The Book That'll Change How Mental Health Disorders Are Diagnosed If you're not familiar with the term "DSM-5" yet, you will be. In May 2013, the American Psychiatric Association (APA) will publish the 5th version of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM is used by clinicians use to diagnose psychiatric disorders, and it's what insurance companies and policy makers use to determine whether a person needs treatment, and what type they need. This latest version is well over a decade in the making, and we've already heard lots of debate over the major changes.
For instance, many people--parents and professionals alike-are worried about the plan to eliminate Asperger's Disorder from the DSM-5 and create one category of autism spectrum disorder (ASD). Critics contend that kids who currently have Asperger's will either not meet the criteria under the new category, or their educational and therapeutic services won't be covered because their symptoms won't be considered severe enough to require it. Early intervention is critical for improving the developmental progress of children with Asperger's as well as ASD, so any change in criteria that may reduce the likelihood of making services available will be a disservice to parents and their children.
Meanwhile, new categories like Disruptive Mood Dysregulation Disorder have others worrying that kids with massive temper outbursts could get diagnosed, when in fact their behavior is normal (albeit poor). Some parents and doctors fear that these children could undergo unnecessary treatments, especially drug therapy. And yet others argue that the new category will finally get help for kids who need it.
Even conditions that won't be revised in a major way will be scrutinized. For instance, people will look closely to determine whether growing rates of ADHD diagnoses are warranted, especially since they go hand in hand with an increase in drug treatment. We can guarantee one thing: The implementation of DSM-5 will have a profound impact on how we diagnose and treat the more than 15 million kids in the U.S. who struggle with mental health disorders.
Kids and Play In 2012, intriguing scientific papers revealed conflicts between how much and what type of play toddlers need, and what they're actually doing. Many experts now agree that toddlers and preschoolers should get three hours a day of physical activity--which basically means 15 minutes of every hour. But this can be hard to do, especially in a child-care setting. For one thing, some parents would rather childcare providers emphasize academics over running around and playing. What's more, some play experts contend that our playground equipment has become so safe it's actually boring to toddlers, who end up not using it for very long (or at all).
Physical activity guidelines are not just necessary to combat the obesity epidemic-they impact cognitive development, too. A game-changing review paper published last August in Psychological Bulletin argued that pretend play promotes social and language skills rather than creativity and imagination, which is better cultivated through "playful learning" opportunities that involve more hands-on manipulation and exploration. Although some interpreted this as an argument against the importance of play, it did illuminate how playful learning (which includes activities like drawing along with physical activity) should be an essential part of early childhood education. Simply put, schoolyard activities promote cognitive development by boosting motor skills. We anticipate researchers, educators, and policy makers will focus intently on the barriers that prevent toddlers from getting the amount and type of play they need to best nurture their physical and cognitive development.
Pregnancy Risks and Sports Injuries
Pregnancy Health Risks Over the past year we've heard a lot about potentially risky prenatal influences. Antidepressant use is a big one, because depression in women is common during the childbearing years. A controversial paper published last October in Human Reproduction came down on a common class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs, because they may pose a heightened risk for pregnancy complications, preterm birth, and a number of neurobehavioral problems during infancy. Researchers also reported a link between antidepressant use during pregnancy and autism rates. Another study associated maternal flu during pregnancy with increased risk of autism, supporting the idea that pregnant women should receive flu shots (but not the nasal spray, which contains a live virus).
Let's be clear: These studies are important--but we need many more of them before we can generate solid recommendations for pregnant women. The research so far has been exploratory, and the actual level of risk has been pretty small, despite what headlines may lead you to believe. It's unfortunate that pregnant women are being asked weigh the blurry pros and cons of antidepressant use for both maternal and baby health without definitive guidelines. You can expect more data in the coming year on these topics as well as other prenatal exposures (such as mercury, which was recently associated with risk for ADHD)... and more debate and confusion.
Injuries: The Downside Of Physical Activity While child development experts worry that young kids aren't active enough, older kids are at risk because of their involvement in sports and recreation activities. The Centers for Disease Control and Prevention (CDC) reported that the frequency of concussions and other traumatic brain injuries due to sports and recreation injuries have increased in kids by 60 percent over the last decade. The CDC estimates that over 4 million youth concussions are reported every year-and that's actually an underestimate, because many go unrecognized. The National Eye Institute (NEI) has brought attention to how severe and frequent sports-related eye injuries have become; many lead to temporary or permanent loss of sight. In October, the American Academy of Pediatrics (AAP) issued safety guidelines for cheerleading because of a distressing rise in the number of injuries-including catastrophic ones-due in part to the increasingly risky demands of this activity.
In the coming year, there'll be a lot more discussion about guidelines to keep active kids injury-free. The NEI is promoting protective eyewear in sports like baseball; the AAP suggests that cheerleading be considered-and regulated-as a sport rather than an activity in all 50 states. Meanwhile, preventing and recognizing concussions are complex issues, and experts will study how this impacts sports like football and soccer. And we'll also hear more about the dangers of recreational activities, such as the recent report that inflatable bouncers—just like trampolines—can cause a variety of injuries.
PTSD and Obesity
Post-Traumatic Stress Disorder At the American Academy of Pediatrics' annual conference in October, several sessions addressed children and trauma. Part of that may have been because it was held in New Orleans, where many local experts could speak with considerable authority on the lasting effects of Hurricane Katrina on children. And it's also partly due to changes in the upcoming DSM-5 (see "The Book That'll Change How Mental Health Disorders Are Diagnosed," above). This version will better address young children-particularly preschoolers-so that post-traumatic stress disorder, or PTSD, will be more easily recognized, diagnosed, and hopefully treated.
The AAP conference took place before Sandy, the storm that killed more than 100 people in New York, New Jersey, and Connecticut, and caused more than $78 billion in damage. This kind of disaster is a major cause of PTSD in children, and for that reason alone we can expect to hear even more about the condition in the months ahead.
Parents should know that genuine post-traumatic stress requires professional help, says Michael Scheeringa, M.D., M.P.H., a Remigio Gonzales professor of psychiatry at Tulane University in New Orleans who has an expertise in preschoolers and PTSD. "People think of it as cuts or bad memories that fade with time, but it's not just going to go away," he says. If your child shows symptoms of PTSD a month after the traumatic event, seriously consider getting help. Symptoms after a weather disaster like Sandy may include panic during a rainstorm, fear of wind, and being afraid of the dark or even to take a bath (seven years after Katrina, "we still see this," says Dr. Scheeringa). Another important point: "You can't tell a child has PTSD just by looking at him or her," he says. The condition is triggered by certain events, so the signs can be fleeting. If you have any concerns about your child, speak to your pediatrician. "Simply saying 'My child isn't acting the way he usually does? should be all the doctor needs to make a referral," insists Dr. Scheeringa.
Obesity It's impossible to do any kind of "hot-button issue" roundup without including childhood obesity, which continues to plague our kids, more than one-third of whom are overweight or obese. But in 2013, pediatricians should be better equipped than ever before to help families manage the problem. The American Academy of Pediatrics (AAP) recently announced its Institute for Healthy Childhood Weight, which has the simple but monumental goal of training pediatricians to assist kids and their parents in obesity prevention and treatment. Doctors have long wanted to do this effectively, explains Sandra Hassink, M.D., chair of the advisory committee for the Institute: "It's often a matter of their getting the information, getting the workflow in the office, and getting the logistics worked out." This is where the Institute comes in, particularly its new Healthy Active Living for Families (HALF) program, which offers both parents and doctors age-by-age advice. Pediatricians are also getting lots of training on how to talk to families; Dr. Hassink described a very cool avatar-based program that allows doctors to practice having those potentially tricky conversations, since "motivational interviewing is a big part of helping families create goals and make change." The bottom line is that in 2013, parents should feel good about turning to their doctor with any concerns about their child's weight. Pediatricians now have the tools to help.
Copyright © 2012 Meredith Corporation.