Here’s how it typically works. A parent brings their child to their pediatrician, concerned about a potential mental health condition — maybe it’s anxiety, or maybe it’s depression. That pediatrician asks the child a set of questions, then assigns a numerical score based on the answers. If the score exceeds a certain threshold, the child is diagnosed with a condition and referred for treatment — maybe it’s pills, maybe it’s therapy. This process relies on classifications created in a tome called the Diagnostic and Statistical Manual of Mental Disorders, a book that has been the dominant paradigm in children’s mental health diagnosis since the 1970s and is now on its fifth edition (DSM-5). To James Li, this process is, to put it succinctly, “a crock.”
For the past few years, Li has been trying to do just that. In 2020, he became part of a growing nationwide consortium of researchers and medical professionals looking to replace the DSM-5 with something that’s more data-driven, nuanced and patient-specific. The emerging new model is called the Hierarchical Taxonomy of Psychopathology (HiTOP), and it’s designed to reconceptualize mental health into something more than a system that efficiently places patients into pigeonholes. Li co-chairs the Diversity, Equity, and Inclusion Scientific Workgroup within the consortium, which is focusing on ensuring that HiTOP applies to all populations.
“Most patients don’t come in as garden variety, ‘I have ADHD,’ or ‘I have autism,’ and that’s all you’ve got,” explains Li. “Most patients are coming in with some combination of a lot of different psychological and mental health traits and behaviors that don’t fit neatly into one treatment category or diagnosis.”
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