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• DSM-V Work Group Reports (Apr. 2009)
• Childhood and Adolescent Disorders Work Group Report

Report of the DSM-V Childhood and Adolescent Disorders Work Group

April 2009
Daniel Pine, M.D.

Much of the work performed by the Child and Adolescent Disorders Work Group during the past year focuses on preparing for Field Trials.  The group has delineated five sets of issues that generate questions for Field Trials.  Three of these issues relate to the creation of either relatively new syndromes or relatively novel developmental extensions of existing DSM-IV syndromes.  The final two issues relate to the need to increase the focus on development in DSM-V by increasing the focus on developmental manifestations and by considering the addition of novel developmental subtypes.  Moreover, these two issues also might be addressed by the addition of dimensional measures.     

The particular questions in some areas are still taking shape.  However, the details are sufficiently clear to provide initial answers to the questions posed to each Work Group on anticipated future directions.  The specific issues are delineated in five categories. 

The current document summarizes areas where field trials appear indicated.  The document also briefly delineates the populations in which such trials might be based. 

1. Non-Suicidal Self Injury: The Child and Adolescent Disorders Work Group continues to work on the proposal that DSM-V should involve a new entity, labeled non-suicidal self injury (NSSI).  A few issues have emerged that should be answered before field trials are considered for this entity:
   1. Draft criteria for NSSI must be established.
   2. The relationship between these criteria and suicidal ideation or behavior must be clarified. 
   3. Measures for assessing the criteria for NSSI as well as suicidal ideation or behavior must be studied in diverse settings and age groups; this work also should consider methods for distinguishing NSSI from suicidal ideation or behavior.  

2. Pediatric Mood Disorders: Work continues by the Child and Adolescent Disorders Work Group on possible modifications to various mood disorder syndromes. 
   1. Pediatric bipolar disorder:  New criteria for mania and bipolar disorder may emerge from the Mood Disorders Work Group.  Applications of these precise criteria to samples of pediatric mood disorder patients are needed.  A field trial would require data among individuals of various ages, including school-aged children, adolescents, and adults. 
   2. Severe irritability: A new entity related to severe irritability is being defined, potentially as a subtype of both oppositional defiant disorder and mood disorders.  A field trial would require data among individuals of various ages, including school-aged children, adolescents, and adults.  Moreover, the trial would require data both in psychiatric patients and in community-based individuals. 
   3. Pediatric Major Depressive Disorder: New criteria for major depressive disorder may emerge from the Mood Disorders Work Group.  Applications to pediatric samples are needed, as is a consideration of eliminating the “irritability” criterion. 

3. Pediatric Trauma-Related Disorders: Work continues by the Child and Adolescent Disorders Work Group on possible modifications to various trauma-related syndromes. 
   1. Preschool post-traumatic stress disorder (PTSD): New criteria for PTSD in preschoolers will be proposed.  Applications of these precise criteria to relevant samples are needed.
   2. Child and Adolescent PTSD: New criteria for PTSD in adults may emerge.  These will need to be applied to studies in youth.  Moreover, developmental manifestations of PTSD also may emerge.  These will need to be applied as well.
   3. Developmental Trauma Disorder: A proposal for a new disorder has been made.  If this proposal is approved, new criteria must be evaluated.   

4. Developmental Manifestations: A new proposal for DSM-V concerns the inclusion of a section on “Developmental Manifestations” of other DSM syndromes.  When new criteria have been finalized for each DSM-V syndrome, applications of developmental manifestations should quickly be attempted.  A few areas appear particularly ripe for such work.
   1. As noted above, work on PTSD will need to consider developmental manifestations.
   2. All of the disruptive behavior disorders should include developmental manifestations.
   3. Other categories of disorders that should include considerations of developmental manifestations include the autism-spectrum disorders, mood disorders, anxiety disorders (particularly separation anxiety disorder), personality disorders, and eating disorders. 

5. Developmental Subtypes:  Work Groups are considering whether the early vs. late-onset conduct disorder designation should be maintained.  Beyond this age-related subtype and the consideration of a new age-related subtype of pediatric PTSD, a few other entities may have sufficiently strong data to support consideration of including age-related or developmental subtypes in DSM-V.  These comprise: obsessive compulsive disorder (OCD); generalized anxiety disorder (GAD); major depressive disorder; and substance-use disorders.   

6. Dimensional Measures: Finally, the group has begun to consider methods for developing symptom-based dimensional measures that can be used for measurement-based care.