以琳自闭症论坛

标题: 对 DSM-5 出来以后的猜想 [打印本页]

作者: lixiaomeng 时间: 2012-12-21 13:42
标题: 对 DSM-5 出来以后的猜想
AS + some HFA(pdd-nos) =>

1. social communication disorder
2. intellectual disability
3. ASD level 1
4. diagnostic mix of social, attention, and executive functioning symptoms

AS 和 HFA 作为社会概念将依然存在。

作者: lixiaomeng 时间: 2012-12-21 13:43
标题: Ending Fear Over the New Autism Diagnosis
A few weeks ago, a study was published that I hope will dispel the fears of parents and caregivers of children and adults with autism spectrum disorders (ASD) who have been worried about proposed changes in diagnoses. As a clinician who has seen families and people with ASD almost every day of my life for more than 30 years, and as a member of the Neurodevelopmental Disorders Work Group for the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it has been heartbreaking to hear how frightened families were by the proposed changes. So I was glad that we had data to actually test whether their concerns are well-founded. Nevertheless, it has been striking how little the mainstream press has been interested in the new findings compared to the front page headlines about the problematic study that raised the fears.

Our recognition of ASDs has improved in the past decades, but we are still using a diagnostic system from the American Psychiatric Association's 1994 revision, DSM-IV. It divided what were called pervasive developmental disorders (PDDs) into subcategories including autism, Asperger Disorder and a fallback category, PDD-NOS (not otherwise specified). PDD-NOS was intended to capture the small number of children who almost met criteria for autism, but instead it became a very common diagnosis.

In the DSM-5, we propose a new way of looking at these disorders, merging them into a single diagnosis of autism spectrum disorder. We believe this will create more accurate diagnoses and improved access to services. It should also improve research into ASD, because there will be less diagnostic confusion.

Some critics claimed that the changes would decrease the number of diagnoses and leave some families without services. Today, I'm hoping that recent literature reviews and our new analysis of data from more than 4,400 carefully-studied children will get equal attention and put fears to rest.

Diagnosing an ASD is different from diagnosing a tumor or a heart condition. Even though ASD is a neurobiological disorder, there are no biological tests. There is no standard protocol, such as for diabetes, that is covered by insurance and that provides clear directions for treatment across the lifespan. ASD diagnoses are based on behaviors, as witnessed by clinicians and as reported by caregivers. Families arrive at our center afraid that we will not listen to them or "see" their child as he or she is, yet at the same time hoping that we won't see or hear evidence of autism. One of the problems with the DSM-IV system was that families were often given PDD-NOS diagnoses because clinicians did not want to upset caregivers. Parents were relieved by the term PDD-NOS, which avoided the stigma of "autism," and consequently they sometimes did not pursue appropriate treatments, only to discover later that their child had had autism all along. We need ways of representing an individual's strengths and difficulties within ASD, but the DSM-IV subcategories did not work.

Having a name for a diagnosis is important. A mother of a boy with ASD recently described how she designed a T-shirt for their 10-year-old son to wear on a family plane trip that said "AUTISM?" in big letters. Unlike a previous flight, this one went well because other passengers understood why he squealed and put his hands over his ears. It is not surprising that parents might be frightened to learn that the name of their child's diagnosis will be changed.

The fear of losing services for children is also understandable because many parents have had to fight so hard to get this help. Health care and insurance systems often exclude autism from reasonable coverage, and families with a child or adult with ASD live in a complicated world of conflicting information about what treatments are effective. New legislation may rectify aspects of this situation, but there are many loopholes and gaps into which children and adults with ASD can still fall. This situation is not unique to autism, but the complexity of ASD and its severity in terms of frequent lifelong impairments make it stand out.

So, we've tried to be careful in making these changes. My colleagues and I had access to data from several studies for the analysis of more than 4,400 children seen by more than 100 clinicians from across North America. We found that that the DSM-5 criteria did not change the number of children with clinical diagnoses identified as having ASD. And the number of children who did not have ASD who were mistakenly identified as falling within the spectrum dropped significantly. When the diagnosis was based on information provided by a parent and from a clinician's interaction with the child, diagnoses were most accurate.

We are in a time when support for education and health is being questioned every day. Having a single category of ASD improves the chances that services won't be reduced for individuals who need them. Clinicians and families need to work together to be effective. Providing more accurate data about these changes may seem like a small gain, but I hope our study will help us take a larger step in improving diagnosis and decreasing the fears of families who already have to fight for what their children need, often across a lifetime.

作者: lixiaomeng 时间: 2012-12-21 13:45
标题: re:DSM-5 官方内部评估，ASD 减少...
DSM-5 官方内部评估，ASD 减少 10%

外部评估，ASD 减少 50%

综合：减少10% - 50%

[IMG=0,absmiddle]http://specialedpost.com/wp-content/uploads/2012/10/dsm-v-estimates.png[/img]

作者: lixiaomeng 时间: 2012-12-21 13:52
标题: re:What happens to all...
What happens to all those individuals diagnosed with Asperger Syndrome? Will this descriptive label really go away?

None of us know the answer to this question for certain, but my best guess is that Asperger Syndrome as a diagnostic description, even if it is not officially included in the DSM-5, is here to stay. High functioning autism (HFA) has never been an official diagnostic descriptor sanctioned in previous or the current edition of DSM (DSM-IV) yet is a commonly used descriptor not only by us lay people but also by researchers who use it to define their study subjects. Furthermore, Asperger Syndrome is more than a diagnostic label; it has become a cultural identifier for many of our students and adults who recognize themselves as AS and have sought networks of support, friendship and collaboration within it.

作者: lixiaomeng 时间: 2012-12-21 13:53
标题: re:What happens to thos...
What happens to those clients already diagnosed with Asperger Syndrome or any other label that currently is included as part of ASD? Will they need to be diagnosed again?

When I posed this question to one of the DSM-5 committee members the response was that every community will have to figure out how to address this question. State and local systems that serve our clients need to start getting organized NOW to figure out how they will handle this change!

作者: lixiaomeng 时间: 2012-12-21 13:53
标题: re:How will this impact...
How will this impact coverage for private services by insurance companies?

Insurance companies in some states are being mandated to provide services for children with ASD. It is likely that these insurance companies will take a definitive stance in refusing to cover services such as ABA therapy for those who are not “ASD” under the new definition. However, consider that many (not all, but most) clients who don’t fall into the DSM-5 ASD category are less likely to need the ABA model of treatment as they have developed language and need to learn a more complex (synergistic) set of communication skills that are beyond the more linear stair-stepped approach offered by traditional ABA programs.

Many insurance policies will consider covering a student who has mental health needs or social communication needs if the therapist can document the need for services and the benefit from services. However, insurance companies don’t cover anyone enthusiastically and they will try to find reasons (very often, not always) for refusing services. One significant issue with our clients is that insurance is very unlikely to cover our students as they transition into adulthood or live as an adult, as non-ASD neurodevelopmental disorders are not easily covered into adulthood, even though our students are showing great benefit from treatment as they transition and live as adults.

作者: lixiaomeng 时间: 2012-12-21 13:55
标题: re:How might the shift...
How might the shift to Social Communication Disorder change assessment and treatment strategies?

It is my best guess that students diagnosed with Social Communication Disorder (SCD) will be referred to a speech-language pathologist as the first level of services. This is also fairly routine for students with ASD, so this is not all together a “new” idea. However, right now those with higher level ASD often have behaviorists included as an integral part of their treatment plan, often as case managers, and this may not be the case with those diagnosed with SCD. This means that a lot more students will receive SLP referrals with the SLP becoming the primary case manager. Our national and state organizations for SLPs need to get organized NOW and determine how to handle this influx of attention on SLPs as primary treatment providers for students diagnosed with SCD. Currently there are many SLPs who have taken a strong interest in the more complex, subtle yet significant social learning challenges of this population. But there are also many in our field who want little or nothing to do with this type of student.

The SCD diagnostic descriptor identifies individuals with global social communication issues, not just students with challenges in social language. This means our assessment procedures will also need to change to account for nonverbal social pragmatic challenges. Currently most standardized assessments are based on Social Language competency and fail to evaluate how one effectively reads nonverbal cues from the context as well as the body and face of others. We do not presently have standardized tests to assess how one codes his or her own nonverbal behavior. In California, our state Speech and Language Association has not updated the manner through which we can qualify students for speech and language disabilities since before the DSM-IV was written. There is no recognition of a pragmatic social communication sample when standardized tests fall short.

Researchers (Matson, Hattier & Williams, 2012; Matson, Kozlowski, Hattier, Horvitz & Sipes, 2012; Gibbs, Aldridge, Chandler, Witzlsperger & Smith, 2012) are concerned that the algorithm for qualifying for ASD is just too strict and removes people who have serious issues but who may not meet all 5 of the 7 descriptors. Their findings show a significant percentage of people currently diagnosed with ASD will no longer qualify (-47.74%) using the current DSM 5 proposed criterion。

作者: 爱橙子 时间: 2012-12-21 14:55
标题: re:只是名称变了而已，孩子的状况又不会变。这...
只是名称变了而已，孩子的状况又不会变。这个只对国外需要政府财政提供支持的才有关系，跟我们国内的没有关系。美国政府缩小诊断范围，实际上是减少财政对自闭儿童的支持。

作者: lixiaomeng 时间: 2012-12-21 17:15
标题: re:我觉得不完全是如此。因为离开 ASD 的...
我觉得不完全是如此。因为离开 ASD 的孩子，并不是就宣布他们正常，然后没有任何福利支持。现在增加了 SCD 和 interlectual disability 这两个项目。而且，最新的 DSM-5， SCD 还又被分成了两个子项，说明 DSM-5 的 committe 在这方面还是很用心的。Interlectual Disability 会包括传统的 MR，和那些有很轻微智力不足的孩子。可以明显感觉到智力发育有问题，但是又肯定没有严重到智障。其实这一类孩子在国内反正有的时候就 AS 了。

不过说实在的，像盖茨，爱因斯坦，扎克伯格，我个人看，他们就是 NT。

作者: lixiaomeng 时间: 2012-12-24 15:40
标题: A Specialists’ Debate on Autism Has Many Worried Observers
A debate among medical professionals over how to define autism has spilled over into the public domain, stirring anger and fear among many parents and advocates of those with the neurological disorder, even as some argue that the diagnosis has been too loosely applied.

A study reported on Thursday found that proposed revisions to the American Psychiatric Association’s definition would exclude about three-quarters of those now diagnosed with milder forms of autism called Asperger syndrome or “pervasive developmental disorder, not otherwise specified,” also known as P.D.D.-N.O.S. These are people who have difficulties with social interaction but do not share the most severe impairments of children with classic autism.

“He was right on the border, they told me when he got the diagnosis; that’s what scares me,” said Amanda Forman of Flourtown, Pa., whose 5-year-old son was diagnosed two years ago with P.D.D.-N.O.S. After receiving play therapy, occupational therapy and 17 hours a week of behavioral therapy, the boy, who was once unresponsive to other children and engaged in self-destructive behavior, may enter a mainstream kindergarten class next year, his mother said. “What if he has to be re-evaluated? If the criteria were stricter, he might not get these services that have been helping him so much.”

The proposed revisions, which would take effect in 2013, are likely to have practical implications for those who would once have qualified for services that experts say can improve an individual’s abilities to socialize, learn and ultimately live independently. But they have also ignited a broad discussion over the value of a diagnosis for behavior differences, and how to fairly apportion services at a time when resources are shrinking.

The Diagnostic and Statistical Manual, now under revision, is the standard reference for mental disorders, driving research, treatment and insurance decisions. Since 1994, when recognition of Asperger syndrome was first included as an autism-spectrum disorder, diagnosis of the condition has surged.

Over the last decade, the number of 6- to 21-year-olds with autism in public schools has quadrupled, according to the Department of Education. Such students may get private school placement, a classroom aide or curriculum adaptations. In recent years, 29 states have passed laws requiring insurance companies to provide behavioral therapies and other forms of care to people with an autism diagnosis.

“We have to make sure not everybody who is a little odd gets a diagnosis of autism or Asperger disorder,” said Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force making the revisions, which are still subject to change. “It involves a use of treatment resources. It becomes a cost issue.”

But some autism advocates argue that acknowledging the neurological basis for socially odd behaviors has benefits beyond eligibility for services, promoting cultural tolerance and a degree of self-understanding that may be lost without it.

“Having a diagnosis helps people understand why we process thoughts and emotions differently and make positive changes,” said Michael John Carley, director of the Global and Regional Asperger Syndrome Partnership, which urged members to call the psychiatric association to complain. “Sadly, we may be heading back to the days when our differences are seen through the lens of character deficits rather than in the context of brain wiring.”

Even within the medical community, the number of people who would not be eligible for an autism diagnosis under the new criteria is a matter of dispute. Some may fall under a new category, “social and communication disorder,” though it is not clear what kind of aid, if any, they would be eligible for as a result.

Catherine Lord, the director of the Institute for Brain Development at NewYork-Presbyterian Hospital, and a member of the committee overseeing the revisions, said that the goal was to ensure that autism was not used as a “fallback diagnosis” for children whose primary trait might be, for instance, an intellectual disability or aggression.

She said the committee’s own data shows that very few who currently have a diagnosis would be dropped. And another analysis of the effect of the proposed new definition, published this month in The Journal of the American Academy of Child and Adolescent Psychiatry, found that roughly 40 percent of individuals with Asperger syndrome would not be given a diagnosis under the new definition. That study suggested that altering the criteria slightly could recapture most of those who would otherwise be excluded.

Yet some parents of severely autistic children who are nonverbal, and may need constant care to avoid injuring themselves and others, say they would welcome a narrowing of the spectrum.

“Everyone on the spectrum benefits when money and services available are applied more specifically and appropriately to the individual needs of each person affected,” said Mark L. Olson, of Henderson, Nev., whose daughter, 16, does not speak. Mr. Olson has argued on his blog that those with more severe needs have been overshadowed by people with the Asperger diagnosis, who have typical intelligence and language development.

Many comments, on the Web site of The New York Times and elsewhere, expressed the view that autism was overdiagnosed: “Come on, 1 in 100 children today?” one commenter wrote. “This pathology did not exist in the past because we did not label it.”

And even some parents of autistic children noted in the debate this week that a diagnosis can be a double-edged sword.

“With it, a child gets needed services,” wrote one Boston parent, whose son has a language impairment that makes socializing difficult. “The downside is that a child will be perceived by his peers as being abnormal and shunned socially. I noticed a huge change after my son was diagnosed. Once he got the autism label he rarely got birthday party invitations, for instance.”

But like many parents, Ms. Forman, who requested that her maiden name be used to shield her son, said she sought the diagnosis only because her son so badly needed the services it would secure.

“I didn’t know that feeling was so prevalent, that autism is so overdiagnosed,” she said, having read many of the comments on Web sites. “I just know the amount of work I do for him, and that’s not something I would do if I didn’t have to do it.

“It’s not the easy way out for anybody.”

作者: 何子 时间: 2012-12-25 05:20
标题: re:“不过说实在的，像盖茨，爱因斯坦，扎克伯...
“不过说实在的，像盖茨，爱因斯坦，扎克伯格，我个人看，他们就是 NT。”

坦率地说，我很反感拿这些名人说事。他们有诊断吗？

作者: 微微爸 时间: 2012-12-25 08:39
标题: re:牛顿在大门旁边开了两个狗洞（大洞给大狗进...
牛顿在大门旁边开了两个狗洞（大洞给大狗进出，小洞给小狗进出），怎么像有点AS的症状呢

作者: 沉静 时间: 2012-12-25 10:49
标题: re:“不过说实在的，像盖茨，爱因斯坦，扎克伯...
“不过说实在的，像盖茨，爱因斯坦，扎克伯格，我个人看，他们就是 NT。”

盖茨，爱因斯坦，扎克伯格，他们本来就是NT啊。有AS特征的正常人多了去了，我觉得普通人通常也都会有一样两样的，难道都算成AS?A博不是说了，如果AS特征有100个，达到80个以上的才有可能达到诊断资格，还得是核心特征。

作者: thankstoyilin 时间: 2012-12-25 10:54
标题: re:说这些的人都是把NT概念绝对化。我倾向于...
说这些的人都是把NT概念绝对化。我倾向于人的社会性能力、思维、情感、认知能力分布是一个连续集合（continuum），其中在某一个置信区间内的，咱们管他们叫NT，这其中的人怎么可能千人一面呢？！我们称之为typical的这些特质，可以从进化角度来解释，因为作为群居动物，具有这些特质有利于相互支持、获得帮助。同时，我们生活中见过太多社会性能力相对笨拙一些的人，可我们还会有其他的褒奖之词送给他们，比如大智若愚、大巧不工、憨直质朴等等等等。

作者: lixiaomeng 时间: 2012-12-25 16:45
标题: re:关键问题在于, DSM-5 中 AS 就...
关键问题在于, DSM-5 中 AS 就要没有了。 AS 一直是个综合征，发展到后来，可以说已经是社会概念了。 AS 本身就是一系列孩子的综合体。包括社会交往障碍的朋友，一些人把除了肯纳症之外的所有自闭症谱系都称为AS。 AS 到了现在根本没有严格的定义。既然如此，当然是各说各话。 AS 现在还有核心特征吗？我觉得早就没有了。

说实在的，对于一个没有严格定义，每个人心中都有自己看法的 AS，本来就是说你是你就是，说不是就不是。

作者: lixiaomeng 时间: 2012-12-25 16:52
标题: re:现在的 AS 等同于不是经典自闭症，但是...
现在的 AS 等同于不是经典自闭症，但是心理，性格，人格，或者智力有问题，而家长又愿意称为 AS 的那些人。

就我个人而言，非常同意 DSM-5 取消AS 同时缩短 ASD。社会交往有障碍，人格有障碍，就要按照那个去治疗。智力轻度落后，努力提高。智力轻度落后+社交轻度落后+ADHD，也就按照这个本身去治疗。有些人把 ASD 一分为二，除去肯纳症之外的都称为阿斯伯格，其实呢，他们就是 ASD level 1 甚至 level 2。

最最关键就是 AS 早就社会化了，根本没有严格和统一的定意。真的是觉得是就是，觉得不是就不是。

作者: lixiaomeng 时间: 2012-12-25 16:54
标题: re:[QUOTE][B]下面引用由[U]何子...

下面引用由[U]何子[/U]发表的内容：

“不过说实在的，像盖茨，爱因斯坦，扎克伯格，我个人看，他们就是 NT。”

坦率地说，我很反感拿这些名人说事。他们有诊断吗？

DSM-5 发布以后，还有谁可以有 AS 的诊断呢？作为一个社会概念，AS 现在早就无所不包了。 Adam Lanza 可以是，当然盖茨也可以是。现在的 AS = 心理特殊与众不同的人。

作者: sxy 时间: 2012-12-25 23:45
标题: re:每一个AS都是不同的，最重要的可能不是界...
每一个AS都是不同的，最重要的可能不是界定或划分，而是社会的包容和接纳。

米国枪杀案后，俺年轻时经常混迹的一育儿网站，虽然都是当妈妈的，但是护自家牍心切，大家对亚当和他妈妈恨得咬牙切齿，说什么的都有，有的说国家应该把这些长大了的ZB症患者限制出门，有的说包括家属国家应该统一管理，看不好就追究责任，看得俺心那个痛。

有时带着孩子出门，偶尔闹情绪，孩子会打自己的头，小的时候大家都还笑这孩子脾气真火爆，现在大了，人家都躲得远远的，其实俺孩儿连勺子都拿不好，根本不会攻击人，只会拿自己生气，有人问俺这孩子咋了？害怕人们对ZB有误解，俺就指指脑袋说脑子不好，基本大家叹叹气就走开了，唉。。

作者: 方静 时间: 2012-12-26 10:44
标题: re:抱抱大S。我可以想象那些论坛里的言论...
抱抱大S。
我可以想象那些论坛里的言论的。
十几年前石头和一个同学有冲突，捡起一块小石头砸了过去，人家脑袋开花送医院，缝了一针。
本来那同学家长没有什么想法的，但是有个学法律的同事挑唆，然后矛盾就激化了，理由就是监护人应该负法律责任啊。
到现在想起来，心里都很痛。
其实我真的是很清楚孩子们，尤其是高功能孩子未来的生活处境有多么的难，尤其这档子事一出，媒体为了博眼球做的一些过分的甚至是不实的宣传，带来的后果只会让我们难上加难。

作者: lixiaomeng 时间: 2012-12-26 14:56
标题: re:[QUOTE][B]下面引用由[U]sx...

下面引用由[U]sxy[/U]发表的内容：

每一个AS都是不同的，最重要的可能不是界定或划分，而是社会的包容和接纳。

米国枪杀案后，俺年轻时经常混迹的一育儿网站，虽然都是当妈妈的，但是护自家牍心切，大家对亚当和他妈妈恨得咬牙切齿，说什么...

那当然了，对世界而言，对我们的社会而言，最重要的肯定是包容和接纳，并不仅仅是特殊的孩子和大人。

每一个AS都是不同的，就像这个社会上每一人都是不同的。不过就 AS 而言，它更合适作为一种社会概念而不是诊断标准，因为已经不同到没有什么核心标准了。这个就是诠释的力量。同一个手册，经过大家不断的诠释，然后就很灵活了。

作者: 秋爸爸 时间: 2012-12-26 18:53
标题: re:DSM-5修订，在论坛上有过好几次好几个...
DSM-5修订，在论坛上有过好几次好几个帖子讨论了。比如：DSM-5草案正在公示征询意见中 [3]
我的微博里也曾经写过好多条。

美国APA之所以调动资源费力气做这个精神/心理领域的指南，根本目的只有一个：指导临床。
而其他的，如社会学，教育学，法律法规政策，乃至人文思潮人生哲学，谁想傍都尽管去傍，谁都想给自己的观点找些权威的科学依据，但那些统统都不是apa的本意。

apa的本意只是顺应医学科学的进步，apa不会被轻易绑架，坚持这点也才有了权威性，才让这DSM成为业内“圣经”。它一变动，全世界包括联合国的国际疾病分类也必然跟着变，咱自己也有此类“中国版”，据说不会再跟着修新，索性废了算了，直接拿来主义本来就最有效率，何苦又跟进又喊“中国特色”呢，这就对了，君不见航母“走你”，扬国威的大事，都直接山寨美军手语就很好了嘛。在生命和疾病上，更是几乎不存在值得在临床强调的人种差异、国际差异、文化差异的。即便有研究这种差异的，在科学里也都只属于花边八卦研究。

现行的DSM-4r在临床诊断和防治应用过程中，这么多年下来，存在种种问题被发现积累，比如AS诊断常现的困惑，-NOS也是，往往不同的医生会有不同的迟疑，贴还是不贴标签，贴AS还是贴HFA。不仅自闭症这边，其他类别中也有此类困惑，如儿童双极障碍那边，也有划圈过大现象，且在某些AS那里，如果按照DSM-5划分的话，不少或许很可能会被划入那边去，设立新病名。

作者: lixiaomeng 时间: 2012-12-26 22:27
标题: re:目前来看，确实设立了新的病名。好像还不只...
目前来看，确实设立了新的病名。好像还不只一个。所以除了自闭症谱系的，不是说就哪里都去不了。不过还是那句话，确实有那么些孩子，我觉得真的就是正常孩子，可能正态分布里面没有在那个人最多的地方。

作者: 秋爸爸 时间: 2013-1-3 16:46
标题: re:转帖燕原的博客，我黑体字加着重。...
转帖燕原的博客，我黑体字加着重。

CBS NEWS 新年科技展望（心理学和精神病学段落） (2013-01-03 00:24:14)转载▼
标签：杂谈
CBS NEWS 新年科技展望
全文地址：http://www.cbsnews.com/8301-205_162-57561496/scientists-give-their-wishlist-for-2013/

心理学家和精神病学家们怀着忐忑不安的心情迎来2013年，原因来自即将出版的 DSM-5 --《精神疾病诊断和统计手册，第五版》，这是被称为“精神病学圣经”的手册从 2000年以来所作的第一次重大修订。

相比以前的修订版本，DSM-5 的改革力度更大，带来的后续影响也更大，因为这本手册不仅仅要作为精神科医生和临床心理医生的诊断指导，同时也决定了在什么条件下，可以符合相应的医疗保险、残疾政策，以及其他福利政策。

DSM-5中最主要的一个变化是取消了阿斯伯格综合征，合并入更广泛的自闭症谱系障碍（ASD）。另外，囤积障碍从强迫障碍（OCD）中独立出来，成为一个单独条目。

在争议最大的几个变动中，有新建立的“破坏性情绪失调障碍”（disruptive mood dysregulation disorder）。支持者们希望这条诊断能够帮助那些 6-18岁，每周爆发三次以上情绪问题的孩子；批评人士则认为，这条诊断可能会扩大化，导致发脾气也算作精神类疾病。

“DSM-5对喜欢散播疾病的大药厂有利，他们会说服正常人成为精神类疾病患者，以便出售更多药品。”Allen Francis 评论说。他是杜克大学的精神病学家，DSM 上一版本修订小组的负责人，也是针对 DSM-5 版本的主要批评者。

Francis说，这一领域目前已经超越常规医学范畴，导致可能对严重精神类疾病患者的忽略，让他们得不到足够的治疗，甚至产生犯罪行为。

“我们必须回到理智的精神病学。”他说。

Frank Farley，坦普尔大学的心理学家，美国心理学会前主席。他认同目前有大量专家和学者对DSM-5背后的科学性持怀疑态度。

“展望2013年，一个国际化的，从基础开始要求重新建构诊断标准的运动将会开展起来，我期待着能在这个重要议题上获得进展。”Frank说。

“在心理学的研究方面，2013年也必须要解决如何重塑的问题。”Frank说，“有大量没有经过同行重复验证的实验结果，因为新奇抓眼球，被媒体重点关注，这个过程不符合科学研究规范。另外，还有大量初步研究，特别是那些没有获得明确统计结果的，不能在科学文献上发表的，在文学领域被扩散而导致大众产生歧义和偏见。”

最后Frank说，“过去的一年，我们有一个悲伤的结尾：康州小学20名孩子和6位成人在枪击案中离开。心理学界应当反思如何解决类似的暴力问题。”

“头疼医头，脚疼医脚的方法，无法解决暴力问题。应当有必要建立起一个国家范围的合作协调组织，类似二战期间的曼哈顿计划，60年代的登月计划，以及目前的人类基因组计划。”Frank正在给《生活科学》杂志写信，宣传他的设想。

“这个拟定中的全国抗暴力项目将会产生出我们能达到的最佳方案，并且列出最需要进行的下一步研究方向。”Frank说，“政府需要投资，同时也要从私人机构，包括基金会来募集资金，并且汇集社会各种资源。我坚信发展全国抗暴力项目，是2013年社会科学领域的一件要事，也应当是白宫的一个努力目标。”

作者: liuyao66 时间: 2013-1-9 10:35
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