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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;

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