Last week after writing about the DSM-V “Temper Dysregulation Disorder with Dysphoria,” I received several emails asking my opinion regarding the proposed merger of autism and Asperger’s disorder into a single ’spectrum’ category.  This change has clearly generated some significant political debate in the media and the blogosphere, with some in favor of the change (see for example Dr. Roy Ginker’s NYT article), while others have expressed reservations about the potential impact that this change may have in the autism and Asperger’s community. So I wanted to keep my contribution to this discussion somewhat removed from the political/social issues associated with the change, and instead focus on the scientific/clinical basis for this specific move.  Thus, my aim with this post is not to take a position for or against the proposed DSM-V changes. Instead, I simply want to provide some background information about some of the research data and clinical issues that may have contributed to the DSM-V committee’s decision to propose the merger of all ASDs into a single category. Read More…

Today the American Psychiatric Association released a draft of the major changes that are expected in the new version of the Diagnostic and Statistical Manual of Mental Disorder – 5th Edition (DSM-V). While most people in the field will be underwhelmed by the relatively minor changes,  there are a few areas where the DSM-V will likely make some drastic changes.  Today most of the news coverage was focused on the proposed changes to the Autism diagnosis, which has raised some heated debate in the autism community. However, there is another major change that has received little, if any, attention: the clarification that a syndrome that in recent years has been labeled childhood bipolar disorder is actually NOT bipolar disorder. Instead, a new disorder category was created: Temper Dysregulation Disorder with Dysphoria (TDD). Read More…

In our neuropsychology practice we see a large number of children with special health care needs (i.e., medical conditions) as well as children with neurodevelopmental or psychiatric conditions (autism, language impaiments, ADHD). Although the main goal of these evaluations is to identify their patterns of cognitive strengths and weaknesses to guide intervention, we always evaluate the current mental health functioning of these children. We do this because we often see that these children have high levels of anxiety and depression, which many times go unnoticed.  Although this is a very common clinical observation, and many studies have shown that specific chronic physical or developmental conditions are associated with internalizing mental health symptoms (depression and anxiety), less is know about the prevalence of mental health symptoms in this population and the factors that increase the risk for experiencing or developing internalizing symptoms. Read More…

Do you remember the Mozart Effect? In the 1990s a small yet very influential study showed that listening to classical music, and in particular Mozart, improved test performance in college students -thus Mozart must make you smarter! The public reacted and an entire industry was born. Parents rushed to the stores to purchase Mozart CDs so they could play it to their unborn children (hopefully not Mozart’s Requiem – which, although is one of my favorite works of all time, it is bound to traumatize anyone under 14). Even the State of Georgia passed a law requiring the free distribution of CDs to new mothers! The Governor at the time was widely quoted saying:

As you know, the brain has two lobes. The studies show that music engages both hemispheres of the brain — its creativity and emotion engage the right lobe, while rhythm and pitch engage the left. So people who receive musical exposure at a young age develop a bundle of nerves that connects those two halves* Read More…

In an article soon to be published in the Journal of Child Psychology and Psychiatry I, with a colleague at the University of Pittsburgh, discuss the need for a new approach to the development of early therapeutic interventions for child depression, as current interventions are, sadly, barely effective (see this article for a more extensive discussion on the efficacy of child depression treatments). Our basic argument is that most current interventions are not designed to address the underlying processes and pathways that lead to the emergence of depression in childhood. This is partially due to a disconnect between what we know about the development of child depression (basic science) and how clinicians are trained to diagnosed and work with these conditions.  So I was not surprised, although I was excited, when I read a new article in the same journal that discussed the need for the development of new early interventions for the treatment of ADHD. In this article, the authors use many of the same arguments we use to advocate for new child depression treatments. I was excited because this is a reflection of the ongoing changes in our entire field that advocate for 1) a reconceptualization of ‘disorder’ and its onset, and 2) more ‘translational science’ or the translation of basic scientific discoveries into clinical and practical applications. Read More…