DSM 5® Diagnosis in the Schools
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The First Session with Children and Adolescents:
Conducting a Comprehensive Mental Health Evaluation
Alvin E. House
DSM-5® Diagnosis
in the Schools
Renée M. Tobin
Alvin E. House
The Guilford Press
New York London
© 2016 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in
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Last digit is print number: 9 8 7 6 5 4 3 2 1
The authors have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards
of practice that are accepted at the time of publication. However, in view of the
possibility of human error or changes in behavioral, mental health, or medical
sciences, neither the authors, nor the editors and publisher, nor any other party
who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete,
and they are not responsible for any errors or omissions or the results obtained
from the use of such information. Readers are encouraged to confirm the
information contained in this book with other sources.
Library of Congress Cataloging-in-Publication Data
Tobin, Renée Margaret.
DSM-5 diagnosis in the schools / Renée M. Tobin, Alvin E. House.
pages cm
Includes bibliographical references and index.
ISBN 978-1-4625-2372-6 (hardback)
1. Child psychopathology—Diagnosis. 2. Adolescent psychopathology—
Diagnosis. 3. Diagnostic and statistical manual of mental disorders.
I. House, Alvin E. II. Title.
RJ503.5.T63 2016
618.92′89075—dc23
2015016848
DSM-5 is a registered trademark of the American Psychiatric Association.
The APA has not participated in the preparation of this book.
About the Authors
Renée M. Tobin, PhD, is a licensed school psychologist in Illinois and Pro-
fessor in the Department of Psychology at Illinois State University. She is an
associate editor of the Journal of Psychoeducational Assessment and serves
on the editorial board of the Journal of School Psychology. Dr. Tobin’s pri-
mary research examines personality and social development, with a focus
on promoting emotion regulation processes in youth.
Alvin E. House, PhD, is Professor Emeritus in the Department of Psychol-
ogy at Illinois State University. His professional practice and research focus
on applying assessment results in school, vocational, medical, and forensic
consultations. Dr. House is the author of The First Session with Children
and Adolescents and coauthor of a manual on observational assessment of
children. His publications also include journal articles and book chapters
on intellectual, personality, and neuropsychological testing.
v
Acknowledgments
W e thank our spouses, Joel Schneider and Angie House, for their support
and encouragement. We also thank our children, Ryan Tobin-Schneider,
Tiechera Samuell, and Brannan House. Witnessing their development has
added depth to our understanding of the processes of change and growth
that we discuss in this book. Our family members also put up with long
periods of unavailability while we worked to bring this book to fruition,
and we are grateful. We thank the chair of our department, J. Scott Jordan,
who recognizes the unique contributions of each member of our depart-
ment and allowed us the space to follow our interests. We thank two gradu-
ate assistants, Kiera Dymit and Allyson Satterlee, for their efforts in gath-
ering relevant materials for this book. Finally, we applaud the patience of
our editor at The Guilford Press, Natalie Graham, who gently pushed this
project to its completion.
vii
Contents
1. Introduction: Purposes and Features of This Book 1
What This Book Is—and Is Not—Intended to Do 1
A Guide to Stylistic Conventions in This Book 3
The Six Types of Notes and Their Purposes 5
PART I. DIAGNOSTIC ISSUES AND THE USE OF DSM-5 7
2. Psychiatric Diagnosis: Issues for School Psychologists 9
Psychiatric Diagnosis as a Task in School Settings 9
Psychiatric Classification and Its Role in School Settings 10
Who Can Diagnose with DSM-5? 12
Developmental Considerations in Diagnosing Children
and Adolescents 13
3. An Overview of the DSM-5 Diagnostic System 16
Basic Definitions of Mental Disorders and Other Conditions 16
Removal of the Multiaxial System of Classification 20
Precedence of Diagnoses: Diagnostic Conventions, Hierarchies,
and Multiple Diagnoses 25
Child and Adolescent Mental Health and DSM-5 27
4. Learning to Use DSM-5 30
Categorical Classification 30
Differential Diagnosis 31
Ordering of Diagnoses 33
Degree of Diagnostic Confidence 33
How to Record Diagnoses 34
Interpretation of Diagnostic Impressions from Other Sources 35
ix
x Contents
PART II. GUIDELINES FOR EVALUATION 37
OF PRESENTING PROBLEMS
5. Problems with Intellectual Ability and Cognition 39
Overview 39
Intellectual Disability and Related Problems 40
Neurocognitive Disorders 50
6. Learning, Communication, and Motor Problems 55
Overview 55
Learning Disorders and Related Problems 56
Communication Disorders 62
Motor Disorders 65
7. Highly Atypical Symptom Patterns: 69
Autism Spectrum Disorders and Psychoses
Overview 69
Autism Spectrum Disorders 70
Psychoses 72
8. Mood Problems 82
Overview 82
Specific Mood Disturbance Patterns 84
Mental Disorders Involving Mood 86
Other Mood-Related Disorders and Conditions 96
Issues in the Evaluation of Mood Disorders 100
9. Anxiety Problems 104
Overview 104
Specific Anxiety Patterns 107
Obsessive–Compulsive and Related Disorders 116
Disorders Discussed along with Obsessive–Compulsive Disorder 119
Traumatic and Stressor-Related Disorders 121
Comorbidity 130
Child Maltreatment 130
10. Other Internalizing Problems 132
Overview 132
Somatic Symptom and Related Disorders 132
Other Mental Disorders/Conditions Involving Presentation
of Physical Symptoms 139
Dissociative Disorders 140
Contents xi
11. Problems with Conduct 145
Overview 145
Differential Diagnosis 149
Specific Behavior Patterns 153
12. Problems with Impulse Control 161
Overview 161
Attention-Deficit/Hyperactivity Disorder 162
Other Specified or Unspecified Attention-Deficit/Hyperactivity
Disorder 169
Other Impulse-Control Disorders 170
Other Specified or Unspecified Disruptive, Impulse-Control,
or Conduct Disorder 171
13. Highly Focused Symptom Patterns 173
Overview 173
Eating Problems 173
Specific Feeding and Eating Disturbance Patterns 174
Clinical Considerations for Eating Disorders 178
Elimination Disorders 180
Gender Dysphoria 181
Paraphilic Disorders 182
Sleep–Wake Disorders 183
14. Substance-Related Problems and Other Addictive Behaviors 185
Overview 185
Other Addictive Behaviors 188
Comorbidity 188
Continuing Issues in the Diagnosis of Substance Use Problems
in Youth 189
15. Personality Disorders 193
Diagnosing Personality Disorders in Youth:
Controversy and Cautions 193
Other Cautions about Diagnosing Personality Disorders 195
Cluster A (Odd–Eccentric) Personality Disorders 196
Cluster B (Dramatic–Emotional) Personality Disorders 198
Cluster C (Anxious–Fearful) Personality Disorders 200
Residual Cases 201
Alternative DSM-5 Model for Personality Disorders 202
16. Additional Codes and Categories 204
Other Mental Disorders 204
Other Conditions That May Be the Focus of Clinical Attention 205
Emerging Measures and Models 208
xii Contents
PART III. THE APPLICATION OF DSM-5 211
IN SCHOOL SETTINGS: ISSUES AND TOPICS
17. Ethics and Professional Responsibility in Evaluation 213
The Role of the School Psychologist in Mental Health
Assessment 213
Best-Practice Recommendations for School Psychologists
Regarding Diagnosis 215
18. The Case Record: Data and Supporting Documentation 217
for Diagnosis
Confidentiality, Freedom of Information, and Parents’
and Children’s Rights 217
Maintenance of Records 218
19. Seeking Reimbursement for Assessment and Diagnosis 220
within School Settings
Physicians’ Current Procedural Terminology Codes 220
“Medical Necessity” as a Criterion 221
Ethical and Professional Responsibilities in Billing 223
Diagnostic Disagreement 225
20. DSM-5 and the Individuals with Disabilities 227
Education Improvement Act
21. Concerns about DSM-5 230
Concerns about Psychiatric Classification in General 231
Concerns about the Overall Conceptualization and Structure
of DSM-5 232
Specific Concerns about DSM-5 234
Did They Get It Right? 236
Concluding Remarks 237
References 239
Index 261
1
Introduction
Purposes and Features of This Book
What This Book Is—and Is Not—Intended To Do
Efficient and accurate use of the fifth edition of the American Psychiatric
Association’s (2013b) Diagnostic and Statistical Manual of Mental Dis-
orders (DSM-5) has become a necessary part of the professional duties of
psychologists in a variety of clinical, rehabilitative, and youth service agen-
cies. For several reasons, this development has extended into public school
systems, where school psychologists are increasingly being asked to make
DSM-5 diagnostic determinations. Research examining prevalence rates
indicates that one in five youth has a mental health issue (Kessler et al.,
2005, 2012). Consistent with these findings, Doll’s (1996) review of epide-
miological studies concluded with the statement that “a typical school of
1,000 students could be expected to have between 180 and 220 students
with diagnosable psychiatric disorders” (p. 29). This book is intended to
increase school-based practitioners’ familiarity with DSM-5 and to bolster
their confidence in using it within school settings. The use of DSM-5 is
often made difficult by both the size of the text (806 pages presented in 20
chapters on disorders) and the complexity of the taxonomy (more than 300
diagnoses). Some of the rules and conventions adopted to bring increased
structure and reliability to the system add further to the complexity of the
document for novice users. These considerations, combined with timidity
1
