The DSM-5: Juvenile Court Changes from a Mental Health Practitioner s and Defender s Perspective

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1 The DSM-5: Juvenile Court Changes from a Mental Health Practitioner s and Defender s Perspective Presented by: Antoinette Kavanaugh, Ph.D Forensic Clinical Psychologist, IL Mary Ann Scali, JD, MSW National Juvenile Defender Center, DC 1

2 Session Outline - Function of Diagnosis Changes in the DSM-5 Importance of Behaviors/SYMPTOMS 2

3 Clinical and Legal FUNCTION OF DIAGNOSIS 3

4 What is the Function of a Diagnosis? 4

5 What is the Function of a Diagnosis II? 5

6 How are Diagnoses Used in Court? Diversion Intake Detention Adjudication Diagnosis Disposition Post- Disposition 6

7 Clinical and Legal HIGHLIGHTS: DIAGNOSTIC CHANGES IN THE DSM-5 7

8 Diagnostic Criteria Summary: Disruptive Mood Dysregulation Disorder (DMDD) o Persistent & severe verbal and/or behavioral outburst 3 or more times / week for 12 months (caveat) o Irritable and angry mood, most of the day nearly every day as observed by others. o In 2 of 3 settings. o Symptoms before age 10. o Can t diagnosis in kids six or younger. 8

9 Disruptive Mood Dysregulation Disorder DMDD Is this the new Bipolar for kids? Highlights-Chronic not Episodic Trumps Oppositional Defiant Disorder Intermittent Explosive Disorder Legal Implications 9

10 PTSD Moved from Anxiety disorder to Trauma and Stressor- Related Disorder Is subjective fear and horror a necessity? New symptom cluster How does blame or persistent emotional state matter? Reckless or self-destructive behavior is now recognized How does age matter? 10

11 PTSD: What does or doesn t count? Exposure to actual or threatened death, serious injury, or sexual violence. In one of four way 1) experienced directly, 2) witnessing what occurred to others, 3) learning that a close friend or family member was the victim of a traumatic event or, 4) NEW: Repeated exposure to details of a traumatic event. 11

12 Symptom Clusters Intrusion (1+ of 5) Avoidance (1+ of 2) Marked Arousal and Reactivity (2 + of 6) Negative altercations in mood and cognitions 12

13 Negative altercations in mood and cognitions (2+ of 7) Can t remember important aspects Persistent/exaggerated negative beliefs I am bad Distorted cognitions about the cause and consequences-> blaming self Inability to experience positive emotions Persistent negative emotional state (fear, horror, guilty...) Diminished interest in things 13

14 Disruptive, Impulse-Control and Conduct Disorders o o This is a new chapter for DSM-5 Includes: o Oppositional Defiant Disorders o Intermittent Explosive Disorders o Conduct Disorders o Unspecified Disruptive, Impulse-Control, and Conduct Disorder 14

15 Oppositional Defiant Disorder (ODD) 3 types of symptoms (4 of 12) 1. Angry/Irritable Mood, 2. Argumentative/Defiant Behavior, and 3. Vindictiveness**. Frequency Settings How is this different from being a normal teenager? of Psychology and Law. 15

16 Intermittent Explosive Disorder (IED) NEW: verbal aggression counts Two categories Verbal or physical aggression- no harm o 2/week over 3 months behavioral outburst that results in harm o 3 over a 12 month period 16

17 Intermittent Explosive Disorder (IED)- 2 Gives clarity re: type of aggressive outbursts Impulsive Not premeditated, not goal oriented Can have this + ADHD, CD, or ODD Associated with financial and legal consequences 17

18 Conduct Disorder Limited Prosocial Emotions Specifier (CD + 2 or more) Lack of remorse or guilt Lack of empathy Shallow affect Unconcerned about performance Different Onset & Different Prognosis 18

19 Web-Based Resources Provides an overview of the development Great PDF document describing all the changes Sign up to receive notice of changes in the DSM-5 19

20 Clinical and Legal IMPORTANCE OF BEHAVIORS/SYMPTOMS

21 If diagnosis isn t the end all, what is or could be? 21

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23 EXAMPLE: ADHD Youth with the SAME diagnosis may have VERY different behaviors and symptoms 23

24 Example: ADHD Legal practitioners should be looking beneath the diagnosis and focus on BEHAVIORS/SYMPTOMS 24

25 Questions? Comments? Contact Antoinette: Contact Mary Ann: x