Why the DSM-5 Should Concern Us All
By Mary Romaniec
On December 13, 2006, a four year old girl named Rebecca Riley died of an overdose of prescribed medication. Her parents had given her a toxic combination of Seroquel, Clonodine and Depakote, along with an over-the-counter cold medication. Their reasons for the medications were to calm a child who had been diagnosed with bipolar and ADHD when she was two years old. Her parents were to eventually go on to face charges of murder after the autopsy confirmed that she had died from the mixture of these medications. While her parents were convicted of all changes in 2010, the prescribing physician, Dr. Kiyoko Kifuji, faced a whole different scrutiny, and one that put the entire psychiatric community on notice.
This is where the problems with DSM-IV are on display. In the diagnostic manual that was established in 1993 by a committee of leading psychiatrists, the wording for diagnosing bipolar and other disorders did not clarify at what age a person could receive said diagnosis. In other words, what is considered abnormal at say twenty, would also be construed as abnormal in a two year old. In Rebecca’s case, Dr. Kifuji, who worked at Tufts Medical Center in Boston, readily admitted that her diagnosis of Rebecca and her two siblings with mental illness at young ages was influenced by her working relationship with Dr. Joseph Biederman of Massachusetts General Hospital, considered the cult-like figure around the cause of early diagnosis of bipolar.
Dr. Biederman, chief of pediatric psychopharmacology and associated with Harvard University, believes that the moment a child is born is the time to begin looking for bipolar and other mental health disorders. What was once diagnosed as a disease in young adulthood can now be diagnosed when a child is a mere toddler, meaning that the child can begin receiving antipsychotic medication for behavior that most would consider “the terrible twos.” He considers his work to be breakthrough science on par with the first vaccinations of disease. Kifuji was one of his followers.
The reason why he can make these diagnoses at this young age is because DSM-IV doesn’t limit him. What also was not limited was the financial windfall Dr. Biederman enjoyed from the pharmaceutical companies. By one account, Biederman earned $1.6 million from his consultations to these companies from 2000 to 2007. He failed to report all but $200,000 to Harvard. At one point Biederman was receiving funding from 15 drug companies and served as a paid speaker or advisor to seven of them, including the makers of Zyprexa and Risperadal. Court documents filed over the years indicate that Biederman told drug maker Johnson & Johnson that planned studies of its medicines in children would yield results benefiting the company. He went on to receive $700,000 in funding from Johnson & Johnson.
The investigations into his conflict of interest concluded in 2011 with Harvard sanctioning (read: slap on the wrist) Biederman and two of his colleagues. He is at present the subject of a lawsuit filed by over 2000 families whose children were harmed by Risperadal. Unfortunately the damage to children, and the credibility of research in psychiatry, has already been done. The $14.6 billion made in annual sales of antipsychotic medications is the reason.
Why then would anyone protest a revision of DSM-IV? Enter DSM-5 (roman numeral has been removed). With the illustration of what is wrong with the current DSM, it would seem like a good idea to find wording that prevents the type of abuse displayed by Biederman and Kifuji in diagnosis and treatment. But the opposite is about to happen in May 2013, when the DSM-5 manual is released. The American Psychiatric Association, creators and publishers of the DSM manual, are about to expand into more behaviors that are considered part of the human experience and create a label that fits a conjured diagnosis (pejorative intended). Not only can your toddler be effectively diagnosed with a myriad of disorders but now you teenager, going through typical teenage angst can have a potential psychosis assigned to the behavior.
To be fair, there are some children who display symptoms of mental health disorders at a young age, perhaps a correlation in line with autism where there is a genetic predisposition with an environmental trigger. Consider the case of a family I mentored. Their three year old son had just been diagnosed with ADHD, bipolar and schizophrenia. He received the diagnoses under the parameters of the DSM-IV for these disorders as well as a series of brain scans conducted by the well-know southern California clinic. The attending physicians gave the news that their son needed to start three antipsychotic drugs right away, although the safe dosage levels were considered unclear because these medications had never been approved for children. No matter because in a matter of about five years the meds would stop working and their son would face institutionalization. At this point the mother hung up the phone and called me for advice, thus beginning their odyssey out of mental illness the way autism families do. . .diet, biomed and behavior therapies. Medications would have to wait and the DSM-IV diagnoses would have no bearing on their decisions.
Dr. Allen Frances, the one who wrote DSM-IV, is not proud of his work. In an interview with Wired Magazine he makes it clear that it is “bullshit” to define every neurosis known to mankind. The DSM-IV is a project that he now regrets participating in because of the ensuing abuse. Instead of adding in more neurosis for common human experiences, he had hoped that the DSM-5 committee would fix the problems with DSM-IV. But they didn’t. He now accuses these former colleagues of the worst kind of intentions mixed with bad science and hubris, all to benefit the bottom line of drug companies.
He’s not the only scientist with these reservations about the upcoming changes. The idea that drug companies have a hand in the upcoming DSM-5 has caused a huge alarm in the psychiatric community, with several open letters from recognized psychiatrists objecting to the lack of transparency and sound science coming from the DSM-5 committee. Many, if not most, see the pitfall of loss of credibility when they become further beholding to pharmaceutical remedies for what is considered normal maladies, especially in wake of the fact that the diagnostic criteria is being reduced in some of these disorders.
Since 1952 the Diagnostic Manual has been considered the bible of psychiatry, giving it a sense of legitimacy on par with medical community, which is why this upcoming version of the DSM is getting a justifiable pushback from the community. It’s a grassroots campaign spurred on by the very members that are the most affected—the psychiatrists and mental health workers. What is ironic is that they are launching the first salvo against the establishment, with the repercussions unknown to them or to the public at large. They want to stop this out of control train before it reaches the station. It would be nice to see some moxie and pushback coming from pediatricians on the vaccine schedule, but that’s another day perhaps.
Why this matters to us in the autism community is that our children face greater scrutiny to potential new labels, with the only course of treatment coming from the pharmaceutical companies. Of course our children already face a greater likelihood they will be medicated at some point in their lifespan with an antipsychotic medication, but add on another potential label and the risk of this possibility rises. And children without a diagnosis of autism face a greater likelihood that their normal life reactions to their experiences may be interpreted as a new neurosis. The potential for abuse is huge.
A portion of one of the concerned Open Letters dated January 4, 2012, submitted by the Society for Humanistic Psychology Division of the American Psychological Association to the APA, sums it up:
We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers. Further, growing evidence suggests that though psychotropic medications do not necessarily correct putative chemical imbalances, they do pose substantial iatrogenic hazards. For example, the increasingly popular neuroleptic (antipsychotic) medications, though helpful for many people in the short term, pose the long-term risks of obesity, diabetes, movement disorders, cognitive decline, worsening of psychotic symptoms, reduction in brain volume, and shortened lifespan (Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Whitaker, 2002, 2010). Indeed, though neurobiology may not fully explain the etiology of DSM-defined disorders, mounting longitudinal evidence suggests that the brain is dramatically altered over the course of psychiatric treatment.
Conclusions
In sum, we have serious reservations about the proposed content of the future DSM-5, as we believe that the new proposals pose the risk of exacerbating longstanding problems with the current system. Many of our reservations, including some of the problems described above, have already been articulated in the formal response to DSM-5 issued by the British Psychological Society (BPS, 2011) and in the email communication of the American Counseling Association (ACA) to Allen Frances (Frances, 2011b).
In light of the above-listed reservations concerning DSM-5’s proposed changes, we hereby voice agreement with BPS that:
• “…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.”
• “The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgments, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.”
• “… [taxonomic] systems such as this are based on identifying problems as located within individuals. This misses the relational context of problems and the undeniable social causation of many such problems.”
• There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma.”
• An ideal empirical system for classification would not be based on past theory but rather would “ begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.”
The present DSM-5 development period may provide a unique opportunity to address these dilemmas, especially given the Task Force’s willingness to reconceptualize the general architecture of psychiatric taxonomy. However, we believe that the proposals presented on www.dsm5.org are more likely to exacerbate rather than mitigate these longstanding problems. We share BPS’s hopes for a more inductive, descriptive approach in the future, and we join BPS in offering participation and guidance in the revision process.
To this end we can all agree for the need to stop, pause and re-evaluate the DSM-5 proposal. It’s just that now the mental health professionals are leading the way against this train wreck. Let’s hope they are successful.
Rebecca Riley’s death will never be justified as collateral damage for the greater good, although the practice of over-prescribing medications has the same effect as Russian-roulette on the health of our kids. The $2.5 million judgment against Dr. Kifuji awarded to the “estate” of Rebecca Riley will remain a hollow victory. About the only good that came out of the senseless tragedy is that we as a society are waking up to the abuse of power that is inherent in our established medical and psychiatric professions, with collusion and conflict of interest rife at the highest levels.
And that family with the three year old boy? Today he is eleven, fully main-streamed and virtually symptom free. . . and not on any medication! It turns out that he was missing the gene to make his own glutathione (very common in mental health patients), meaning he was unable to detox the environmental triggers. With IV glutathione and a myriad of other alternative treatments their son showed almost immediate improvement. This is when we begin to wonder if the lack of treatment for autism coming from the traditional medical community might actually be a blessing. This family will tell you yes.
Maybe one day there will be an Occupy-Pharma movement with those both in and out of the establishment bent on change, holding these companies, government agencies and medical associations fully accountable. Oh, we can only hope. Until then, we can only be aware of what is coming.
Mary Romaniec has been a mentor to families who have a child with autism, and a consultant on special education issues. She is the author of numerous published articles and the creator of the 10 week GFCF calendar. Her book The Autism Revolution: Empowered Parents, Recovered Children is forthcoming. She can be reached at [email protected].
Diagnostic & Statistical Manual: Psychiatry's Deadliest Scam
https://www.youtube.com/watch?v=MFhm-xhQocM
Posted by: humanati | March 01, 2013 at 02:42 PM
I am not against psychiatric medication but I don't believe it offers a long term solution unless combined with biomed treatment, especially chelation and sauna detox. Because mainstream psychiatrists eliminate this line of thinking entirely, I do not feel they give these children the best chance of gaining stability and even recovering. Since I know that psychiatric problems are extremely painful, it is cruel not to open the field to biomedical solutions that make sense. Instead, these kids are being used as a market. If doctors and big Pharma can't make a buck, they are not interested.
Posted by: Lisa | January 23, 2012 at 08:48 PM
A little OT from the DSM-5: I've watched family members NOT be helped by psychiatric medications that were so confidently prescribed based on the "chemical imbalance" theory that research has, rather quietly, not been able to support, but they are still on medications and still dealing with the same difficulties. It looks like slavery to me, especially when I read that research has shown individuals in countries without access to these drugs have a greater chance of recovery from some psychiatric conditions than in more "developed" countries, that these drugs were developed as a step off from practices like lobotomy at a time when individuals with these conditions were assumed to be and treated as inferior. The drugs were developed mainly for short-term institutional convenience without acknowledging long-term effects, and the newer psychiatric drugs have essentially been tested against these older drugs (kind of like vaccines), on patients in a state of withdrawal from these older drugs... The only thing that makes this insanity more excruciating for me is also seeing hyper-charged immune dysfunction very common in my family and strongly suspecting that all or much of this is man-made in the first place. From Freud to today, the "science" has been channeled or banked by convenience.
On a slightly different line, how long has the "terrible twos" been the norm? For as long as autism has been with us? My daughters had long-term periods of crankiness even in their first year of life. A tooth might break through after a few especially bad days and then I'd see a few exceptionally good days and think "Was she 'teething' for nearly two months and now I'm seeing her 'true' personality?" Now I wish I had better documented these phases of moodiness that tended to become normal to me to see how they aligned with certain practices such as going in for well-baby checkups. If I had a do-over, would their infant/toddler years have been happier and healthier? For one daughter, at least, I am sure that is the case.
Posted by: Jeannette Bishop | January 21, 2012 at 02:20 AM
The DSM-V is fraud in progress.
We know that Autism rates are going down due to excellent efforts to expose vaccine manufacturing drug companies depositing toxic levels of brain poisoning Thimerosal in vaccine vials.
Aspberger's and other Autism Lite categories will now pad sagging ASD rates. Remember Autism Lite has always been counted separately.
This is the same fraud Poul Thorsen used to pad ASD rates after Denmark had removed Thimerosal from their childhood vaccines.
http://adventuresinautism.blogspot.com/2010/03/thorsen-leaves-dsm-v-team-still-has-not.html
Posted by: Media Scholar | January 20, 2012 at 08:18 PM
We hit the big time. Yesterday, "Autism" was "trending now" on Yahoo. On the top ten list at the top of the www.yahoo.com page, there it was in the 8th spot - just a few down from a Kardashian. When I clicked on Autism, it brought me to an article about the new DSM.
Soon, Overmedicated People with Autism will be "Trending Now" on Yahoo.
Posted by: Take that, Khloe | January 20, 2012 at 01:01 PM
What, did the market for drugging foster kids suddenly dry up after Diane Sawyer's investigative report? Or do they just need a larger market in order to keep profits and income up? These people make me ill.
But they also confuse me. With these proposed changes will it now appear that the numbers are going down? How would that help them - if numbers go down then doesn't that support the concerns about thimmersol? If the numbers appear to be decreasing then what happens to the argument about all the adults walking around with autism (although we know that has never been true)? Of course, moving the "goal posts" will also muddy the waters for anyone trying to do honest research.
For the record I do beieve that their are children that do need the support of these kinds of meds and that they should have access to them. I just get frustrated when that is the first conculsion made.
Posted by: Shelly | January 20, 2012 at 11:40 AM
I heard Snyderman talking about the "scientific New World Order" on the MSM this morning in the context of making the "definitions" of autism and ASD more specific. You really can't make this stuff up, folks! What an utterly shameless shill! She's a shoe-in for induction into the "Hall of Shame".
Posted by: patrons99 | January 20, 2012 at 10:53 AM
Psychiatrists are about as useful as mammary glands on adult male cattle.
These guys are the leading edge of a wave of arrogance and indifference. Most aren't smart enough to realize that there's a huge difference between a symptom and a root cause, and the ones who do are making way too much money to speak up for the truth.
The medical profession has thrown our children under the bus, and the mind numbing ignorance of these pseudo-professionals is a big part of what's keeping them there.
Posted by: Barry | January 19, 2012 at 08:33 PM
I completely agree with Heidi. Thanks you for that well thought out response.
My two cents.
It is very sad to see people say they detest psychiatrists. There are good, mediocre and bad in EVERY profession so to paint psychiatrists with such a broad brush is unfair.
My son who is 26 has what most would consider to be fairly severe Autism which he slowly regressed into after his MMR vaccine. His Autism continued to worsen over a period of a few years as I continued to vaccinate him. (This was the mid 80s before we knew any better.) During and after his regression Andrew also exhibited behaviors that were blamed on the Autism, but thanks to me keeping a journal, we (my son’s psychiatrist and I) discovered almost a decade later that he was showing symptoms of Bipolar when he was as young as 3 years old.
My son’s psychiatrist, who has been a God-send to our family, saved my son and saved my sanity. My son by age 13 at 5’ 6” and 150 pounds had degenerated to a horrifying place of not sleeping at night, he had severe outbursts daily (and sometimes more often) that lasted an hour to 90 minutes at a time, he had kicked over 20 holes (we're talking 6 x 8 inches or larger) in the walls of our home, broken 3 car windshields and numerous windows.
It was collaboration between our psychiatrist, who diagnosed the bipolar and prescribed the right combination of medications, and our Autism Consultant, who moved us away from behavior modification, who saved our son. Rather than becoming a drugged up zombie our son was able to start to have a real and very enjoyable life again.
Both my son’s psychiatrist and I aren’t thrilled by the number of medications Andrew needs to take. We are always looking at ways to eliminate something, but we will not do at the expense of Andrew’s mental health. More importantly we won't do it at the expense of his ability to lead as fulfilling and as happy a life as he can, considering the severity of his Autism. In fact there have been very very long stretches of time where Andrew’s Bipolar has been a MUCH bigger problem than his Autism.
This is NOT to say that I believe a 3 year old should be on heavy duty medications. The case where the child died is extremely sad and outrageous.
I’ve also read stories about pediatricians put two year olds with Autism on risperdal because they don’t sleep well at night, before other options were even tried. I think that is insanity.
I also don’t believe that all psychiatric medications are unnecessary or bad and I don’t believe that all psychiatrists are bad or are in bed with the pharmaceutical companies. In fact although medications (from big pharma) have had a positive impact on Andrew, I still loathe them for their drug and vaccine pushing ways, and for causing Andrew’s Autism and my daughter’s Fibromyalgia. In fact I often wonder if the vaccines had something to do with Andrew’s psychiatric problems.
I just urge people to not throw out the baby with the bathwater when it comes to psychiatrists and psychiatric medications. There are medications, that when used properly are lifesavers and there are psychiatrists who are dedicated to their patients, and their patients well being.
Posted by: Jan Randall | January 19, 2012 at 08:27 PM
Vickie Hill Thanks for telling us about your son. I am truly sorry.
Posted by: Benedetta | January 19, 2012 at 08:11 PM
Parents need to stay far-far away from Dr.Biederman,(and his
followers)it is clear he serves bigPharma,not the children. They are already
building mega-psychiatric hospitals,so they know the future.
We all need to serve them and be on "their meds".
Posted by: oneVoice | January 19, 2012 at 07:10 PM
Good article. Thank you.
Posted by: Melissa | January 19, 2012 at 06:46 PM
What this article says to me is that there is fear that the changes in the new DSM-5 will justify more psychotropic medication rather than promote "other," safer treatments.
I do believe children really are displaying troubling behaviors more than ever, but looking for medical causes really should be the priority. One doesn't have to look far. The medical research is full of pathogens, toxins, and nutrient maladies being the cause of troubling behaviors. Plus, psychiatrists are suppose to rule out medical conditions before diagnosing with psychiatric conditions. Thus, the problem is getting the psychiatrists to practice what they are told to practice - to not just try this than try that, but to actually do efficient medical testing. Currently, psychiatrists rely on patients telling them that their family practitioner referred them to decide that medical causes have been ruled out.
What is currently being done:
1. Patient goes to family doc, doc says it sounds like a psychiatrist thing and refers to a psychiatrist.
2. Patient goes to psychiatrist and says their doc says that it's not a medical condition, it's a psychiatrist condition.
3. Psychiatrist then says, based upon your symptoms, we'll try this med, and if it doesn't work, we'll make changes as needed.
4. Liver testing is done to make sure the liver is healthy enough to handle the psych meds, and thyroid testing is done to rule out thyroid issues.
But, what should be done is this.
1. Medical literature states that genetic metabolic disorders cause psychiatric symptoms, so let's test for that.
2. Borna virus, Strep, Lyme, Bartonella, worms, protozoa, Epstein Barr, and many more have been associated with developmental and psych symptoms, so let's test for that.
3. Toxins and nutrient deficiencies have been shown to cause psych symptoms, so let's test for that.
4. Plus, the environment, itself, should be at least questioned to learn about trauma experiences, mold exposures, etc.
5. If all this fails, then we can look at psych meds, but testing should be done to see how the neurotransmitters are being effected, since the meds are reportedly prescribed for the purpose of effecting such. We do need to keep track.
Posted by: Heidi N | January 19, 2012 at 06:31 PM
Mental healthcare and psychiatrist do not wish to find the root causes of the problems.I did the the follow up with the
"experts" in a fragmented health care system (different care
givers,dosages,changing meds,combining meds etc.)while they treated my son.I am totally disgusted with Psychiatry and mental heath care.If I would of know this will happen (the
suffering)I would not given birth to a child.I can only agree with the previous writer.The "experts" are very ineffective and useless and the problems (meds) are only increasing with the adverse side-effects.
Posted by: oneVoice | January 19, 2012 at 06:23 PM
To be clear to Vicki, the DSM-5 diagnostic standards for diagnosing mental health disorders is about to be lowered, not strengthened. A child with a real mental health disorder will now potentially be relegated into the same arena as a child and adolescent going through a developmental phase, with both being called mental health disorder on the DSM-5. That is the scary part. I am equally concerned for the child whose diagnosis is real as I am for the child whose diagnosis is conjured. This is also a concern by the psychiatric community who sees the pitfalls of loss of credibility to their profession.
My friend's son did have the disorders I mentioned, and he did recover from those disorders without medication. It was an approach that family chose because the alternative of institutionalization was a dire prospect. And his improvement was almost immediate when diet was started and further improved when they started IV glutathione.
Medication is definitely an answer for some kids. It's just that the DSM-5 is expanding into areas where no diagnosis belongs, creating the very real possibility that unnecessary medications are on the way too.
Posted by: Mary | January 19, 2012 at 06:12 PM
I detest psychiatrists. Every experience my son Rory or I have had with a psychiatrist has been negative. Their only goal has been to drug him until he is quiet (or better yet, asleep).
When he was an adolescent, we dealt with a whole range of self-injurious and aggressive behaviors. At one point, he hit his leg so many times he had permanent bruises and all the hair fell off. He would yell at the top of his lungs for hours every night, usually between midnight and 3:00 a.m. Biomedical interventions -- which we had been working since his diagnosis at age 4 -- no longer worked. Over a couple of years, out of desperation, we tried a number of different drugs -- SSRIs, anti-anxiety meds, anti-depressants, anti-convulsants, and several different anti-psychotics. None of these worked to deal with the behaviors, and they tended to make him either hyper or sleepy.
When I became frustrated, our psychiatrist actually laughed at me and said he only expected medication to work 20% of the time. He didn't seem to realize that this was quite an indictment of his profession, nor did he care that he had so little to offer and that what he did offer was so ineffective. When a medication didn't work, he always wanted to increase the dose, usually doubling it. He always wanted to add a different drug.
As an attorney, I've worked in juvenile justice, and I frequently see young people (usually boys) who are on more than one drug at once. What surprises me is that they are kept on the drugs even though the drugs don't seem to work. And of course, no one listens to the attorney or the parent -- just to the psychiatrist.
Posted by: Aimee Doyle | January 19, 2012 at 05:27 PM
The pharma industry sure is working hard to convince people to take meds. I was just talking to one of my friends whose child has ADHD ( he is on medication). My friend and her husband often participate in "focus" groups and do market research type surveys as it does give money for participants. In a recent instance, a telephone person asked the husband a series of questions to see if he "qualified" to participate in an upcoming focus group. It was for parents (specifically male, I believe) who have a child with ADHD. When the husband answered one question with some kind of response to the effect that he "doesn't use medication for headaches and only as a last resort" the interviewer stopped him and said, " look, normally I don't intervene but if you answer this question differently I.e. More along the lines that you would consider taking pain meds for a headache then you will qualify to join this focus group and make 100.00. So he said, "fine, change my answer." well he got to the focus getup and the bottom line was that they were told they were there because they were all parents of ADHD kids and it is inherited by the male and "don't you think you could have done more in your life?" You got it- it was pharma-sponsored (my friend never knew what group) and they were corralled there to be pressured/shamed/cajoled into taking ADHD meds. Unbelievable. Quite a non-triumph for them, though. Most apparently stood up for their lives and said they functioned o.k., were with partners who loved them and helped them and thankyou but they did not feel that they wanted or needed to take meds for it. Never mind that how are they so darned sure that ADHD is hereditary anyways? Absolutely sickening.
Posted by: Jen | January 19, 2012 at 05:03 PM
In this recent autism article, http://wantagh.patch.com/articles/baking-with-a-twist-felecia-rozansky-s-recipe-to-help-autism-43c23f15 the pharma-funded site WebMD is cited as the source for autism info......and we're told that autism is "a mental disorder."
http://dictionary.webmd.com/terms/autism
"A mental disorder characterized by severely abnormal development of social interaction and of verbal and nonverbal communication skills. Affected people may adhere to inflexible, nonfunctional rituals or routines. They may become upset with even trivial changes in their environment. They often have a limited range of interests but may become preoccupied with a narrow range of subjects or activities. They appear unable to understand others' feelings and often have poor eye contact with others. Unpredictable mood swings may occur. Many demonstrate stereotypical motor mannerisms such as hand or finger flapping, body rocking, or dipping. The disorder is probably caused by organically based central nervous system dysfunction, especially in the ability to process social or emotional information or language."
So we're to believe that the kids everywhere with autism are mentally ill. Just look at their bizarre behaviors as proof.
One sure way to make the autism epidemic go away is to make the definition meaningless. If any abnormal behavior can put a child on the spectrum then no one will know for sure what autism is. It's also a way to marginalize those children whose autism is so severe it can't be explained away. Showing us smiling, interacting children with a therapist and calling it autism is no cause for real concern. The disorder with no know cause is about to become even more of a mystery.
Anne Dachel, Media
Posted by: Anne McElroy Dachel | January 19, 2012 at 12:37 PM
not to get too "kumbaya" on this but i really think we're on the same page. i know vicki and have met her son -- she's a great advocate for him and people with autism. mary's article raises important uber-issues about the rigging of the dsm to favor medicines and the business interests of shrinks who probably have no business controlling the treatment of people with autism, period...there is much more to be said about the toxic manipulation of the dsm-5 to try to normalize and medicalize autism and we will be covering it closely...
Posted by: Dan Olmsted | January 19, 2012 at 12:14 PM
I wasn't addressing the Riley case at all. I was addressing the author's comment: "What was once diagnosed as a disease in young adulthood can now be diagnosed when a child is a mere toddler, meaning that the child can begin receiving antipsychotic medication for behavior that most would consider “the terrible twos.” "
My point is that there are real children with real issues that are far removed from "the terrible twos." Any psychiatrist should see the patient as well as speak to the child's parents (and possibly other observers,should there be a discrepancey between what the professional observes and what the parents are reporting).
Certainly there are mistakes in diagnosis in mental illness, just as there are mistakes in diagnosis in autism. But I doubt anyone here would call into question the existence, or treatment, of all autism in children simply because some children were misdiagnosed.
As to multiple medications, the standard protocol is to start with a single medication and adjust the dosage as symptoms warrant. If that isn't enough, then either try a different medication or add another medication to the mix. For reasons that aren't fully understood, many children with mental illness do better on low doses of multiple meds than on higher doses of individual meds. So I wouldn't focus so much on the number of meds without taking into account the dosages. In fact, I would be more concerned with the medical professional who put a child on a very high dose of a single med than I would if the child was on very low doses of three meds.
Posted by: Vicki Hill | January 19, 2012 at 11:43 AM
"Doctors" like Biederman are very scary. The trend now is to not research the true causes of illness, label problems incorrectly and or blame the parents.
Posted by: Jen | January 19, 2012 at 11:24 AM
Vicki,
The issue isn't just whether or not a young child should be prescribed a drug that hasn't been tested on children. It's also the widespread use of MULTIPLE drugs on young children. Rebecca Riley would probably be alive today if her doctor had prescribed just one drug. Did your child receive 3 heavy duty prescriptions at age four? I doubt it.
I know of one "bi-polar" child who, at about age 11, was on TEN medications simultaneously. I promise am not exaggerating. (It's possible one or more were OTC - I don't know for sure.) He was a patient of Dr. Biederman's. A school nurse opened her cupboard and showed me this boy's array of drugs. She was dumbfounded. For sure, it was a breach of confidentiality for her to have shown me this, but I saw it nevertheless. (And this child was not suicidal or homocidal.)
Posted by: no name | January 19, 2012 at 11:01 AM
The new DSM-V is planning to label children who dislike math as having (an) MD. MD is Mathematical Disorder. We already have the term, "Dyscalculia," for mathematical Dyslexia, so why add this new label? The new label will turn a child that does not like math into having a Psychiatric/ Mental Disorder which can then be MEDICATED as supposedly part of a treatment plan,,,best practices, early diagnosis and any other TAG FADS. Shell of "Recovering Autism ADHD and Special Needs."
Posted by: Shell Tzorfas | January 19, 2012 at 10:53 AM
@ Vicki Hill - I am sure that intent of this article is not to deny there are children with very serious psychiatric disturbances such as schizophrenia. What I took from this article is that there are children with much less severe problems, who are possibly even misdiagnosed, and who are being prescribed very dangerous drugs not suited to their much lesser symptomatology. Anti-psychotic drugs have a place, but they are not suitable for all children. I am aware of a push to have all children screened for mental illness by lay people without any personal knowledge of the children tested, or any medical degree in psychiatry, in a school setting. The program is called Teen Screen, and its goal is to direct children who answer some questions "wrong" on a ten question quiz to a psychiatrist after the lay person who administered the quiz makes a quickie "diagnosis" based upon the quiz results, prior to referral to a doctor who will likely place them on SSRI's. Not every single child in America has a psychiatric disorder. Nor does every single adult. DSM-5 seeks to offer diagnoses for human behaviors that do not warrant a diagnosis, much less psychiatric care, in order to create a market for psychiatric treatment and ensure a "guaranteed market" for psychiatric medications, whether they are needed or not. We should all be concerned about this.
I am sorry to read about your son's condition, and I wish him the best.
Posted by: Not an MD | January 19, 2012 at 10:26 AM
The vast majority of psychotic breaks do not happen until adolescence or adulthood. Some children do have psychotic episodes, and these should not be ignored - indeed, they may need to be medicated. But what Vicki is ignoring is that the doctors did not INTERVIEW THE CHILD. They got their data, and the idea to medicate the children, from the demands of the Riley PARENTS.
It is pretty clear when a child is having a psychotic break with reality, even when they are primarily nonverbal. I've worked with a child who was put on who had been tolerably high functioning. He would verbalize in single words, occasionally phrases and toilet trained, but his stimming was getting worse, which made it difficult for him to use his hands for purposeful behavior. His parents turned to conventional medication, which prescribed adding Abilify to the Risperdal and other medications he was already taking.
Two days later, he was back in pull ups. The only phrases he was using was screaming, "Get out, get OUT!" while hitting his head until it was bloody. He began kicking holes in the wall, and had to be watched closely, because he went after a female student's breasts with his teeth.
In other words, he was not psychotic to begin with, adding (another) atypical antipsychotic/neuroleptic medication to the load he was already on caused the break.
The technical term for this is toxic psychosis. I've also seen it in an adult diagnosed with Asperger's Syndrome, who is much more verbal, and was able to tell us about his hallucinations. Once upon a time, he was able to live in his own apartment, go shopping, and generally survive off his social security check and a little money from his parents. Now he has moved back in with his parents, and spends his days at a pschiatric day program, because he is unable to even keep a reliable eye on the stove.
Posted by: Tara Marshall | January 19, 2012 at 09:35 AM
To compare a child with serious mentall illness to a child experiencing the "terrible twos' is insulting. Surely no one on this website would compare a child with autism to a typical-developing child with the "terrible twos". Why? Because most people here have lived with, or see up close and personal, a child with autism and know the difference. The parents and the doctors who deal with children with serious mental illness have also see it up close and personal and know the difference.
"Terrible twos" do not climb out a window and try to jump off the roof because the voices in their head told them they could fly. "Terrible fours" do not take daddy's belt and fit it around their necks in attempts to strangle themselves after saying they should never have been born and 'need' to die. Most people have never seen a seriously mentally ill child; it doesn't mean that such children don't exist.
I served on the founding committee many years ago for the Child and Adolescent Bipolar Foundation, now The Balanced Mind Foundation. There were precious few of us who dealt with children with true mental illness; we found each other via the Internet and set up a nonprofit website to help others dealing with similar situations.
One thing I've seen over time is that a significant minority of the kids with serious mental illness have co-morbid ASD. The ASD is frequently diagnosed a bit late because the mental illness symptoms are overwhelming. Only when those symptoms are under control via medication can the underlying ASD be truly seen for what it is.
As for the meds not being tested on children...no manufacturer is willing to try to test them on children due to ethics rules of informed consent. So what do you do with a child with symptoms as severe as what I've described? Trying various diets or 'let's wait until you are age 18' sounds well and good...except when you are dealing with a child who has frequent suicidal or homocidal ideations or is actively hallucinating. As a parent, my job - and that of other parents - was to keep such a child ALIVE until the age of 18, at which point he could legally decide for himself.
My own son is now grown. He has chosen to stay on meds because he absolutely hates the hallucinations and knows the incredible risk he is at when under the influence of hallucinations. Sure, the meds have side effects. But the illness is far worse. Suggesting 'no meds' for children with serious mental illness is akin to suggesting 'no meds' for a child with cancer. After all, those meds have side effects as well. But until there is a better solution, some people will rightfully choose to go with the best chance they have at life.
Posted by: Vicki Hill | January 19, 2012 at 08:26 AM
It is frightening to think that DSM-5 will provide even more opportunity for greedy "pill pushers" .. in the words of Dr. Allen Frances, the one who wrote DSM-IV .."bullshit to define every neurosis known to mankind".
I wonder if main-stream media ADVERTISERS will use DSM-5 as a means to quickly replace the relatively inexpensive drug they recommend for "restless leg syndrome" .. with a more powerful, expensive, antipsychotic drug?
Posted by: Bob Moffitt | January 19, 2012 at 07:04 AM