Death of the DSM – What does this mean for child mental illness diagnosis?

DSMI had the opportunity to meet with a wise and sage pediatric neurologist Dr. Fred Baughman at a conference in New York who enlightened me on the historical origins of mental illness. Dr. Baughman revealed that up to the mid-1940’s, neurologists treated both physical and mental illness. Due to the absence of any biochemical, anatomical or genetic evidence for mental illness at that time, neurologists split off from treating mental illness, and psychiatry was born. Fast forward to today, nothing has really changed. After millions of dollars spent in research, there is still no evidence that mental illness has physical underpinnings. This statement is supported by the recent decision of the National Institute for Mental Health’s (NIMH) to pull their support for the new Diagnostic and Statistical Manual for Psychiatry Fifth Edition (DSMV). Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria, so in essence, the DSMV is dead. Insel goes on to state “The weakness (of the DSMV) is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure”. Of particular concern to the pediatric health professional community has been the escalating trend to diagnose and medicate problematic behaviors in children, many as young as two years of age. NIMH recently launched the Research Domain Criteria to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. So the search for the origins of child mental illness continues, and millions more will be spent looking for the elusive cause as to why so many children are so unhappy. This article challenges traditional diagnostic and medication procedures for children with “mental illness”, and explores reasons why so many children are so unhappy and offers proven alternative treatment options.

Dr. Baughman also enlightened me on the role of medication in supporting child mental illness, and how health professionals developed somewhat “backward thinking” in this area. When a child demonstrates problematic behaviors that are not acceptable to their family, teacher or society in general, these children are increasingly prescribed psychotropic (mind altering) medication e.g. antidepressants, antipsychotics, antianxiety, stimulants, and sedatives. When considering use of psychotropic medication with young children, understanding the impact of long term use on the child’s neurochemistry is imperative.  Psychotropic medication acts to alter the brain’s own biochemicals, termed neurotransmitters. When given psychotropic medication, children generally exhibit improved functional outcomes e.g. less disruptive behavior, which consequently supports the assumption that the child must have a “chemical imbalance”, a popular belief still held by many health professionals today. Long term effects of chronic use of psychotropic medications on a child’s brain is to “down-regulate” the production of its own biochemicals, or neurotransmitters. This down regulation of neurotransmitters occurs largely because the brain perceives they are no longer needed. This receptor down-regulation causes permanent changes in the child’s biochemistry, and eventually can result in an exacerbation of the child’s problematic behavior, and/or causes new disorders, which are readily diagnosed as yet another “mental illness” and also medicated. Hence begins the birth of co-morbid diagnoses and polypharmacy, or the assigning of multiple diagnoses and use of multiple medications to treat the original “mental illness”. Prescribing young children one or many psychotropic medications does not have the support of reliable and replicable research, and could prove to be harmful in both the short and long term. Great Britain and Australia prohibit use of psychotropic medication with children younger than 17 years of age, yet North America uses 95% of the world’s psychotropic medication.

So why do health professionals continue to pursue child mental illness diagnosis and use of psychotropic medication, instead of actively exploring treatment alternatives such as working with the family unit? When research abounds showing the positive benefits of physical exercise, nutrition, family counselling, nature, touch, and human connection on child mental health, why wouldn’t health professionals utilize these modalities as primary treatment options prior to the diagnostic and medication model? Possibly because the diagnosis and medication model is quick and familiar, and is the way it has always been done, albeit unproven and potentially harmful. Or maybe health professionals aren’t knowledgeable about mental health support services in their own community, or how to refer children to these services. Possibly the referral source (parents and teachers) are pushing the health professionals for the drugs, looking for a “quick fix” to problematic behaviors that they are finding just too difficult to deal with. Worth consideration is the power of the pharmaceutical industry, now the most lucrative industry in North America, to sway both consumer and health professionals alike. Investigations have uncovered, time and time again, flagrant conflict of interest at university and government levels showing financial remuneration to researchers for hiding studies which don’t support use of psychotropic medications.

When considering the recent school shootings, health and education professionals might consider taking into account that all shooters are proven video gamers (but not all video gamers are shooters). Prescribing psychotropic medication to an already unhappy and disconnected child or youth, who is also addicted to video games and has access to guns, could create a very dangerous situation where this child or youth now has the propensity to become violent and/or suicidal.  Symptoms of psychotropic medication toxicity are violence and suicide, and therefore medication toxicity must be understood and readily identified by health and education professionals in order to provide ethical and effective intervention, as well as provision of alternative treatments.

It makes sense, in light of recent initiatives by NIMH, to explore proven alternatives to diagnostic and medication procedures for human unhappiness, especially when treating children. As a pediatric occupational therapist, I have witnessed the relationship between thousands of child : parent and child : teacher dyads, the quality of which appears to greatly affect the happiness (or unhappiness) of the child. My clinical observation about the child : parent/teacher relationship is receiving increased support in the research literature, leading me to the conclusion that children possibly aren’t born mentally ill or unhappy, but that parents, teachers, and society make them that way. I want to clarify that organic brain damage sustained from neurological injury or exposure to toxins, is not termed mental illnesses by health professionals, but is instead considered to be brain damage, and therefore does not have causality in the environmental structure of parenting and societal influence. In light of current research showing the power of the parents and teachers to influence child mental illness and addiction, effort toward empowering and supporting these two primary groups could prove to be effective treatment for child mental illness. Education and information dissemination regarding attachment building strategies, and community support networking, could be very beneficial initiatives toward building family and classroom capacity to better support child mental health.

The move toward immersion in technology has coincided with escalation child mental health disorders, as disconnected parents fail to connect with and attach to their young children. In the absence of parental attachment, children are detaching from humanity and attaching to devices in droves. Children need the loving and consistent attention of their parents, and when deprived, will seek “feel good” stimulation elsewhere. Research now indicates 1 in 11 children between the ages of 8 and 18 years have an addiction to technology, some as early as 4 years, primarily to video games and pornography. We have never in the history of human kind witnessed children with addictions. Research shows that family interventions that successfully build child: parent connection and attachment bonding, reduce the child’s reliance on and use of technology. As health and education professionals of the future, we will all need extensive skill and knowledge in assessing and treating family disconnection and technology addition, and the sooner the better.

Building Foundations Virtual Futures

This article was written by Cris Rowan, a pediatric occupational therapist, visionary, and author of “Virtual Child – The terrifying truth about what technology is doing to children” available on  You can find out more about Cris and her programs, Foundation Series Workshops, and consultative services on the Zone’in website, or email Cris at Research references used in this article can be located on the Zone’in Fact Sheet on

2 Responses to “Death of the DSM – What does this mean for child mental illness diagnosis?”

  1. Patty Gee
    May 23, 2013 at 9:36 am #

    Where does autism, a neurological disorder, that we now know starts prenatally due to brain predisposition to develop atypically? Autism spectrum disorders are listed in the DSMV, and the only guidelines available for individuals to be diagnosed in order to get insurance to cover treatments and medication.
    Autism often has co-existing mental health issues that often exist in childhood. Autism and accompanying mental health challenges are not the family’s or parent- child relationships fault and I am deeply offended that this was the impression.
    I do agree that autism is aggrevated by video game addiction, and violence may increase as the mental illness increases. There is no common answer, as each case is so individual.

    • Cris Rowan
      May 23, 2013 at 5:34 pm #

      Please provide referenced research regarding the brain’s “predisposition to develop atypically”. Doesn’t every brain have this potential, based on specific environmental exposure?

      There is no dispute that a child’s mental status is highly dependent on the child:parent dyad, nor is there any dispute that autism is a primary attachment disorder.

      Health and education professionals should strive toward creating attachment enriched relationships between parents and children with autism. Promoting and allowing use of technology with children with autism, will only separate the child further from what they really need, a primary relationship with their parents.

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