• My practice is doing just fine, and many of the new diagnostic codes – completely lacking in common sense – are worthless to me. This DSM in particular lacks any discernible value for me and most certainly does not improve my position from an assessment or diagnostic standpoint, and won’t help me with the insurance companies.
• Our National Institute of Mental Health doesn’t support it nor do segments of the international community for fear that it will have an amoeba-like effect on diagnosis in countries that don’t use the DSM as a diagnostic guide.
• Frankly, I’m offended by much of the new criteria inclusion. Will anybody be considered normal anymore? Are we now just a veritable culture of psychiatrically sick people? Delve into this manual enough and you’ll find something wrong with you when, in truth, you’re just fine.
• Reacting to the rhythms of life’s ups and downs illogically and irrationally from time to time doesn’t render you sick, it makes you human.
• DSM-5 field trials demonstrated poor reliabilities and the APA refused to endorse any independent review challenges. Who do these people think they are? They’re not grand, high, exalted, mystic rulers! All of us, and our work, should be subject to evaluation. If not, how are we to know what’s working and what isn’t? This is classic close-minded arrogance.
• This manual will fuel the fire for giving psychiatry a bad rap. Psychiatry can be very successful when it sticks to what it does best – assessing and treating symptom-based mental illness – not “sickifying” (word I made up) ordinarily healthy people in an inadvisable way.
• The cultural bar for meeting criteria for a psychiatric diagnosis may now be irrevocably lowered. People with bona fide psychiatric illness are already badly shortchanged due to our severely fractured mental health system. DSM-5 will be a contributor to directing scarce resources away from the very ill, and instead toward people simply mislabeled as mentally ill.

Maybe some good can come out of all of this. Perhaps the swell of concern about this DSM edition will serve as a catalyst for finally having serious, well-intentioned discussions about how to address overdiagnosis and overmedicalization. And just maybe the well-respected NIMH and CDC will launch a series of public service ads and announcements cautioning clinicians about the possible perils of diagnostic exuberance and warning parents not to willingly accept any diagnosis for which a clinician cannot provide a clear rationale.

The number of methodologies, technologies and treatment plans through which expertise is delivered is as long as the longest arm; and I’ve found – through years of trial and error – that the more convoluted and complicated the strategy, the more it dilutes my expertise. Why? Because sounding smart, intelligent and academic doesn’t necessarily translate into value for the client. These factors contribute to my feeling competent, but it’s not about me.

I focus primarily on having a conversation with the client in each session. I want them to relate to me and to be as relaxed as possible in my presence. Accomplishing this puts me in a better position to focus on objectives and outcomes with me serving as their navigational system, their GPS, so to speak.

Then, with our collective eye on the goal we’ve established, I’ll help them determine the shortest route possible to that end. And if I need electron microscopes or high-powered telescopes to get there, my true expertise will be realized – if and only if – the client readily and easily understands their purpose and how they will help.

The Center for Disease Control and Prevention (CDC) is reporting that nearly one in five high school age boys (20%) in the U.S. and 11% of school-age children overall, have received a diagnosis of ADHD. Two-thirds of those with a current diagnosis receive prescription stimulants. And even more adolescents will likely be prescribed medication because the American Psychiatric Association has plans to change the new onset diagnostic age requirement such that symptoms appear before age 12 rather than age 7.

I find this push to pathologize kids’ behavior preposterous. And these lame arguments that rising diagnostic rates are evidence of better recognition are laughable. Given the above stats, it is undeniable that some doctors are viewing even minor symptoms of distraction or inattentiveness as full-criteria ADHD. At the same time, pharmaceutical companies are crafting advertisements and commercials glamorizing how medication can substantially improve a child’s life. Such ads play to parents’ fears by showing children struggling in school or abandoned by peers. Moreover, parents who can’t, won’t, or don’t know how to parent – and are badly in need of such training – are pressuring prescribers for drugs to simply make their lives easier.

To be fair, psychostimulants prescribed to children who meet the right symptom set can make a world of positive difference. And this is where the focus should be – making life a bit less hard for affected kids. It’s about the children, not the other players.

Slipshod diagnosis = inappropriate prescribing of potentially dangerous stimulants = increased drug diversion = greater opportunity for misuse or abuse.

Stimulants should not be used as mental steroids to serve as motivators, nor should they be used as a shortcut to better grades or to give to friends. When the diagnosis is handed out without proper assessment and accompanied by prescriptions for stimulants, the user becomes the loser, and we know who that is – the child.

I like this product and believe that it will serve its users well for these reasons:

1. There are a goodly number of people who have trouble swallowing pills and capsules. This formulation will be particularly helpful to younger children who fear swallowing solid preparations and elderly individuals with swallowing difficulties.
2. This drug will be useful to those in need of dosage “fine tuning.” Quillivant XR doesn’t involve the opening capsules and sprinkling of contents on food or placing it in other liquids – making dosage titration much easier and streamlined.
3. Quillivant XR’s delivery system is exactly the same as with other XR products such as Concerta. The active ingredient is “pulsed” into the bloodstream at select intervals throughout the day, providing eight hour symptom coverage.

Quillivant XR was the only new, novel psychotropic medication release in 2012. The wheels of progress in Psychopharmacology have turned very slowly over the past few years.

Once you’re organized, your personal control grows – this in turn, enhances your personal power (flexibility, versatility, influence, and so on); more power leads to more success – which enriches your self-esteem.

It’s no more complicated than this. So… get organized mentally and physically, and cease telling yourself and others that you’re “overwhelmed,” or have “writer’s block,” or feel “lost.” All of this is negative nonsense and you deserve better.

By organizing your life and thereby gaining the control you desire, you’ll extricate yourself from the “doom and gloom loop” and propel yourself into the “success loop.”

Next, consider possible physical causes. Is sleep apnea a problem; how about restless legs? Pain? Then, are you taking any medications that may be keeping you awake? Remember, caffeine is a drug and the nasal decongestant you may be taking for a sinus or allergy condition often contains drug components that promote wakefulness.

When contemplating a sleep aid for the management of insomnia, the most important issues to consider are (1) what do you want the drug to do and (2) for how long. Insomnia is often transient and may improve within a matter of days. For example, if you’ve experienced a recent loss, you may want to consider an over-the counter agent that will help you manage your difficulty sleeping for only a few days. Benadryl or melatonin may very well be sufficient. If, on the other hand, your sleep difficulties are chronic, ruling out the aforementioned possible medical causes in consultation with your primary care physician is imperative.

If the decision is for you to try a prescription sleep aid, you need to know: drugs such as Ambien or Lunesta will typically help you get to sleep; they have a poor track record however, at keeping you asleep. And then there’s the issue of how long you intend to take them. Tolerance develops, meaning you eventually may need to take more to obtain the desired results, creating a cycle of dependence.

Whether insomnia emanates from what’s going on in your head or what’s happening within your body, there will be limitations to what any drug can do for you.

If you’re able, the most efficacious remedies are behavioral, brisk walking and yoga are a couple of excellent choices. Both help improve body and mind, which is as good as it gets when it comes to better sleep.

For example, yellow pills tend to make the most effective antidepressants – like doses of drug-induced sunshine! Green tablets or capsules reduce anxiety – looking out over a plush landscape is soothing, and the dominant verdant color scheme is obvious to us all. And red tablets are associated with a stimulating “kick” and “charged-up” sensation.

The placebo response couldn’t care less whether or not the impetus for someone’s improvement is due to the therapeutic effect of a drug. All it requires is someone with a reasonable expectation of getting better. I’d call that powerful medicine!

For more information, or to purchase a copy, click here.

1. Whenever possible, observe the child in multiple milieu. Children may behave different in social situations when compared to their actions in school or at home.
2. Obtain input from collateral sources (teacher, coach, child care provider) to help confirm what you observe. Assessing and evaluating children appropriately is a team effort.
3. Conduct extensive interviews with the affected child and at least one parent. Children respond to cues and exercises, which although important, may not be enough to confirm your findings. Responsible parents are your de-facto specialists as they observe, interact and listen to the child every day.
4. Do a thorough review of the child’s medical history. Undiagnosed medical disorders may be driving the undesirable behaviors exhibited by some children. Think ruling out medical issues first in general, but particularly do so when the child’s behavior is violating the rights of others or accepted social norms.
5. Obtain a thorough family history of psychiatric disorder. Co-occurring conditions are the rule rather than the exception when assessing children, so genetic predisposition issues can potentially be a major ally for you.