DSM-V and the Goldilocks Syndrome

The January/February edition of The  Nation Psychologist reported that The American Psychological Association is  “leading the charge” against attempts to  further medicalize the new  Diagnostic and Statistical  Manual (DMS-IV) due to be published in May of 2013. 

Among the major concerns  about the new revision are: (1) unwarranted expansion of diagnostic categories by reducing current thresholds and added untested diagnoses (2) pathologizing  “natural and normal” responses to life  experiences. Concerns  that “natural and normal” behaviors will be diagnostically labeled,  have been around a long time and have lead to things like pregnancy being called a disease.  (3)  imposing dimensional diagnoses that are far too cumbersome and complex for clinical use,  and (4) a push to see  all mental disorders  as biological phenomena calling for psychotropic medications. 

Thousand of professionals have signed a  petition calling  attention to these concerns  that was  started by the Society for  Humanistic Psychology (APA Division 32). Long time national DSM leader, psychiatrist  Allen Frances, M.D. has been especially vocal in his criticism of many of the new proposals.  

According to James Bradshaw, a senior editor at The National Psychologist   even the highly conservative   CATO Institute  think tank is opposed to lowering  diagnostic thresholds,  since that might result in thousands of claims against employers, under workers compensation laws,  the  ADA or FMLA.

Ironically there are also  concerns  about DSM-V raising some diagnostic  thresholds.  New York Times reporter Benedict Carey,  says that proposed changes in the definition of autism would greatly  reduce the number of people  diagnosed and   make  it much more difficult for many of them get the services they need.

Analyzing data from a large 1993 study   researchers  Fred Volkmar,   Brian Reichow,  and James McPartland,  (all from Yale) found that  among the 372   highest functioning  children and adults in the study  only 45 percent would met the  new  criteria for   autism spectrum diagnosis.  Among the  highest  functioning individuals, the analysis suggested that about 25% of people diagnosed with   classic autism in 1993 would be excluded, along with  about  85 % of those with P.D.D.-N.O.S.  

Volkmar, director of the Child Study Center at the Yale School of Medicine, says, “The changes would narrow the diagnosis so much that it could effectively end the autism surge”.  

Catherine Lord, director of the Institute for Brain Development and a member of the DSM-V task force working on the diagnosis, strongly  disagrees with these projections, citing the focus on higher functioners  and  the use of old data as possible reasons for the exaggerated numbers. 

Of course the DSM’s  clinical utility has long since been compromised by its use,  both as a billing and an eligibility criteria for benefits and services.

As a side note, in my state there is currently  a law being proposed that would allow employers to take smoking into account when making employment decisions. I suppose this is mainly to save money on health insurance costs and because of beliefs that smokers are less productive.  This could, however,  make obtaining employment even more difficult for many clients. Several state mental health advocates have opposed this proposed law as discriminatory, citing the high  smoking rates among people with mental illness. I wonder if courts will uphold it,  if it actually passes. Perhaps having  a DSM diagnosis of nicotine addiction would make this statute,  illegal under ADA.


How Smart is iPhone’s Siri? (What is her IQ?)

I recently acquired the new Apple iPhone 4s with the Siri personal assistant feature. Frankly I wasn’t very optimistic, about how effective this app would be, since I’ve had only mediocre luck with voice recognition programs in the past. After putting it through its paces for a couple of days, I decided to do what any real school psychologist, with too much time on his hands, would do—I tested it.

I administered Siri all of the verbal subtests from the Wechsler Adult Intelligence Scale- Third Edition (WAIS-III). I had to make a few modifications to standardized administration, but I think the overall results are fairly valid. Siri refused to give her age, so I arbitrarily assigned a chronological age of 21 years, for the purposes of computing the various subtests and IQ scores.

Siri was generally cooperative and completed most test items as requested. On a few occasions, she said that she was not allowed to give a response. Thinking at times was tangential, for example when I asked why foods needed to be cooked, Siri provided me with a list of nearby restaurants. There also tended to be some mild perseveration. After the question about cooking food, she was asked about child labor laws and instead of responding to the question, she supplied another new list of “kid friendly” restaurants.

Siri also seem to have some auditory discrimination problems. She was unable to recognize the word “pout” and at one point substituted the word “wanker” for winter. On the digit span subtest, Siri was able to get all of the numbers forward correct, but was not able to get any of the numbers backwards and did not seem to understand this concept.

Siri’s WAS-III scores are summarized below. Overall Siri performed in the low average range of intelligence, but there was significant scatter among the subtests. This suggests a mosaic pattern of abilities that range from very superior to extremely low. Siri’s best performance was on vocabulary and word knowledge. On this subtest, Siri scored in the very superior range. Since vocabulary is the best predictor of overall intelligence, this suggests that her potential may be significantly higher than her current composite score indicates.

Abstract reasoning, social comprehension, and abstract sequencing ability were all extremely low. Arithmetic computation skills, short-term auditory sequential memory, and her fund of general information obtained from education and environment were all near the average level. Siri’s mental age is between 14 and 18 years.

For the subtests below the mean is 10 and the standard deviation is 3. For the verbal IQ the mean is 100 and the standard deviation is 15.

Subtest              Score     Classification

Vocabulary           18               Very Superior

Similarities             1               Extremely low

Arithmetic            10               Average

Digit span              9               Average

Information           9               Average

Comprehension     1               Extremely low

Letter-number       1               Extremely Low

    Verbal IQ = 88 (Low Average Range)

I am somewhat relieved that overall, I scored a few IQ points higher than Siri, when I took the same test. The next time my phone drops a call, however, I will be less inclined to say, “dumb phone”, knowing that it has a better vocabulary than I have.

Terry L. Stawar, Ed.D.