

This was written by Mark Phillips, professor emeritus of secondary education at San Francisco State University and author of a monthly column on education for the Marin Independent Journal .

By Mark Phillips

There is a very important controversy related to children that is flying under the radar of most educators and parents that affects schoolchildren nationwide.

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 is 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 added to the number of conditions labeled as mental disorders.

Some disputes are taking place 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 in 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.

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. Under the proposed DSM-5 bar, thousands of children who didn’t have ADHD according to DSM-IV would meet the “test” according to DSM-5. That means more children will be diagnosed with ADHD and treated with drugs.

We already have a documented problem with overzealous prescribing of psychiatric drugs in this country, and many educators 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 who 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 is a concern on the part of psychologists that some psychiatrists prescribe drugs too quickly as the first line of treatment. The pharmaceutical industry plays a role in this as well.

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 which has mounted a campaign to have the task force rescind its proposed changes in diagnostic criteria for ADHD as well as some other changes that are of concern.

A petition launched by the society now has more than 10,500 signatures, including those from mental health professionals and mental health related organizations worldwide. 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 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 recently wrote: “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.”

The DSM-5 Task Force will finalize its work by May, so those concerned in the psychological and educational communities have a limited window to speak up.

Anyone interested can go to this website , which provides a description of the problems with the proposed DSM-5 as well as the petition. They can also write directly to the American Psychiatric Association (not to be confused with the American Psychological Association!) at apa@psych.org or to their office address: American Psychiatric Association, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209.

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