Monday, October 24th, 2011
There is debate swirling around a proposed new diagnostic category in child psychiatry: Disruptive Mood Dysregulation Disorder or DMDD. The online conversations illuminate a phenomenon that makes me worry: when parents and clinicians can’t control a child’s behavior, there is a tendency to diagnose a disorder, and then use the diagnosis to justify medication.
Look, I sympathize with every parent who has difficulties in managing their child, especially one who is highly irritable and has extreme outbursts and tantrums (which is the territory of the DMDD label). The reality is that some kids are much tougher to parent than others. I also understand the frustrations of practitioners who find that conventional behavioral treatments are not as effective as we’d like them to be for some kids. And I fully get that some kids do benefit from medications.
But I am getting concerned that we are moving towards a system that uses diagnosis and medication as a first line of attack whenever there are behavioral issues in a child. In the case of DMDD (which is being considered as a new diagnostic category in the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association), it could be argued that the primary motivation is to provide a diagnostic label to kids whose profile doesn’t neatly fit other alternative diagnoses (such as bipolar disorder, ADHD, or oppositional defiant disorder). I’ve read that the idea here is that this new diagnosis will prevent misuse of the other diagnoses when they are not really appropriate. But that raises the following question: Why do we need to apply a diagnosis? Unfortunately, in many cases the reason is that a diagnosis goes hand in hand with a prescription. And if this happens without intensive efforts to use behavioral methods to change both child and parent behavior, the only thing that would be achieved is finding a way to suppress behavior, not manage it.
The discussion about DMDD comes on the heels of the suggestion that kids as young as 4 can be diagnosed with ADHD – and also prescribed medication for it (click here to see my take on that topic). At what point will we stop relying on arbitrary application of diagnostic labels and immediate prescription of drugs when it is far from clear that many of the targeted children suffer from a medical disorder? And what ever happened to using behavioral methods to shape development in kids, even those who may display “difficult” behavior?Add a Comment