Wednesday, December 5, 2012

The DSM-V

So the DSM-V (which apparently is now called the DSM-5) reportedly has been finalized.  It is projected to be published in May 2013.  In some ways, I've been wondering what's been going to be in this new book for a long time; in other ways, I couldn't care less.

To be perfectly honest, I'm not sure how much it will affect us.  M1's current diagnoses were made when he was 5, and I haven't felt a compelling need to get him reevaluated since.  Technically his diagnoses are PDD-NOS (pervasive developmental disorder, not otherwise specified), ADHD (attention deficit hyperactive disorder) combined type, and GAD (generalized anxiety disorder).  However, I'm almost 100% sure the anxiety was simply due to the fact that he was in kindergarten at the time and was basically running on 'high' 24/7, and I'm quite sure that if I had him retested now, the PDD-NOS would be a full diagnosis of Asperger's.  Under the new DSM-5, however, it won't matter which of those he has.  They're all lumped together under Autism Spectrum Disorder.  OK, so theoretically this should make it easier for us to get treatment, since insurance companies and clinics will have to plan treatment for all cases equally.  I've heard that some parents are upset that their child who was formerly 'high-functioning autistic' will now be under the same umbrella as a severely autistic child, but honestly, if they're all on the same spectrum, I hardly see that it matters.  The treatment for both is similar and has to be tailored to the individual child regardless of the 'type' of autism.

M2's diagnoses have the potential to change as well.  Right now she has the working diagnoses of mood disorder NOS, GAD, and separation anxiety. The first one has the most potential for change; that, however, was a given when we got the diagnosis.  She has been stable now - more or less - for nearly a year, and sometimes I wonder if perhaps all her depression and manic actions were just a phase that she was going through.  Still, it's entirely likely that they will recur at some point, because I can also be stable for years before again flinging myself off the deep end.  I hope she isn't like me, but if she is, then I suspect any new diagnoses would fall under the new DSM category of 'disruptive mood dysregulation disorder.'  That fits her manic/depressive phases to a T.  But we shall see.  Again, I suspect treatment for that would be similar to that of her current diagnosis, so what does it matter?  What's in a name, anyway?

The one new thing that really caught my eye, though, is something I haven't touched on here, largely because it has only been a recurrent issue, not a constant one.  Lately, though, it's reared its ugly head again, and I want to share it with you, not to embarrass my son (though no doubt it would) but simply to raise awareness of an issue that I find many families struggle with, especially families with socially impaired or ADHD children (primarily boys).  It's to be called Internet use gaming disorder.  In short, electronics addiction.  M1 struggles with this and always has.  It's hard to use the word 'addiction' when talking about a 10-year-old boy, but what else does one have to consider when catching your son with stolen electronics under his sheets at 12:30 a.m.?  I struggle with whether this is really a diagnosis or simply another symptom of his Asperger's or ADHD, but I suspect that if I brought it to the attention of doctors after the DSM-5 is published, it's a diagnosis that would be added to his list.

Some people would say that I simply haven't parented him right.  Either I've been too strict with electronics and he's begging for more freedom, or I've been too lax and just need to make more rules.  Before we go further, let me tell you how electronics time works in our house. (I'm aware that these folks just need to go take a long walk off a short pier into a bayou full of hungry alligators, but I'm laying it all on the table today, so bear with me.)

Rule #1:  No more than an hour or two of screen time per day.  Some days we have no screen time; other days he gets the full complement.  It varies. 
Rule #2:  All chores must be completed before screen time occurs.  'Nuff said there, I think.
Rule #3:  When screen time is up, you must turn off the device within 5 minutes.  I had to implement this rule when 'I have to save/get back home/finish this episode' turned into another 30 minutes of screen time.

On the computers, we have passwords, and the content is more or less controlled.  On the TV upstairs, we have parental controls locked down for content and time.  When they're borrowing an iPad, they have to stay where we can see or hear what they're playing.  In other words, we're hardly lax parents, but usually when they ask for screen time, if chores are done, they get it.  And yet, if you ask M1, we're tyrants.  We never let him have as much screen time as he wants.  When he does get screen time, he begs for more.  He gets angry when you make him turn things off.  He gets very upset if you don't say yes to his demands right away.  If he's been promised electronics 'later,' you won't hear anything else until he gets that time... and if we're out somewhere, the instant we hit the door, it's, "Can I have my electronics time now??"  If the electronics are in his room, he will be found on them at 12, 1, and 2 a.m. with great regularity.  If I take them away, he steals them back - or, once and very memorably - steals his sister's electronics just to get his 'fix.'  In many ways, his electronics obsession sounds like an addiction.

Unlike an addiction, however, I can't take away all electronics.  I can keep them out of his room, yes, but he's going to need computers to do school work, to send e-mails, and to do research.  He's going to have a phone to make phone calls and send texts - and probably play games - when he gets older.  He will no doubt use computers daily in whatever job he has as an adult.  This isn't like alcohol or drugs, which one can avoid simply by avoiding the atmosphere and/or the product itself.  It isn't like gambling, which can be avoided with more difficulty but with a large degree of success.  This is why I suspect that this diagnosis in the DSM-5 is simply a symptom of an underlying disorder, not a disorder in its own right.  But I'm not the powers that be, and I don't get to make that decision.  I can, however, keep an eye on him and decide if he needs special treatment for it.  For now, like I said, I keep electronics out of his room and make sure he uses them under special circumstances only.  If he gets older and the usage gets more disruptive and I'm no longer able to help (as teens rarely want to listen to their parents), there may be external help available for him, and maybe some books will be written on the topic in the next few years.  I might not approve of the diagnosis as such, but it's kind of nice to know that it'll be there to fall back on if we have to.

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