Changes in psychiatry's 'bible' altered kids' care

Times Staff Writer

In the early 1980s, a profound shift in psychiatry set the stage for the growth of psychiatric diagnoses in kids. In a third revision of the manual often called the profession's bible (the Diagnostic and Statistical Manual of Mental Disorders, or DSM), the American Psychiatric Assn. began adding descriptions of newly recognized anxiety disorders.

The new entries set forth symptoms of extreme shyness, worry or fear. To diagnose patients, the manual gave psychiatrists broad latitude in interpreting frequency and severity of symptoms seen in patients.

The psychiatric establishment updated the DSM in 1994, adding and refining dozens of new disorders, including social anxiety disorder, obsessive-compulsive disorder and tic disorder. They also expanded the definition of several conditions that had already been recognized in earlier manuals: A broadened new definition of what was then commonly known as attention deficit disorder, for instance, paved the way for many more children to come under treatment for problems of hyperactivity, forgetfulness, disorganization and inattentiveness.

Before long, the field's most influential thinkers, led by Dr. Joseph Beiderman, chairman of Harvard Medical School's pediatric psychopharmacology unit, began asking why new psychiatric drugs, which were proving so effective in treating adults, were not being used more widely in the treatment of children.

Before long, many Americans' troublesome quirks and behaviors began looking like symptoms of mental illness, and the aggressive marketing of new generations of antidepressants and antipsychotics brought psychiatric diagnoses and their treatment into the popular lexicon.

By 2005, an eminent group of mental-health researchers asserted, in an article published in the Archives of General Psychiatry, that at least one-half of adult Americans would at some point in their lives meet the criteria for some recognized mental disorder in the newly drafted version of the diagnostic manual.

Their survey also had found that most mental illness grew out of conditions that began before adulthood. Ronald C. Kessler, the Harvard researcher that had led the group, said the findings dictated that "interventions aimed at prevention or early treatment need to focus on relatively mild cases among youth."

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