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Allen Frances: Newsflash from APA Meeting: DSM-5 Has Flunked Its Reliability Tests

May 08

Frances is miffed because HE WORKED ON THE DSM IV that supposedly caused the “epidemic” of autism in the first place.

Now the DSM 5 will erase all he’d done for humanity. I wrote about Frances for AoA last year. (below)

Lost in all of this is any recognition of the fact that we’re losing a generation of children to autism.

I didn’t even bother to post a comment. This guy is such a Nero that he can’t even feel the flames licking at him.

Newsflash from APA Meeting: DSM-5 Has Flunked Its Reliability Tests HERE

The whole purpose of having a manual of psychiatric diagnosis is to promote diagnostic agreement. The great value to the field of DSM-III was that it established reliability and preserved the credibility of psychiatry at a time when it was becoming irrelevant because it seemed that psychiatrists could not agree on diagnoses. Everyone knew that the reliability achieved in DSM field testing far exceeds what is possible in clinical practice, but DSM-III took the major step of proving that reliability could be achieved at all. Until now the DSMs have facilitated communication across the clinical/research interface, promoted research, and provided credibility in the court room.

But bad news was recently reported from the annual meeting of the American Psychiatric Association in Philadelphia. The hard-won credibility of psychiatric diagnosis is compromised by the abysmal results reported by the DSM-5 field trials. This failure was clearly predictable from the start:

The writing of the DSM-5 criteria sets was far too raw and imprecise to be ready for the rigors of field testing. The ambiguity cried out for expert editing, without which reasonable reliability is impossible.

The design of the field trial was byzantine in complexity and could never be done on schedule.

Constant delays in starting and completing Stage 1 of the study forced DSM-5 to cancel the planned Stage 2, which was meant to clean up the poorly performing criteria sets identified in the first stage.

With Stage 2 cancelled without explanation, it looks like even the worst diagnoses are being given a social pass.

Most absurdly, the design was totally off-point, failing to ask the only question that really counted: the impact of DSM-5 on rates.

 

2011: AOA—Allen Frances, Thomas Insel and the Black & White Rise of Autism (It’s Fashionable?)  HERE

Recently a story also appeared in the Gulf Times, Qatar’s only English language newspaper, titled, The real reasons for the autism ‘epidemic.’

It was written by Allen Frances, MD. Frances was chair of the DSM-IV Task Force and he’s with the department of psychiatry at Duke University School of Medicine in Durham, NC.

DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, and while many of us wonder why our children’s neurological problem, namely autism, is in a manual about mental illness, that’s where the criteria for diagnosing autism is found.

Frances was in charge of the DSM 4 that came out in 1994. This is important because that’s when the diagnosis of Asperger’s Syndrome was officially added as a form of autism. In his Qatar piece, Frances went into great detail about why he’s not worried about all the children everywhere with autism. There is no epidemic. We’ve just expanded the definition of autism so much that many more people now qualify. He’s convinced that adding Asperger’s in 1994 is the reason the current autism rate is one in 110 and he’s sure that when the DSM 5 comes out in May 2013, the autism rate will soar even higher—because they’re going to drop Asperger’s as a separate category. If that really doesn’t make sense to you, I’m sure you’re not alone. All that’s clear to me is that if they keep playing with the definition of autism, the term itself will lose all meaning. The spectrum will include so many atypical behaviors that on a bad day, anyone could be labeled “autistic.”

Frances wrote, “Not long ago, autism was among the rarest of disorders, afflicting only one child in every 2,000-5,000. This changed dramatically with the publication in 1994 of DSM IV (the manual of psychiatric diagnosis widely used around the world). Soon, rates exploded to about 1 per 100.”

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