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Healthy Kids: Changes in mental health diagnosis
HEALTHY KIDS • Dr. Ujjwal Ramtekkar > Mercy Children’s Hospital

Healthy Kids: Changes in mental health diagnosis

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Surprisingly, nearly one in five children has one or more mental, emotional and/or behavioral disorders.

Of those, one in 10 has an issue severe enough to impact daily life.

To help better address this, the Diagnostic and Statistical Manual of Mental Disorders, a publication of the American Psychiatric Association, was recently updated to more specifically classify and treat these children.

The update, called DSM-5, significantly differs from earlier versions because of its new “dimensional approach” that allows clinicians to address individual symptoms rather than using a “checklist” method. This will help physicians better understand, diagnose and treat behavioral health issues, while working toward destigmatizing them. Many diagnoses are complex disorders that are difficult to understand, but others are as well known as ADHD.

It’s important for parents to know about their child’s diagnosis under the new classification system because it may affect treatment choices and access to school services.

Some notable changes relevant to childhood psychiatric disorders include:

• Expansion of criteria for autism by eliminating terminologies such as Asperger’s syndrome and pervasive developmental disorder. Those terms will be replaced by a single term, “autism spectrum disorder,” allowing everyone with that diagnosis to access services without any distinction.

• Changing the cutoff age for diagnosis of ADHD from “7 or younger” to “12 or younger” to allow treatment and provision of services to children, especially older kids who were not diagnosed at a younger age.

• Disruptive mood dysregulation disorder has been added as a new diagnosis to address the issue of overdiagnosis of bipolar disorder in children.

• Terms such as stuttering and mental retardation, just to name a few, have been deleted and replaced by communication disorder, intellectual disability and others that may help reduce stigma toward mental illness.

DSM-5 has 22 major diagnostic categories, including the introduction of a few completely new categories and the regrouping of some disorders into new ones. For example, obsessive compulsive disorder and post-traumatic stress disorder are now separated from anxiety disorders into independent categories.

Other changes include:

• Severity rating scales for several disorders and a new functional assessment scale that allows monitoring the progress of the child over time rather than focusing on the diagnosis.

• Availability of cultural formulation interview, a set of 16 questions that will help clinicians assess and address the effect of culture on a child’s symptom presentation and perception, in turn helping improve communication between clinician and children and their parents.

DSM-5 also includes screening tools that can be used effectively by primary care physicians to assist in diagnosis. This will help parents as they seek help and appropriate referral to specialists for early and effective treatment.

Together, these changes will help streamline efforts to focus treatment on the unique aspects of mental, emotional and behavioral health faced by one in five children and their families.

Dr. Ujjwal Ramtekkar is a Mercy Kids pediatric psychiatrist with Mercy Children’s Hospital. For more information, please visit mercykids.org.

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