Dear Danny; As we discussed at the DSM-V meeting last week, I am resigning from the Child and Adolescent Disorders

workgroup. As you know, I have been thinking about this for some time, but have been reluctant to take this step because I very much enjoy working with this extraordinary group of people, and learning so much from them. However, I cannot in good conscience continue. These are my reasons: 1. I am increasingly uncomfortable with the whole underlying principle of rewriting the 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 to rewrite 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 there were 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 between what we need to know in order to make revisions and what we do know has grown wider and wider, while the time to fill these gaps is shrinking rapidly. More and more, changes seem to be made for reasons that have little basis in new scientific findings or organized clinical or epidemiological studies. 3. Efforts by Pat Cohen and myself in 2007 to provide data to fill some of the gaps in the knowledge base were rejected. One reason given by David was that the answers to questions were needed within 6 months, i.e., by the end of 2007. Now Prudence’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 process in place for feeding to Prudence the questions that the data sets could be used to answer, so any results are likely to be even more delayed. This, as we have all agreed, makes no sense. 4. One reason why it took so long to get a data base in place was that a decision was made that the work had to be done via a grant application to NIMH, with all the time delays entailed by that process. The reason given was that the funding allocated by the APA for research for DSM-V was not enough to support the necessary work. I continue to be shocked that the APA would even consider revising the DSM without being willing to allocate the funding necessary to carry out the underlying scientific studies. A drug company that tried to bring a product to 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 I am 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 between DSM-IV and DSM-V will be the more prominent use of dimensional measures in DSM-V”, and going on to introduce an Instrument Assessment Study Group that will advise workgroups on the choice of old scale measures or the creation of new ones. Setting aside the question of who “decided”, on what grounds, anyone with any experience of instrument development knows that what they proposed last month is a huge task, and a very expensive one. The possibility of doing a psychometrically careful and responsible job given the time and resources available is remote, while to do anything less is irresponsible.

It has taken me a long time to reach this conclusion, largely because I greatly value and enjoy working with you and the workgroup, and respect your commitment to the DSM-V process. I honor your position – that given DSM-V is going to be written, the best people should do it. You know that, as always, I am ready, as in the past, to carry out any data analyses that could be helpful to your decision-making on specific issues. Please give my greetings to the rest of the workgroup, and feel free to share with them as much of this as you choose. Very best wishes;