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The DSM-5: Juvenile Court Changes
from a Mental Health Practitioner’s
and Defender’s Perspective
Presented by:
Antoinette Kavanaugh, Ph.DForensic Clinical Psychologist, IL
Mary Ann Scali, JD, MSWNational Juvenile Defender Center, DC
1Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Session Outline-
Function of Diagnosis
Changes in the DSM-5
Importance of
Behaviors/SYMPTOMS
2Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
FUNCTION OF DIAGNOSIS
Clinical and Legal
3Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
What is the Function of a Diagnosis?
4Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
What is the Function of a Diagnosis II?
5Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
How are Diagnoses Used in Court?
Diagnosis
Diversion
Intake
Detention
Adjudication
Disposition
Post-Disposition
6Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
HIGHLIGHTS: DIAGNOSTIC
CHANGES IN THE DSM-5
Clinical and Legal
7Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Disruptive
Mood
Dysregulation
Disorder
(DMDD)
Diagnostic Criteria Summary:
o Persistent & severe verbal and/or
behavioral outburst
3 or more times / week for 12 months
(caveat)
o Irritable and angry mood, most of the
day nearly every day as observed by
others.
o In 2 of 3 settings.
o Symptoms before age 10.
o Can’t diagnosis in kids six or younger.
8Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Disruptive Mood Dysregulation Disorder
DMDD
Is this the new Bipolar for kids?
Highlights-Chronic not Episodic
Trumps
˃ Oppositional Defiant Disorder
˃ Intermittent Explosive Disorder
Legal Implications
9Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
PTSD
Moved from Anxiety disorder to Trauma and Stressor-
Related Disorder
Is subjective fear and horror a necessity?
New symptom cluster
How does blame or persistent emotional state matter?
Reckless or self-destructive behavior is now recognized
How does age matter?
10Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
PTSD: What does or doesn’t count?
Exposure to actual or threatened death, serious
injury, or sexual violence. In one of four way
1) experienced directly,
2) witnessing what occurred to others,
3) learning that a close friend or family member
was the victim of a traumatic event or,
4) NEW: Repeated exposure to details of a
traumatic event.
11Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Symptom Clusters
Intrusion (1+ of 5)
Avoidance (1+ of 2)
Marked Arousal and Reactivity (2 + of 6)
Negative altercations in mood and cognitions
12Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Negative altercations in mood and
cognitions (2+ of 7)
˃ Can’t remember important aspects
˃ Persistent/exaggerated negative beliefs “I am bad”
˃ Distorted cognitions about the cause and
consequences-> blaming self
˃ Inability to experience positive emotions
˃ Persistent negative emotional state (fear, horror,
guilty...)
˃ Diminished interest in things
13Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Disruptive, Impulse-Control and
Conduct Disorders
o This is a new chapter for DSM-5
o Includes:
o Oppositional Defiant Disorders
o Intermittent Explosive Disorders
o Conduct Disorders
o Unspecified Disruptive, Impulse-Control, and Conduct Disorder
14Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Oppositional Defiant Disorder (ODD)
3 types of symptoms (4 of 12)
1. Angry/Irritable Mood,
2. Argumentative/Defiant Behavior, and
3. Vindictiveness**.
Frequency
Settings
How is this different from being a “normal
teenager”?
15of Psychology and Law.
Intermittent Explosive Disorder
(IED)
NEW: verbal aggression counts
Two categories
˃ Verbal or physical aggression- no harm
o 2/week over 3 months
˃ behavioral outburst that results in harm
o 3 over a 12 month period
16Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Intermittent Explosive Disorder
(IED)- 2
Gives clarity re: type of aggressive outbursts
˃ Impulsive
˃ Not premeditated, not goal oriented
Can have this + ADHD, CD, or ODD
Associated with financial and legal consequences
17Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Conduct Disorder
Limited Prosocial Emotions Specifier (CD + 2 or
more)
˃ Lack of remorse or guilt
˃ Lack of empathy
˃ Shallow affect
˃ Unconcerned about performance
Different Onset & Different Prognosis
18Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Web-Based Resources
http://www.dsm5.org
˃ Provides an overview of the development
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-
tr%20to%20dsm-5.pdf
˃ Great PDF document describing all the changes
http://dsm.psychiatryonline.org/DSM5CodingSupplement#
˃ Sign up to receive notice of changes in the DSM-5
19Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
IMPORTANCE OF
BEHAVIORS/SYMPTOMS
Clinical and Legal
If diagnosis isn’t the end all,
what is or could be?
21Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
22Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
EXAMPLE: ADHD
Youth with the SAME diagnosis may
have VERY different behaviors and
symptoms
23Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Example: ADHD
Legal practitioners should be
looking beneath the diagnosis and
focus on BEHAVIORS/SYMPTOMS
24Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
Questions? Comments?
Contact Antoinette:
312.719.8498
antoinette@drkavanaugh.com
http://www.drkavanaugh.com
Contact Mary Ann:
202.452.0010 x102
mscali@njdc.info
http://njdc.info/
25Knowledge, Clarity and Passion at the Intersection of Psychology and Law.
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