The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as DSM-5, helps clinicians diagnose mental disorders that aren’t as easily identified by symptoms like many other health conditions, e.g., a broken arm or case of pneumonia. Plus, the new manual offers greater insight into many of these disorders.
The DSM-5 revisions aim to capture children’s experiences and symptoms more precisely. Rather than isolating childhood conditions, the new manual underscores how they might manifest throughout a patient’s life span. Each disorder is now set within a framework that recognizes age-related aspects, chronologically listing diagnoses that are most applicable to infancy and childhood first, followed by diagnoses that are more common to adolescence and early adulthood, and ending with those that are often diagnosed later in life.
Erik Ulland, M.D., the medical director of Rogers’ child and adolescent inpatient services, says the DSM-5 changes help clinicians look at what disorders may look like as children grow older, rather than just as the result of behavioral problems that may be occurring right now. He says many children and adolescents may be affected by a new diagnosis – disruptive mood dysregulation disorder (DMDD) – that will in turn affect other diagnostic categories.
DMDD is described as intense outbursts and irritability beyond normal temper tantrums in young children. The new diagnosis is needed as more children under the age of 12 years old have been diagnosed with pediatric bipolar disorder over the past decade (since DSM-IV), which often led to prescriptions for antipsychotic medications at a very young age. In addition, hospital stays for this disorder rose significantly.
“Instead of having a separate chapter for childhood illness, each chapter of the DSM-5 is written more in the context of development, this is a big improvement” Dr. Ulland explains. “Illnesses that were often diagnosed earlier in life are reviewed first. DMDD is meant to describe children who were previously identified as bipolar, but did not show up as bipolar adults. That was puzzling for many clinicians. Many pediatric specialists believe the discrepancy is due to many of those kids being incorrectly identified as bipolar."
What is most critical about the DMDD diagnosis, Dr. Ulland says, is that it’s a step that suggests “umbrella” diagnoses are inadequate to describe children and adolescents. “Meds rarely ever fix developmental issues, which is the way many behavioral disorders have been addressed in the past. Accurately described mental illness leads to better treatment. Specific, accurate diagnosis leads to children being referred to treatments that will assist development rather than a reliance on medications as the only answer.” In other words, awareness of the complexity of children is heightened. Shorter medical checks and evaluations are not sufficient to properly diagnose them.
“DSM-5 changes are meant to recognize developmental, emotional and behavioral alignment, rather than simply a collection of symptoms and behaviors. The new guide helps to show more of the natural progression of mental illnesses. With the removal of the section on childhood disorders, practitioners are forced to recognize that disorders that were previously diagnosed in children may be seen in other age groups, and even increase risk for development of other psychiatric illnesses at a later age. Age-relevant examples help clinicians consider the diagnosis within the entire life cycle. Many disorders have a natural history within the person which before probably had not been recognized enough by practitioners,” he continues.
There are many effective treatments for disorders in children and adolescents. Dr. Ulland states that the spectrum of anxiety disorders, depression and attention deficit hyperactivity disorder (ADHD) are among the most common and treatable illnesses. All of these may cause behavioral problems that are rather severe if left untreated, but it’s important that clinicians continue to be as sophisticated as possible in diagnosis, since this informs the most effective treatments. DMDD and the new categories were ultimately made to assist in better treatment of mental illness, while removing part of the divide between current research and treatment.
If you believe a child or adolescent is living with a mental disorder, call Rogers at 800-767-4411 for a free screening or request one online.