This post begins a four part series: No Labels…Should Diagnosis Matter at Church? Today, we look at the purpose of diagnostic criteria…and whether they serve the purpose of the church.
Dr. Fred Volkmar, chief of Child and Adolescent Psychiatry at Yale-New Haven Children’s Hospital and Chair of the Yale Child Study Center created quite a stir within the special needs community this past week when he presented findings from a study demonstrating that 55% of persons currently diagnosed with autism (and 75% of persons with Asperger’s Disorder) will no longer meet the revised criteria for the diagnosis proposed in the DSM-5, the manual used to diagnose mental disorders.
From time to time, leading researchers and clinicians in the mental health field come together to review the appropriateness of the diagnostic criteria we use, consider the evidence for including additional conditions in the DSM-5 and eliminate others, in a process that often generates great controversy. There are three primary purposes served by establishing common criteria…
Common criteria help ensure that our diagnoses are both accurate and consistent. They’re essential for communication between clinicians throughout the world. If one of my patients with ADHD moves to Paris, the physician assuming responsibility for their care needs to be working from the same understanding of the criteria for ADHD that I do.
Common criteria that are consistent and reliable are essential for meaningful research into the underlying causes and risk factors for psychiatric disorders, determination of the incidence and prevalence of specific disorders and the comparative effectiveness of different treatments.
The process of establishing a clinical diagnosis and case formulation helps us to organize our thoughts about how to best treat our patients. When we have residents and medical students rotating through our practice, one of my admonitions to them is “I don’t care what you call it, as long as you know what to do about it.”
Changes in our diagnostic criteria are a big deal because the criteria are used for a multitude of other reasons other than those for which they were originally intended. Consider a few of the ways in which the criteria are used…
- Practitioners and hospitals use diagnoses on the claim forms they submit in order to be paid for their services. Insurance companies and pharmacy benefit managers all too often use diagnostic codes to avoid having to pay for specific treatments.
- Pharmaceutical companies need to conduct research trials demonstrating the effectiveness of their products for specific psychiatric diagnoses in order to market their products legally in the U.S. and receive payment from government-funded health care programs. As you might imagine, changes in diagnostic criteria producing increases or decreases in the pool of potential customers is of great interest to the pharmaceutical industry.
- Diagnoses are required by law for children with disabilities to receive accommodations in public education, and help determine eligibility for special education services.
- Diagnoses are used in determination of eligibility for disability benefits.
- The presence of a diagnosis often contributes significantly to the identity of persons with disabilities. Many “Aspies” (as they refer to themselves) have vociferously protested the proposed elimination of Asperger’s Disorder from the DSM-5 in favor of inclusion into a broader classification of autism spectrum disorders.
Think about this…Diagnosis is ultimately used as a tool to facilitate the treatment of patients/clients with identifiable medical/psychiatric disorders.
Does the church treat kids with disabilities? Or do we disciple them?
Tuesday: Do We Put People in Boxes?