Dear Danny;As we discussed at the DSM-V meeting last week, I am resigning from the Child andAdolescent Disorders workgroup. As you know, I have been thinking about this for sometime, but have been reluctant to take this step because I very much enjoy working withthis extraordinary group of people, and learning so much from them. However, I cannotin good conscience continue. These are my reasons:1.I am increasingly uncomfortable with the whole underlying principle of rewritingthe entire psychiatric taxonomy at one time. I am not aware of any other branch of medicine that does anything like this. (The ICD revisions make no attempt torewrite the details of each diagnosis.) There seems to be no good scientific justification for doing this, and certainly none for doing it in 2012.2.When we began this process, we agreed that changes would only be made if therewere empirical evidence to support them. Sometimes (as with Charlie’s work on preschool PTSD) this has been the case. But as time has gone by, the gap betweenwhat we need to know in order to make revisions and what we do know hasgrown wider and wider, while the time to fill these gaps is shrinking rapidly. Moreand more, changes seem to be made for reasons that have little basis in newscientific findings or organized clinical or epidemiological studies.3.Efforts by Pat Cohen and myself in 2007 to provide data to fill some of the gapsin the knowledge base were rejected. One reason given by David was that theanswers to questions were needed within 6 months, i.e., by the end of 2007. NowPrudence’s grant has a favorable review and may be funded by the fall of 2009,with data available perhaps in 2010. As far as I am aware there is not yet a processin place for feeding to Prudence the questions that the data sets could be used toanswer, so any results are likely to be even more delayed. This, as we have allagreed, makes no sense.4.One reason why it took so long to get a data base in place was that a decision wasmade that the work had to be done via a grant application to NIMH, with all thetime delays entailed by that process. The reason given was that the fundingallocated by the APA for research for DSM-V was not enough to support thenecessary work. I continue to be shocked that the APA would even consider revising the DSM without being willing to allocate the funding necessary to carryout the underlying scientific studies. A drug company that tried to bring a productto market on the basis of inadequately-funded research would rightly be censured.This is what the APA is doing, and now that it is quite clear what is happening Iam afraid that I cannot bring myself to be part of the process any longer.5.The tipping point for me was the memo from David and Darrell on February 18,2009, stating “Thus, we have decided that one if not the major difference betweenDSM-IV and DSM-V will be the more prominent use of dimensional measures inDSM-V”, and going on to introduce an Instrument Assessment Study Group thatwill advise workgroups on the choice of old scale measures or the creation of newones. Setting aside the question of who “decided”, on what grounds, anyone withany experience of instrument development knows that what they proposed lastmonth is a huge task, and a very expensive one. The possibility of doing a psychometrically careful and responsible job given the time and resourcesavailable is remote, while to do anything less is irresponsible.