Running Head: ADDENDUM TO BEAUCHAINE HINSHAW (2nded.)1

Addendum to Beauchaine and Hinshaw, second edition
(Companion to Table 2.1)

Theodore P. Beauchaine, 2013.

In May of 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), following months and in some cases years of speculation regarding likely changes to numerous DSM-IV-TRdiagnostic categories and classes, including several child/adolescent and lifespan developmental disorders. The second edition of Child and Adolescent Psychopathology (Beauchaine & Hinshaw, 2013) was published four months prior to the revised DSM. In Chapter 2, “Developmental Psychopathology and the Diagnostic and Statistical Manual of Mental Disorders” (Beauchaine, Klein, Erickson, & Norris, 2013), we included Table 2.1 (pp. 43-100),which outlines projected changes to DSM-IV-TR disorders of childhood and adolescence, as specified in documents that were available on the DSM-5 website at the time (APA, 2010a, 2010b, 2010c, 2010d, 2010e, 2012a, 2012b, 2012c).

The final manuscript of Child and Adolescent Psychopathology, second edition, was completed almost a year before publication of the DSM-5, and most chapters were finalized several months before that. Thus, even though chapter authors (and we as editors) were using the best information available at the time, a number of anticipated changes to the DSM-5 did not materialize. We are writing this addendum to correct inconsistencies between projected changes to the DSM-5 that were listed in Table 2.1, and actual changes to the final version of the DSM-5.

Before we begin, however, we remind readers that in editing Child and Adolescent Psychopathology, one of our primary objectives was to take a strong developmental psychopathology approach. As articulated in Chapter 1, “Developmental Psychopathology as a Scientific Discipline” (Hinshaw, 2013), we therefore encourage readers to view most forms of mental illness from atransactional perspective in which individual-level vulnerabilities (e.g., heritable impulsivity, trait anxiety) interact with contextual risk factors (e.g., neighborhood violence, trauma exposure) across time to shape behavioral and emotional adjustment. Thus, although we believe it is important for students and professionals to be well-versed in the prevailing diagnostic system, it is equally important to be aware of limitations to that system. As outlined in Chapter 2, almost no DSM-derived diagnoses specify neurobiological vulnerabilities to psychopathology, and very few specify environmental risk factors that potentiate vulnerability. In this sense, developmental psychopathology as a discipline aligns more closely with recent efforts at the National Institute of Mental Health (NIMH, 2012) to develop a dimensional system of classifying psychopathology (i.e., the Research Domain Criteria [RDoC]), which is based on both neurobiological processes and observable behavior. Thus, in writing this addendum, we are not explicitly endorsing the DSMapproach. Rather, both Table 2.1 of Child and Adolescent Psychopathology and this addendum are largely agnostic vis-à-vis the validity of specific DSM-5 disorders. Such questionsare best answered on a disorder-by-disorder basis (see e.g., Beauchaine, 2013). With the exception of personality disorders, which deserve special comment (see below), we do not have space to address such questions in this addendum. Rather, we refer readers to individual chapters.

With these caveats in mind, we first describetwo broad structural changes to the DSM-IV-TRthat were listed as likely in Child and Adolescent Psychopathology, second edition, but were notimplemented in the DSM-5. Second, we outline specific changes to DSM-IV-TRdisorders that we either did not anticipate in Table 2.1, orwere listed as likely in Table 2.1, but were ultimately not included in the revised DSM.

Proposed Structural Changes that were not Implemented

Prior to publication of the DSM-5, there was much speculation about probable changes to the DSM-IVmultiaxial system of diagnosis. As outlined on p. 42 of Beauchaine and Hinshaw (2013), this speculation followed from indications from the APA that DSM-IV-TR Axes I (clinical disorders), II (developmental and personality disorders), and III (general medical conditions)would be subsumed into Axis I of the DSM-5; that Axis IV of the DSM-IV-TR (psychosocial and environmental problems) would become Axis II of the DSM-5; and that Axis V of the DSM-IV-TR (global assessment of functioning) would become Axis III of the DSM 5. Instead, the DSM-5 is explicitly nonaxial, even though, when rendering diagnoses, clinicians are encouraged to provide “…separate notations for important psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V)” (APA, 2013; pp. 16). In part, this change follows from the observation that multiaxial diagnosis was often ignored in applied settings. From a developmental psychopathology standpoint, de-emphasizing psychosocial and contextual factors is problematic given the important role environment plays in shaping almost all forms of mental illness—even those with strong genetic underpinnings, as articulated in Chapter 3, “Genetic and Environmental Influences on Behavior” (Beauchaine & Gatzke-Kopp, 2013).

More surprising was the APA’s conservative approach to revising the DSM-IV-TR personality disorders (PDs), especially given recommendations for sweeping changes from the Personality and Personality Disorders Work Group. This conservatism is manifested in several ways. First, despite compelling research evidence indicating that PDs can be diagnosed reliably in adolescence, and that developmental precursors to several adult PDs exist, the DSM-5 retains wording that largely excludes diagnosis of PDs among those under age 18. Second, the DSM-5 retains all ten DSM-IV-TR PDs, even though preliminary indications suggested that four (paranoid, schizoid, histrionic, dependent) would be dropped in favor of a hybrid approach to assessment/diagnosis that included six specific PDs (obsessive-compulsive, narcissistic, schizotypal, avoidant, antisocial, borderline) and six trait dimensions (e.g., negative affectivity, disinhibition, psychoticism; see Beauchaine & Hinshaw, p. 42). Finally, the DSM-5 retains the longstanding distinction between Clusters A, B, and C, despite extremely little empirical evidence for their validity (see Beauchaine, Klein, Crowell, Derbidge, & Gatzke-Kopp, 2009). Although proposed changes that were offered by the DSM-5 Personality and Personality Disorders Work Group appear in Section III of the manual (emerging measures and models), it is not at all clear that they will be used in practice.
Revisions to Table 2.1

The following table provides revisions to Table 2.1 (pp. 43-100) of Beauchaine and Hinshaw (2013). For sections of Table 2.1 that are accurate as written, we simply state such. Inaccuracies are summarized in the right column.

Running Head: ADDENDUM TO BEAUCHAINE HINSHAW (2nded.)1

Addendum to Table 2.1
Inconsistencies between Projected and Actual Changes to the DSM-5
Disorder and relevant chapter / Description
Attention/deficit hyperactivity disorder
(Chapter 12) / Table 2.1 is largely accurate, with the following exceptions:
  1. Several of the specific criteria for both inattention (criteria 1a-1i) and hyperactivity/impulsivity (criteria 2a-2i) are worded slightly differently, although the meaning of each is the same.
  2. Hyperactivity/impulsivity criteria 2j-2m, as listed in Table 2.1, do not appear in the DSM-5. These criteria were intended to capture hyperactivity/impulsivity across the lifespan (e.g., suddenly quitting a job, speeding while driving, etc.). Although these were dropped, more explicit exemplars of both child and adult manifestations of hyperactivity/impulsivity were added to criteria 2a-2i, as described in Table 2.1.
  3. Table 2.1 stated that only four symptoms of inattention would be required for an adolescent or adult diagnosis of ADHD (as opposed to six for children). In the DSM-5, this was changed to five symptoms for an adolescent or adult diagnosis.
  4. Table 2.1 stated that only four symptoms of hyperactivity/impulsivity would be required for an adolescent or adult diagnosis of ADHD (as opposed to six for children). In the DSM-5, this was changed to five symptoms for an adolescent or adult diagnosis.
  5. Table 2.1 lists a number of options for subtyping (pp. 50-51) that were being considered by the ADHD and Disruptive Behavior Disorders Workgroup. DSM-5 diagnoses will include “presentations” (combined, predominantly inattentive, predominantly hyperactive/impulsive) rather than subtypes, as described on p. 50 of Table 2.1.

Conduct disorder
(Chapter 13) / Table 2.1 is accurate.
Oppositional defiant disorder
(Chapter 13) / Table 2.1 is largely accurate, with the following exceptions:
  1. The eight criteria for ODD are divided in the DSM-5 unto angry/irritable mood, argumentative/defiant behavior, and vindictiveness subcategories, which was not reflected in Table 2.1. A diagnosis of ODD can be made based on four symptoms from any of the three categories. This is not a change from the DSM-IV-TR.
  2. Persistency and frequency requirements were added to the DSM-5. These are listed as “under consideration” (p. 56) in Table 2.1.
  3. The exclusionary criterion for CD was removed. This is listed as a “recommendation” (p. 57) in Table 2.1.

Intermittent explosive disorder
(Chapter 13) / As noted Table 2.1, IED was added to the DSM-5. Proposals for IED criteria were unavailable when we wrote Table 2.1. A diagnosis of IED requires repeated outbursts of verbal aggression and/or property destruction among those who are at least six years of age. The pattern of behaviors described by IED may portend later CD and other impulse control disorders (APA, 2013). Readers are referred to the DSM-5 for more information.
Dyssocial personality disorder
(Chapter 14) / Dyssocial personality disorder was proposed by the DSM-5 Personality and Personality Disorders Work Group as a replacement for DSM-IV-TR antisocial personality disorder. The proposal was abandoned and antisocial personality disorder was carried forward to the DSM-5 with no changes. Pages 58-61 of Table 2.1 should therefore be ignored.
Substance use disorder
(Chapter 15) / As outlined in Table 2.1, the DSM-IV-TR distinction between substance abuse and substance dependence was abandoned in the DSM-5. However, no over-arching SUD diagnosis was added, as the text on pp. 62-65 implies. Rather, SUDsare rendered on a substance-by-substance basis (e.g., alcohol, cannabis, opioids, stimulants, etc.), with specific diagnoses for each substance based on (1) particular disorder manifestation, (2) intoxication symptoms, and (3) the characteristic withdrawal syndrome. For example, alcohol-related disorders include alcohol use disorder, alcohol intoxication, and alcohol withdrawal. Thus, although the general description of SUDs in Table 2.1 is of heuristic value, readers should refer directly to the DSM-5 for specific criteria for the 51 substance-related disorders.
Separation anxiety disorder
(Chapter 16) / Table 2.1 is accurate.
Agoraphobia
(Chapter 16) / Table 2.1 is accurate, although the wording of criteria A1-A5 differ slightly, as does their ordering.
Specific phobia
(Chapter 16) / Table 2.1 is accurate.
Social anxiety disorder
(Chapter 16) / Table 2.1 is accurate.
Generalized anxiety disorder
(Chapter 16) / The following inaccuracies appear in Table 2.1:
  1. The wording of Criterion A was maintained from the DSM-IV-TR (see Column 3) and was therefore not changed (see Column 4).
  2. The wording of Criterion C was maintained from the DSM-IV-TR (see Column 3) and was therefore not changed (see Column 4).
  3. Criterion E from the DSM-IV-TR was retained in the DSM-5, but is now Criterion D due to reordering.

Obsessive compulsive disorder
(Chapter 16) / Table 2.1 is accurate.
Posttraumatic stress disorder
(Chapter 16) / Table 2.1 is accurate
Posttraumatic stress disorder in preschool children
(Chapter 16) / Table 2.1 is largely accurate, with the following exceptions:
  1. The official category is posttraumatic stress disorder for children 6 years and younger in the DSM-5, not posttraumatic stress disorder in preschool children, as listed in Table 2.1.
  2. The age criterion is 6 years and younger, not “less than 6 years old” (p. 77).
  3. The general wording of Criterion B, and several specific criteria, differ slightly, although the meaning is the same.

Acute stress disorder
(Chapter 16) / The following inaccuracies appear in Table 2.1:
  1. The general wording of Criterion A, and several specific criteria, differs slightly, although the meaning is the same.
  2. Although Criterion B symptoms listed in Table 2.1 are correct, they were subdivided into intrusion symptoms (4), negative mood (1), dissociative symptoms (2), avoidance symptoms (2), and arousal symptoms (5) in the DSM-5.

Disruptive mood dysregulation disorder
(Chapter 17) / As noted Table 2.1, DMDD was added to the DSM-5 in part to deal with over-diagnosis of bipolar disorder in pediatric populations. The following inaccuracies appear in Table 2.1:
  1. The DSM-5outlines 11 criteria/symptoms (A-K) for DMDD, rather than the three criteria (A-C) and 5 specific symptoms listed in Table 2.1. Nevertheless, all of the criteria listed in Table 2.1 appear in the DSM-5, although not in the same order. Most of the criteria that were added to the DSM-5(after we obtained a preliminary report from the APA website) deal with age of onset, duration, and delimitation—not with specific symptoms. These include (1) presence of symptoms for at least 12 months (Criterion E); presence of symptoms in two of three settings (home, school, peers; Criterion F), restriction of age of onset to between ages 6 years and 18 years (Criterion G), exclusions based on other disorders (e.g., major depressive disorder, autism spectrum disorder, PTSD; Criterion J), and absence of substance-induced symptoms (Criterion K).

Major depressive episode/
major depressive disorder
(Chapter 17) / Table 2.1 is accurate.
Chronic depressive disorder
(persistent depressive disorder)
(Chapter 17) / Table 2.1 is largely accurate, with the following exceptions:
  1. This diagnosis, which replaces DSM-IV-TR dysthymic disorder, is persistent depressive disorder in the DSM-5, not chronic depressive disorder as suggested in Table 2.1.
  2. In Table 2.1 we state that DSM-IV-TR Criterion E (There has never been a manic episode, a mixed episode, or a hypomanic episode, and criteria have never been met for cyclothymic disorder) will be eliminated from the DSM-5. No such change was made.

Mixed anxiety/depression / This proposed diagnostic category was abandoned, so the bottom of p. 87 through p. 88 should be ignored. Instead, an anxious distress specifier can be used with diagnoses of major depressive disorder.
Borderline personality disorder
(Chapter 18) / Although several changes to personality disorder criteria were proposed by the DSM-5 Personality and Personality Disorders Work Group (see above), none of these changes were implemented. Thus, the likely changes to borderline personality disorder criteria listed on pp. 89-92 of Table 2.1 should be ignored.
Nonsuicidal self-injury
(Chapter 18) / NSSI is a new edition to the DSM-5 that is listed under conditions for further study. The following inaccuracies appear in Table 2.1:
  1. Criteria B in Table 2.1 is Criterion C in the DSM-5, with the exception of
  2. Criterion B4 in Table 2.1, which is Criterion B in the DSM-5.
  3. Additional criteria (D-F) were added to the DSM-5, which specify that the behavior is not sanctioned socially (Criterion D), that the behavior causes clinically significant distress or impairment (Criterion E), and that the behavior is not the result of other disorders (Criterion F).

Bipolar I disorder
(Chapter 19) / Table 2.1 is accurate.
Bipolar II disorder
(Chapter 19) / Table 2.1 is accurate.
Autism spectrum disorder
(Chapter 20) / Table 2.1 is accurate.
Schizophrenia
(Chapter 21) / Table 2.1 is accurate.
Anorexia nervosa
(Chapter 22) / Table 2.1 is accurate.
Binge eating disorder
(Chapter 22) / Table 2.1 is accurate.

Running Head: ADDENDUM TO BEAUCHAINE HINSHAW (2nded.)1

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