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GRASP June 2013 Newsletter

It’s June. Some places school is out already; in others, it will be out soon. Summer is known as a warm, lazy, laid back time. In many places, however, weather has been crazy, with tornadoes and tropical storms. Here in the Northeast, it’s been damp and rainy.Summer can be a busy time as well, full of travel, camping, gardening, and outdoor activities. We have a half dozen articles and a short video to share with you. We have a New Support Group in the NYC area!!!2013 GRASP Benefit: “A Time for Change” (Roads to Learning reviews the 2013 GRASP Benefit in their blog)Thinking differently: Autism finds space in the workplaceEvidence weak for social communication disorderAutism Focus of new legal resource centerIQ Testing Underestimates Autism Spectrum IntelligencePsychiatry's New Diagnostic Manual: "Don't Buy It. Don't Use It. Don't Teach      It."Penn and Teller on vaccines Yvona FastSupport Groups ManagerGRASPThe Global and Regional Asperger Syndrome Partnership, Inc.666 Broadway, Suite 830New York, NY 10012p + f = 1.888.474.7277 (1.888.47.GRASP)info@grasp.orgwww.grasp.org  We have a New Support Group in the NYC area!!! Our newest group is in Brooklyn at Church of the Holy Apostles at, 622 Greenwood Ave.  It will be held on the first Tuesday of every month from 6-8pm and the facilitator is Laurie Abramson.  She can be reached by email at labramson@grasp.org for more information.  2013 GRASP Benefit: “A Time for Change” We were delighted to attend the 2013 Global Regional Asperger’s Syndrome Partnership (GRASP) Benefit last Tuesday, May 14, 2013 at the Downtown Community Television Center in New York to congratulate founder and former executive director Michael John Carley for his ten years of cultivating GRASP into the influential network of support groups it is today. Since its launch in 2003, GRASP has become a nation-wide organization that provides community outreach, support groups, advocacy, and education to adolescents and adults on the autism spectrum. The 2013 Benefit: “A Time for Change” also presented GRASP’s Friend and Benefactor Award, Distinguished Spectrumite Medal, and Divine Neurotypical Award to three prominent individuals for the work that they have done in the autism and mental health communities. This year, GRASP awarded author Andrew Solomon the Friend and Benefactor Award for his book “Far From the Tree,” which describes the travails of families impacted by numerous diagnoses of deafness, dwarfism, Down syndrome, autism, schizophrenia, and more. His book “Far From the Tree” is considered one of the greatest tributes GRASP now has to pluralism itself. A native New Yorker, Andrew studied at Yale and is currently pursuing a Ph.D. in psychology at the University of Cambridge. He has also written several other novels, including “The Noonday Demon: An Atlas of Depression” and “A Stone Boat,” as well as pieces for the New York Times Magazine and The New Yorker. The Distinguished Spectrumite Medal was awarded to Bob Hedin, who has contributed to GRASP’s national status by forming and leading the first GRASP network outside the tri-state area. As an individual with Asperger’s Syndrome (AS), Bob recognized the need for support groups for adults with AS and launched a membership drive in 2004 for adults with AS in Philadelphia. Since then, his group has grown to over 250 members and boasts a lending library of over 125 books on autism. The Divine Neurotypical Award was awarded to scholar and researcher Dr. Barry Prizant, who has been a longtime friend to GRASP. Dr. Prizant has had forty years of experience as a clinical scholar, researcher, and program consultant to children and adults with autism and related developmental disabilities. His most recent work involved developing the SCERTS® Model for children who have or are at-risk for social-communicative difficulties, and their families. Barry also co-facilitates an annual weekend retreat for parents of autistic children each year, and has organized the ASD Symposium for parents, educators, SLPs, OTs, and therapists to address the importance of understanding interests, strengths, and talents of people with Autism Spectrum Disorder (ASD).We want to congratulate Michael John Carley on the incredible work he has done with GRASP and as a spectacular human being. We know he will continue to do amazing things. For more information about the history and mission of GRASP, visit their website at www.grasp.org. http://blog.difflearn.com/2013/05/24/2013-grasp-benefit-a-time-for-change/ Thinking differently: Autism finds space in the workplaceEmployers seeking competitive advantage are hiring more people diagnosed as 'on the spectrum' Kate Kelland, Health and Science CorrespondentReuters June 4, 2013  Some call it neurological diversity, others see it as autism's fight back. People diagnosed as "on the spectrum" are suddenly in demand by employers seeking a competitive advantage from autistic workers more used to being considered disabled than special. Expressing a belief that "innovation comes from the edges", German computer software giant SAP last month launched a recruitment drive to attract people with autism to join it as software testers.  A week later, U.S. home financing firm Freddie Mac advertised a second round of paid internships aimed specifically at autistic students or new graduates.  The multinationals both say they hope to harness the unique talents of autistic people as well as giving people previously marginalized in the workforce a chance to flourish in a job.  "Only by employing people who think differently and spark innovation will SAP be prepared to handle the challenges of the 21st Century," SAP's board member for human resources, Luisa Delgado, said as she announced the plan.  For Ari Ne'eman, president of the Washington DC-based Autistic Self Advocacy Network (ASAN) and a member of the U.S. National Council on Disability, the moves are welcome and well overdue. It's high time autism fought back, he told Reuters in a telephone interview.  "We need to see neurological diversity in much the same way as we've seen workplace diversity efforts in the past on the basis of race, gender and sexual orientation," he said. "We're now seeing a growing level of interest in this."  Autistic spectrum disorders, including Asperger's syndrome or high-functioning autism, are thought to affect around 1 percent of the population worldwide.  The disorders are caused by a combination of genetic and environmental factors and can range from severe mental retardation with a profound inability to communicate, to relatively mild symptoms combined with some high levels of function such as those seen in people with Asperger's.  Among the core features of autism are poor communication skills and social difficulties. In high-functioning autism, features such as intense or obsessive focus and unwavering attention to detail are also common.  These latter qualities, experts say, as well an ability to approach an issue in a different way - often a creative or counterintuitive one - make autistic people potentially attractive as employees in large corporations.  "Historically, there seemed to be a certain perception of this population as being incapable of performing corporate level work," Freddie' Mac's diversity manager Stephanie Roemer told Reuters. "In reality people on the spectrum offer so much to an organization ... willing to think outside of the box and view this cadre of talent as a 'value add'."  OBSESSION AND SUCCESS  Joshua Kendall, author of "America's Obsessives", which argues that some of history's greatest American business and political leaders became successful partly because of obsessive personality traits, says the firms that get in first on this trend are likely to reap rewards.  "These big companies aren't doing it out of the kindness of their heart; they are doing it because they now realize they've been missing something," he said in a telephone interview.  He said the crucial question if such recruitment drives are to prove successful and sustainable is how much society will seek to accommodate people who think differently, or how much it would seek to "cure" them of their disorder.  "These are people who have traditionally been labeled as disabled. So do we want to treat them, or do we want to allow them to be as they are and adapt to them?"  SAP says its global autism recruitment drive, which aims to employ 650 autistic people - around 1 percent of its workforce - by 2020, comes after successful pilot projects in India and Ireland. It is a collaborative project with Specialisterne, a Danish consultancy that gets people with autism into jobs where they can shine.  Ne'eman says so far most of the firms expressing interest in autistic workers tend to be in science, technology, engineering and mathematics (STEM) fields. In future, he says he hopes their success will encourage others to take notice.  "Many of us can and do succeed in a wide variety of professions," he said. "I, for instance, am an autistic person working in politics and public policy, which is certainly not a stereotypical field."  In Britain, only 15 percent of adults with autism are in full-time employment, says Carol Povey, a director at the UK's National Autistic Society - a fraction, she adds, of those who could contribute to the world of work.  In the United States, according to Ne'eman, studies of the working lives of autistic people have not been done, so no comparable data is available.  "It's great to see organizations not just doing from corporate social responsibility, but actually recognizing there is a good business case behind having more people with autism in the workforce," Povey said. "These people will contribute to the effectiveness and growth of the business."  Yet autism campaigners, and the firms seeking to recruit people on the spectrum, know there will be problems, too. Povey notes that "the social aspects of being in a workplace or office may pose particular challenges" for autistic recruits.  "They may be great at doing the task in hand, but really struggle when it comes to 'water cooler moments' or lunchtime.  "In fact they may even make other colleagues feel inadequate or awkward. They are unlikely to get involved in the banter of the workplace, and more likely to just get on with the job."  (Reporting by Kate Kelland; Editing by Will Waterman) http://www.chicagotribune.com/business/careers/sns-rt-us-autism-recruitmentbre9530ka-20130604,0,6970843.story#ixzz2VHmrYVq6 Evidence weak for social communication disorderBy Helen Tager-Flusberg 30 May 2013 Social Communication Disorder" in the DSM-5 broken down. As part of its overhaul of the classification of autism and related pervasive developmental disorders, the DSM-5, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, introduces a new category: social (pragmatic) communication disorder (SCD), classified under the heading of communication disorders. The new disorder’s features include difficulties with social uses of both verbal and nonverbal communication, which overlap with the social communication impairments that now define autism. The major distinction between SCD and autism is that SCD does not include repetitive behaviors or restricted interests, thus capturing a group of children that would fall outside autism’s definition. In the public eye, changes to autism’s diagnostic criteria have sparked the most attention and controversy, but among clinical researchers, SCD is raising far greater concern. The essential problem, as many commentators see it, is that there is little evidence that SCD has either reliability or validity as a distinct category of neurodevelopmental disorder1, 2, 3. No one doubts that there are children and adults who have significant problems with social communication and pragmatic aspects of language, but the question is, do these problems warrant a separate clinical diagnosis or are they better viewed as comorbid symptoms seen in individuals with other neurodevelopmental disorders? Like the framers of the DSM-5, I too once wanted to believe in the existence of SCD (or, as it is referred to in the literature, pragmatic language impairment or semantic pragmatic disorder). Indeed, my colleagues and I received a grant in 1998 to investigate this class of language disorder that seems to lie somewhere between autism and specific language impairment (SLI). The trouble was that we never found any children who met the criteria for pragmatic language impairment who didn’t also have either autism or SLI, especially when we dug into their developmental histories. Multiple reasons: On reflection, then, there are several reasons why SCD should not have been introduced into the DSM-5. First and foremost, SCD opens up a new Pandora’s box — just when the DSM-5 had finally dealt with categories that had been so troubling in the DSM-IV, namely Asperger syndrome and pervasive developmental disorder-not otherwise specified. SCD was meant to fill a gap, perhaps, for children who don’t quite meet the new stringent criteria for diagnosing autism. But it will clearly not help clinicians who are faced with diagnosing a child who shows all the criteria for social communication impairments but only one symptom of restricted or repetitive behavior patterns. Second, there doesn’t seem to be any evidence for the existence of a disorder that is genuinely independent of autism and SLI. Yes, there are children who, by the time they reach school, no longer show any restricted or repetitive behaviors and whose social communication impairments are mild enough that a clinician would say they no longer meet criteria for autism (though they clearly once did). There are also children who may have been significantly delayed in acquiring vocabulary and grammar as toddlers and preschoolers (which would have warranted a diagnosis of SLI), and who still have problems with pragmatics, even though their vocabulary and grammatical skills are now within the normative range. But the histories of such children reveal that they would have once met criteria for these other disorders. From the perspective of how to treat these children, it would be better if they retained their historical diagnoses so that they would be eligible to receive the evidenced-based interventions that address the social, communication and residual language problems that they still have. We still lack reasonable clinical measures for assessing pragmatic language impairments. There are a few standardized tests on the market, but many children who clearly have quite serious problems communicating in everyday life can score well on these tests, as they tap meta-pragmatic knowledge (knowing the right answer in a test situation), not on-line communication skills (the ability to use that knowledge in a real-life situation). Instead, researchers and clinicians rely on parent or teacher report measures (for example, the excellent Children’s Communication Checklist-2, developed by Dorothy Bishop) or the laborious, detailed analyses of transcribed conversational speech for which there are no normative data available for comparison. Most clinicians are not trained in identifying pragmatic impairments, so the absence of readily accessible assessment instruments means that they don’t have the tools with which to make a diagnosis of SCD. Cultural bias: All clinical diagnoses are subject to cultural bias or interpretation, a point that is emphasized in the DSM-5. But SCD is probably even more vulnerable to this kind of bias than any other disorder. Sociolinguists have documented how differently people communicate in different cultures. Even in our own society, contrasting patterns of communication (‘Mars and Venus’) are among the most replicable of all sex differences. The examples of problems listed in the definition of SCD could so easily be seen in immigrants or English-as-a-second-language learners (mis)leading an insensitive clinician to label a child with a clinical disorder who simply comes from a different cultural background. My final concern is that the age criterion for diagnosing SCD is vague and even contradictory as currently written in the DSM-5. On the one hand it states that “onset is in the early developmental period” — but what is early? Later we read “diagnosis … is rare among children younger than 4 years” and then “milder forms … may not become apparent until early adolescence.” I suspect that what underlies these statements is the fact that there is flimsy research literature on SCD, with just a few studies available, none of which included children under age 4. I might take this one step further to suggest that the vagueness reflects the fact that SCD may not really exist as a distinct and unique disorder at any age. Still, deficits in social communication are important for clinicians to identify. There is a growing literature to suggest that they are a significant problem for individuals who outgrow (usually as a result of good treatment) their earlier diagnoses of autism or SLI, for children with other learning disorders or attention deficit hyperactivity disorder, as part of the phenotype for genetic disorders such as Williams syndrome or fragile X syndrome, and even as a core symptom in schizophrenia. I would argue that social (pragmatic) communication impairments are symptoms that should be evaluated as comorbid features across a wide range of children and adults with other disorders. However, it was, in hindsight, a mistake for the DSM-5 to include SCD as a new category of neurodevelopmental disorders without carefully considering whether it has any reliability or validity as an independent disorder. Helen Tager-Flusberg is director of Research on Autism and Developmental Disorders at Boston University. References: 1: Ozonoff S. J. Child Psychol. Psychiatry 53, 1092-1094 (2012) PubMed 2: Skuse D.H. J. Am. Acad. Child Adolesc. Psychiatry 51, 344-346 (2012) PubMed 3: Tanguay P.E. Am. J. Psychiatry 168, 1142-1144 (2011) PubMed http://sfari.org/news-and-opinion/specials/2013/dsm-5-special-report/evidence-weak-for-social-communication-disorderAutism Focus Of New Legal CenterBy Michelle Diament June 4, 2013With autism prevalence on the rise, a new legal resource center is launching that will focus specifically on issues facing those with the developmental disorder across the country.Autism Speaks plans to announce Tuesday that it will form the new center with an eye toward helping establish key legal precedents for this growing population.First on the agenda will be ensuring that autism insurance laws passed in many states in recent years are implemented appropriately, organizers said. Ultimately, however, plans call for the center to address everything from housing to employment to criminal and family law issues as they relate to autism.“There are a whole host of issues having to do with the ADA, housing, family law — autism challenges our legal system in so many ways and we want to be a part of shaping how that plays out,” said Dan Unumb, a South Carolina-based attorney who will head the new initiative.Dubbed the Autism Speaks Legal Resource Center, Unumb said the effort will initially serve to support and provide resources and training to the legal community nationally. The center will not take on requests for representation from individuals, but does plan to offer legal information for families and a referral network for those in need of a lawyer on autism-related issues.Informally, Unumb said many attorneys working on cases related to autism have been networking for years, but as the field emerges, there is a need for a central organization.In addition to Unumb, Autism Speaks expects to hire a second attorney for the center this year and may intervene in legal actions that are of interest with friend-of-the-court briefs. Unumb did not rule out bringing cases as well.http://www.disabilityscoop.com/2013/06/04/autism-focus-legal-center/18087/IQ Testing Underestimates Autism Spectrum IntelligenceBy Rick Nauert PhD Senior News Editor A new study finds that traditional intelligence testing may be underestimating the capabilities of individuals displaying an autism spectrum disorder. Traditionally, autism spectrum disorders, including Asperger’s syndrome, have generally been associated with uneven intellectual profiles and impairment. However, a new study of Asperger individuals published in the online journal PLoS ONE, suggests specialized testing are needed for this special population. Researchers discovered Asperger’s individuals’ scores are much higher when they are evaluated by a test called Raven’s Progressive Matrices, which encompasses reasoning, novel problem-solving abilities, and high-level abstraction. By comparison, scores for non-Asperger’s individuals are much more consistent across different tests. Interestingly, Asperger participants’ performance on Raven’s Matrices was associated with their strongest peaks of performance on the traditional Wechsler. A previous study by the same group found very similar results for autistic individuals as well, whose peaks of ability are perceptual, rather than verbal as in Asperger individuals. This observation suggests that individuals with autism spectrum disorders have a common information processing mechanism for different aspects of information (verbal vs. perceptual). According to co-author Michelle Dawson, “while we know autistics process information atypically, very little thought has gone into how to fairly assess their abilities. In fact, there is so little understanding of what autistics do well that their strong abilities are often regarded as dysfunctional. Dawson said that measurable strengths in autistic spectrum individuals are not “isolated islets of abilities” as previously thought, but are in fact representative of autistics’ intellectual abilities. This in turn raises questions about how to provide autistics with the kinds of information they can process well. “We consider the effort to understand and encourage autistic strengths to be of paramount importance,” Dawson said. The results suggest that although autistic spectrum intelligence is atypical, it is also genuine, general and underestimated. http://psychcentral.com/news/2011/10/03/iq-testing-underestimates-asperger-autism-intelligence/29999.html   Psychiatry's New Diagnostic Manual: "Don't Buy It. Don't Use It. Don't Teach It." That's what psychiatrist Allen Frances, chair of the DSM-IV task force, has to say about DSM-5.—By Michael Mechanic | Tue May. 14, 2013 Mother Jones MagazineI happen to know this guy who knows a lot about mental-health policy. And, well, okay, he happens to be my father. So my ears perked up recently when my dad mentioned that the DSM-5, the latest in a series of diagnostic manuals soon to be published by the American Psychiatric Association, is something of a disaster.Indeed, at the end of April, the National Institute of Mental Health (the branch of the NIH that funds mental-health research) took the drastic step of renouncing the latest DSM (short for Diagnostic and Statistical Manual of Mental Disorders) in advance of its publication—renouncing the whole DSM system, really—and replacing it with something called Research Domain Criteria."Basically, they said they would no longer use it as a main test in grant requests," explains psychiatrist Allen Frances, who chaired the task force that produced the prior version, DSM-IV (past editions used roman numerals), during the 1990s. "They made it sound like DSM-5 and all the DSMs were invalid, and that we should wait for the new discoveries that were going to come from scientific endeavors.""Pretty soon everyone's going to have a mental disorder or two or three, and it's time we reconsider how we want to define this.”Frances considers the NIMH's move misguided, but he's no fan of the DSM either. That much is clear from his new book, Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. (The New York Times reviews it here.) Given the current upheaval in psychiatry, and the impending release of the new diagnostic manual, Frances seemed like the man to bring us up to speed on how the DSM got so bloated, and why so many Americans are popping uppers and antidepressants that we don't need.Mother Jones: What you mean by "saving normal"?Allen Frances: There's been a rapid diagnostic inflation over the course of the last 35 years, turning problems of everyday life into mental disorders resulting in excessive treatment with medication. Pretty soon everyone's going to have a mental disorder or two or three, and it's time we reconsider how we want to define this and whether the definitions should be in the hands of the drug companies, which is very much what's happened in recent years.MJ: To what degree has this trend accelerated lately?AF: We were very, very conservative in doing DSM-IV, which came out in 1994. Despite our efforts to tame diagnostic inflation, the rates of attention deficit disorder (ADD and ADHD) have tripled, the rate of autism increased by almost 40 times. The rate of childhood bipolar disorder increased by 40 times. And the rate of adult bipolar disorder doubled. A lot of this was driven by the drug companies. They had new products on patent—very expensive; it gave them the means and the methods to spread the message to doctors and patients that mental disorders were easily diagnosed, often missed, caused by chemical imbalance, and treated with an expensive pill.MJ: How do they assert themselves in the DSM process?AF: They don't assert themselves at all in the DSM process. They have absolutely no contact with anyone. But they wait on the sidelines, and if something can possibly be misused in DSM, it will be misused. The drug companies have marketed heavily to primary-care doctors, who now prescribe 80 percent of psychiatric medication. That is amazing. Most psychiatric diagnosis is being done in seven-minute sessions with doctors who are not very interested or well trained in psychiatry. MJ: By now, overtreatment of things like ADHD has become a cultural meme. What's an example we might not have heard of?"Studies show that probably about two-thirds of the people taking an antidepressant don't need it."AF: Well, probably the most overtreated is depression. The DSM system has lumped together really severe depressions that are totally incapacitating and definitely require medication with mild depressions that may just be an expectable reaction to everyday life. The mild depressions have a tremendously high placebo response rate—over 50 percent. The severe depressions don't respond to a placebo. We have a terrific misallocation of resources in this country, with the severe depressions being very much undertreated; only one-third of people with severe depression get treated for it. At the same time, we're terribly overtreating the mild depressions with medication. Eleven percent of the population takes an antidepressant. In the female 40-to-50 group, it's 23 percent. Studies show that probably about two-thirds of the people taking an antidepressant don't need it. If you get an antidepressant after a seven-minute visit with a doctor on the worst day of your life, you're going to get better—the placebo response and just time. But if you've taken the pill, you'll assume the pill made you better, and so you'll tend to stay on the pill. So you have lots of people taking medicine they don't need for problems that will take care of themselves, and people who really do need medicine don't have access to treatment. MJ: Why not? AF: The budgets have been cut dramatically for mental health. We now have a million psychiatric patients in prison for nuisance crimes because they weren't given adequate care as outpatients and a decent place to live. As Obama put it, it's easier now for someone who's mentally ill to get a gun than to get an outpatient appointment. "With DSM-IV, we told the experts: 'You're not going to get anything in here unless the data grabs you by the throat.'" MJ: Who is most to blame for the larding up of the DSM-5 with dubious diagnostic criteria? AF: A lot of the blame falls on experts being given too much freedom to expand their pet diagnoses and areas of interest. I've been working in this area for 45 years and I've never met an expert who said, "Let's shrink my area." They always want to expand it. They always worry about missed patients. They don't consider the risks to mislabeled patients. They imagine the suggestions they're making will be done in the best possible way in their own research clinics. They don't realize that most of psychiatry is being practiced in primary care. So they're pure at heart but they're remarkably naive. MJ: In recent years, thanks to the work of researchers at Dartmouth and journalists like Shannon Brownlee and Atul Gawande, there's been a blossoming of awareness about overtreatment in general medicine, and how doctors are susceptible to it even though they may think they aren't. How does any of this apply to the psychiatric community? AF: Psychiatry got on the bandwagon just as the band stopped playing. Part of the justification for these diagnoses that otherwise made no sense at all is, "We're going to be like the rest of medicine. We going to diagnose you early and do preventative treatment to prevent the birth of illness," just at the time when the rest of medicine was realizing that that was, with a few isolated exceptions, causing more harm than good. MJ: How is DSM-5 worse than DSM-IV? AF: With DSM-IV, we were determined to be as modest as possible in ambition and as careful as possible in methodology. We had a very high threshold for change; people had to jump through hoops to convince us. And we rejected 92 of 94 proposed diagnoses. We told the experts, "You're not going to get anything in here unless the data grabs you by the throat." MJ: And DSM-5? AF: They were ambitious. They started out with a grand design to introduce biology into psychiatry, and it was way premature. When that ambition was frustrated, they went to the idea of introducing milder disorders, within the boundaries of normal, because this would be preventative psychiatry. They gave the experts free rein. They said, "This is a blank check." They way they put it is, "Everything's on the table." MJ: Who are these "experts"? AF: Well-meaning researchers in a given area who know everything about that area but nothing about how [their recommendations] will be misused in the real world. MJ: What's your position on the NIMH debacle? AF: The problem is that both the American Psychiatric Association and the NIMH have lost sight of what really matters, which is taking care of patients. The APA, in pushing these new categories, is going to divert attention and resources from the people who really need it: the truly ill. And the NIMH, by renouncing current psychiatric systems without having any promising alternative—it must be going after the Obama research dollars that have been suggested to Congress for brain mapping—is disparaging current psychiatric care. I think it's dangerous and harmful to patients who may lose faith, stop their medicine, and get really sick. We have to get back to treating patients. We can't wait for brain-mapping and the future, because the brain is the most complicated thing in the universe, and it reveals its secrets very slowly. There are going to be no breakthrough answers. MJ: So what do we do with DSM-5? AF: You don't buy it. You don't use it. You don't teach it. There's nothing official about it. "It's important that the diagnostic system be taken away from the American Psychiatric Association. It needs to be in safer hands." MJ: But how can you roll it back to the DSM-IV?AF: I don't think DSM-IV is perfect. I'm actually not the slightest bit proud of it. At the time, we thought we had done a pretty good job of containing diagnostic inflation, but subsequent events proved that we didn't. Three years after the publication of DSM-IV, the drug companies wangled Washington for the right to advertise to consumers. We're the only country in the world that allows that aside from New Zealand. And so they've been given this tremendous power to influence the rhetoric and actually to Shanghai psychiatric care. I think the answer at this point is that everyone should be well informed. Nobody should lose faith in psychiatric treatment, because it's been shown to be very effective for the people who need it. If you're a patient, you should know a lot and ask lots of questions and make sure you get sensible answers. No one should ever accept a diagnosis or a medication after a seven-minute session. It's better to watch and wait, unless the problem is really severe. MJ: Do you think we can expect any further backlash against diagnostic inflation? AF: It's a David and Goliath issue. However, the DSM-5, the NIMH response to it, and the fact that pharma has so far overshot—if 20 percent of teenage boys get a diagnosis of ADD and 10 percent are on medication! The top-selling drugs in the country are antipsychotics and antidepressants and stimulants. We're spending a fortune on treating kids who don't have ADD with drugs rather than taking care of the schools. I think the best hope is the example of tobacco. They were all-powerful 25 years ago and they've been trimmed down to size. It's important that the diagnostic system be taken away from the American Psychiatric Association. It needs to be in safer hands—something like an FDA equivalent—because new diagnoses can be as dangerous as new drugs. And pharma should not be allowed to advertise, just as tobacco isn't allowed to advertise. There's also a huge problem in the insurance industry: A doctor doesn't get paid unless he makes a diagnosis on the first visit. Doctors should be paid for five sessions of evaluation. That would be much better for patients and much cheaper in the long run, because once you get a diagnosis, you may get a lifetime treatment. The 11 Most Harmful Changes in DSM-5 (According to psychiatrist Allen Frances) 1. Disruptive Mood Dysregulation Disorder: DSM-5 turns temper tantrums into a mental disorder—a puzzling decision based on the work of only one research group. 2. Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one. 3. The forgetfulness of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. 4. DSM-5 will likely trigger a fad of Adult Attention Deficit Disorder, contributing to the already large illegal secondary market in diverted prescription drugs. 5. Excessive eating 12 times in three months is no longer just a manifestation of gluttony. Now it's a psychiatric illness called Binge Eating Disorder. 6. Changes in the definition of autism will result in lowered rates—10 percent according to estimates by the DSM-5 work group, perhaps 50 percent according to outside research groups. This may be seen as beneficial, but advocates fear a disruption in needed school services. 7. First-time substance abusers will be lumped in by definition with hardcore addicts, despite their very different treatment needs. 8. DSM-5 creates a slippery slope by introducing the concept of behavioral addictions that eventually can spread to make a mental disorder of everything we like to do a lot. 9. DSM-5 obscures the already fuzzy boundary between Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new "patients." 10. DSM-5 opens the gate further to the existing problem of misdiagnosis of PTSD in forensic settings. 11. Somatic Symptom Disorder makes worrying about your medical illness a psychiatric problem. It would affect 25 percent of chronic pain patients and 15 percent of cancer patients, who may be stigmatized as a result. The first 10 items are excerpted from a list Frances put together previously for Psychology Today. http://www.motherjones.com/politics/2013/05/psychiatry-allen-frances-saving-normal-dsm-5-controversy Penn and Teller on vaccines (naughty language alert) http://www.youtube.com/watch?v=b0IvM8c-Pew See More

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