Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 42

The DSM-5 classification system also has some inherent disadvantages and risks (Hyman, 2011; Rutter, 2011). One drawback of the DSM-5 approach is that it often gains parsimony at the expense of detailed information. Although a diagnostic label can convey considerable information to others, it cannot possibly provide the same amount of information as a thorough description of the individual. As we have seen, children assigned the same diagnosis can display different patterns of behavior and levels of impairment. We must not overlook the unique strengths and weaknesses of each child.

A second criticism of the DSM-5 diagnostic system is that it does not adequately reflect the individual’s environmental context. Mental health professionals seek to understand children’s problems in the context of their developmental level and surroundings. Many problematic behaviors exhibited by children and adolescents can be seen as attempts to adapt to stressful environments at specific points in time. For example, some physically abused children attempt to cope with their maltreatment by becoming defensive and mistrusting others. Although these coping strategies can psychologically protect them when they were experiencing abuse, they may interfere with the development of interpersonal relationships later in life (Cicchetti & Doyle, 2016).

A third drawback of the DSM-5 lies in its focus on individuals. DSM-5 conceptualizes psychopathology as something that exists within the person. However, childhood disorders are often relational in nature. For example, youths with oppositional defiant disorder show patterns of noncompliant and defiant behavior toward others, especially adults in positions of authority. Considerable research indicates that the quality of parent–child interactions plays an important role in the development of oppositional defiant disorder. Furthermore, treatment for this disorder relies heavily on parental involvement. However, in the DSM-5 system, oppositional defiant disorder is diagnosed in the child. The DSM-5 approach to diagnosis can overlook the role caregivers, other family members, and peers play in the development and maintenance of children’s problems.

A fourth limitation of the DSM-5 system is that distinctions between normality and abnormality are sometimes arbitrary. In the categorical approach used by DSM-5, individuals either have a disorder or they do not. For example, to be diagnosed with ADHD, a child needs to show at least six symptoms of inattention or hyperactivity–impulsivity. If the child displays only five of the required six symptoms, he would not qualify for the ADHD diagnosis. Although this lack of diagnosis might seem like a good thing, it could mean that he does not receive the treatment or support services that he needs.

A final criticism of the DSM-5 is that sometimes boundaries between diagnostic categories are unclear. Categorical classification systems, like DSM-5, work best when all members of a diagnostic group are homogeneous, when there are clear boundaries between two different diagnoses, and when diagnostic categories are mutually exclusive. Unfortunately, these conditions are not always met. When two disorders include the same signs or symptoms, children can be diagnosed with both disorders, causing an artificial co-occurrence of the two conditions. For example, bipolar disorder is a serious emotional disorder seen in approximately 1% to 2% of youth. Some studies indicate that as many as 80% of youths with bipolar disorder also meet diagnostic criteria for ADHD. In most cases, children with bipolar disorder clearly show symptoms of ADHD, even when they are not having mood problems. In some instances, however, the high co-occurrence of bipolar disorder and ADHD is caused by the same signs and symptoms included in the diagnostic criteria for both disorders: an increase in activity, short attention span, distractibility, talkativeness, and impulsive behavior. Some children with bipolar disorder may be incorrectly diagnosed with ADHD also because of this overlap in signs and symptoms (Youngstrom, Arnold, & Frazier, 2010).