With three years still left until publication, the fights over the new version of the psychiatric diagnostic manual, the DSM-V, are hotting up and The New York Times has a concise article that covers most of the main point of contention.

- “What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”

- Psychiatrists involved in preparing the new manual contend that it is too early to say for sure which cards will be added and which dropped.

Although I doubt the DSM committee are using that exact metaphor, it certainly illustrates the point that the process requires a certain degree of value-judgement.

It’s interesting, however, that the public debate is currently focused on whether certain diagnoses should be included or not, rather than whether diagnosis itself is useful for psychiatry.

We’ve had psychometrics for a good 100 years that allow us to measure dimensions of human experience and performance with a much greater degree of accuracy than Read the rest of this entry »

Like all psychiatric disorders, ADHD is diagnosed based on the presence of particular behavioral symptoms that are judged to cause significant impairment in an individual’s functioning, and not on the results of a specific test. In fact, recently published ADHD evaluation guidelines from the American Academy of Pediatrics (AAP) explicitly state that no particular diagnostic test should be routinely used when evaluating a child for ADHD.

While most ADHD experts would agree that no single test could or should be used in isolation to diagnose ADHD, there are several important reasons why the availability of an accurate objective test would be useful.

First, many children do not receive a careful and comprehensive assessment for ADHD but are instead diagnosed with based on evaluation procedures that are far from optimal.

Second, although AAP guidelines indicate that specific diagnostic tests should not be routinely used, many parents are concerned about the lack of objective procedures in their child’s evaluation. In fact, many families do not pursue treatment for ADHD because the the absence of objective evaluation procedures leads them to question the diagnosis. You can read a review of an interesting study on this issue at www.helpforadd.com/2006/january.htm

For these reasons an accurate and objective diagnostic test for ADHD could be of value in many clinical situations. Two important conditions would have to be met for such a test to be useful.

First, it would have to be highly sensitive to Read the rest of this entry »