APAJustificationTemperDysregulationDisorderWDysphoria

APAJustificationTemperDysregulationDisorderWDysphoria -...

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Justification for Temper Dysregulation Disorder with Dysphoria DSM-5 Childhood and Adolescent Disorders Work Group © 2010 American Psychiatric Association. All Rights Reserved. See for more information. 1 Proposed change: Introduction of a diagnostic category for temper dysregulation with dysphoria (TDD) into the Mood Disorders Section of DSM-V I. Explication of the reason for a proposed change A. Background One of the most dramatic developments in child psychiatry in the past decade has been a marked upsurge in the rate at which children are being assigned the diagnosis of bipolar disorder (BD) (Moreno et al, 2007; Blader and Carlson, 2007). Moreno et al (2007) found a 40-fold increase between 1994 and 2003 in the number of outpatient pediatric psychiatry visits associated with the diagnosis of BD, while Blader and Carlson (2007) found that the rate of hospital discharges in the U.S. of youth with a primary diagnosis of BD increased from 1.3 to 7.3 per 10,000 between 1996 and 2004. This increase could be seen as reflecting appropriate diagnosis coming after a time of persistent under-diagnosis. However, this increase coincided with a time period during which some child psychiatry researchers and practitioners adopted new conventions in assigning the diagnosis of BD to children. These conventions would be expected to broaden the phenotype of pediatric BD, beyond the explicit boundaries of DSM-IV BD. The DSM-IV conventions, and those of all previous editions of the DSM, are based primarily in work on adults. Beginning with the DSM-IV revision, a major focus in the DSM process has been to maintain continuity between adult and child conventions as much as possible. With this focus, developmental modifications to nosology are only viewed as justified when they are supported strongly by data on validity. This heavily shaped revisions of DSM-III-R to create DSM-IV, and the Child Disorders Work Group recognized the importance of this approach in revising DSM-IV to create DSM-V. In the case of BD, the Childhood Disorders Work Group spent considerable time reviewing the relevant research literature on pediatric BD. The Work Group’s deliberations focused on integrating a critical review of the research literature with the considerable clinical experience of its members, in order to determine the most appropriate developmental modifications to the BD diagnosis. In its deliberations, the Childhood Disorders Work Group was keenly aware that research demonstrates that the “classic” adult phenotype clearly does present in pre-pubertal children, as well as in adolescents, although it may be rare in the younger age group. Unambiguous agreement about this fact weighed heavily in the Work Group’s deliberations. The agreement on the existence of this classic phenotype generates an important standard against which all other phenotypes can be compared in terms of longitudinal course, family history, and pathophysiology. Thus, deliberations heavily weighed research comparing alternative BD phenotypes against
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This note was uploaded on 04/12/2010 for the course PSY 339 taught by Professor Neal during the Spring '09 term at University of Texas at Austin.

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APAJustificationTemperDysregulationDisorderWDysphoria -...

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