I have Type II diabetes. How do I know? Because three separate doctors have confirmed it through a variety of laboratory tests. These findings have been consistent for over 10 years.

 

The nine-year-old boy I saw this morning has Autistic Spectrum Disorder. How do I know? Because I said so.

 

Well, it’s actually more complex than that, but when it comes to assigning a mental health diagnosis, we don’t have the kind of ‘marker’ tests that are common in medicine. Particularly with children, it is often difficult trying to pin-point what a given symptom profile means. Many of the kids I see in my practice, for example, present with inattentiveness, hyperactivity, agitation, irritability, forgetfulness, and difficulty playing quietly or alone. Sounds like ADHD, doesn’t it?

 

What is often missed in this is that most of the kids I see also have histories of severe trauma; physical abuse, sexual abuse, exposure to parental domestic violence, parental abandonment, and/or witnessing crime, for example. Thus, many of them have classic symptoms of Posttraumatic Stress Disorder (PTSD).

 

Unfortunately, the symptoms of ADHD and PTSD—especially with children—often mimic one another, making it difficult to determine which factors (biological versus psychological) are causing these characteristics. Do you see the challenge?

 

With the debut of DSM 5, we have been seeing controversy and debate in the professional and popular media about its use and validity. This was present when the DSM work groups started the revision process, and it is escalating, now that the book is heading toward distribution.

 

The whole notion of assigning a DSM diagnosis is complex. Whereas a diagnosis can ‘open doors’ for some people (e.g., qualifying them for disability, specialized education, or support services), it might ‘close doors’ for others (e.g., limiting their ability to get insurance in the future, labeling them in a way that stereotypes or otherwise disadvantages them).

 

A diagnosis allows medical and mental health providers to have a common language for describing what is happening with a particular person. This is why DSM is best seen as a classification system. That is, it only informs our understanding of which symptoms are needed in order to give a particular diagnosis. DSM, on the other hand, doesn’t offer guidance or advice on what to do about a diagnosis. Thus, one person with depression might choose therapy, while another chooses medication, and yet another chooses a holistic approach to intervention. From the standpoint of diagnosis, how the person treats a condition is irrelevant. What is important, however, is that the various providers working with the person all agree on what the diagnosis actually is. This is why it is helpful to have a standardized system for applying any kind of diagnosis.

 

In many instances, assigning a diagnosis can be exceptionally complex, and again, we don’t have blood tests or scans that can confirm if the diagnosis is correct. At best, we have psychological or neuropsychological tests that strengthen our opinion that a diagnosis is applicable, but in many instances, different providers will not interpret these findings in the same way. Perhaps one exception to this is the diagnosis Intellectual Disability—which requires an IQ score below a certain point, coupled with measurable deficits in adaptive function—but even then, some evaluators are reluctant to ‘pull the trigger’ and assign this diagnosis, even with the data in hand.

 

One criticism of DSM 5 is that age-typical reactions or behaviors—for example, childhood tantrums—will be pathologized and labeled. This is a naïve perspective, as parents who have children with extreme behavior disorders want, need and deserve a term or classification to identify what is happening with their child. They will also need to know if the child’s condition is a behavior disorder, as opposed to something along the lines of Bipolar Disorder (a distinction that will be made clear in DSM 5).

 

When it was announced that revisions to DSM would be taking place, numerous lobbying groups stepped into gear, advocating that their ‘condition’ be included; Parental alienation or internet addiction, for example. Fortunately, the DSM committee stood by the principle that requires each diagnosis to be valid, as evidenced by extensive clinical research into the condition. In other words, think of DSM as a summary of clinical research as opposed to a list of terms made up by a group of psychiatrists.

 

Although at times we all toss around diagnostic terms in a casual manner ("He is so obsessive compulsive …"), the reality is that those with mental health problems are really struggling … as are their families. The people who come to my child psychology practice aren’t doing so as a means of passing time. Rather, parents, teachers, and providers desperately want to know what is behind the difficulties their child is having with mood, anxiety, behavior, learning, thought processes, cognition, etc.

 

While a diagnosis alone does not answer those questions, it can put into motion the procedures, interventions, and approaches that start to address the underlying condition. Treating childhood depression, for example, typically requires a different approach than treating Conduct Disorder, ADHD, Autism, or a learning disability.

 

As a science, mental health is still in its infancy. While we have made significant strides through the years, the human condition—mental and physical—is complex. Increasingly, we are recognizing that emotions and behaviors are influenced by a variety of factors; individual, family, situational, genetic, and biological. As our knowledge grows in this regard, we will develop greater skill at defining and classifying mental disorders, while also learning how best to treat them. Until then, those of us who assess individuals and render diagnostic opinions will do the best we can with what we have to draw upon.