Saturday, May 25, 2013

DSM 5 (Diagnostic & Statistical Manual) Released

The American Psychiatric Association has released the long awaited and controversial DSM V. There have been a number of significant changes to the categories. Some things to call your attention to is the removal of the term Mental Retardation. Intellectual Disability or Intellectual Developmental Disability is now noted along with degree of severity. The language affords greater dignity based on current semantics to those who are vulnerable to additional marginalization based on our words. That being said, any reference to impaired intellect can lead to miscalculation of ability and relevance as seen through participation in the broader society. It is equally important to recognize that receiving the classification of mild, moderate, severe or profound must be looked at as temporary and not a permanent state of being. We must consider this for a number of reasons;

1. The research in the fields of neuroscience and education provide ample proof that those who would have been thought not "trainable" in the not so distant past are able to learn far beyond expectations when provided with effective treatment and intervention. It should be expected, that individuals in these categories will make substantial progress and may move within them or find themselves ineligible altogether. This should be what we expect and move towards, constantly re-evaluating our interventions, their effectiveness and the current research which will continue to guide our actions.

2. We must continue to advocate and teach advocacy as this category holds with it ongoing stigmatization. Our students need to be challenged with a rich curriculum which makes meaningful connections and builds on skills and knowledge. Access alone is insufficient. The curriculum itself must be made inclusive, engage in dynamic exchanges and act as a living conduit to a common ground where all have the opportunity for full participation.

The second classification area which has received a lot of attention is Autism Spectrum Disorder. The American Psychiatric Association considers this one of their most important updates. The category of ASD has gone through many changes over the course of the past century. Children's Hospital Boston has put together an overview of the history and changes to the current diagnostic categories. These new changes are based on current research and what we have learned in practice. It is very concerning for parents when a change like this occurs as it will have both intended and unintended consequences. As parents of a child with Aspergers, we find ourselves updating reports and assessments to transition into adult services, college and the world in general. It is a scary time. We must also consider that many children who have received these types of diagnosis are also categorized as having an intellectual disability as well. For people with ASD, many times the power of their intellect is masked by issues related to access and organization of their world. Caution must be taken in making judgments regarding cognitive powers without first addressing all of the other barriers we have so carefully noted through research and practice over the course of the last century.

Children are treasures and must be treated as such. A diagnosis can be helpful and a barrier at the same time. We must work together to focus on making each category an evolving stance, where research informs and guides in the most respectful and dignified manner. We are talking about human beings with a future not yet written in stone. We must never lose sight of this, and our vision must be barrier free.  

I have included some additional links which provide some other perspectives on these changes.

Is Criticism of DSM-5 'Anti-psychiatry'? by Allen Frances

Autism Speaks: DSM V News & Updates

Temple Grandin on the DSM V

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