Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders

Department of Psychology, University of Michigan, Ann Arbor, Michigan, United States
American Journal of Psychiatry (Impact Factor: 12.3). 10/2012; 169(10):1056-64. DOI: 10.1176/appi.ajp.2012.12020276
Source: PubMed


Substantial revisions to the DSM-IV criteria for autism spectrum disorders (ASDs) have been proposed in efforts to increase diagnostic sensitivity and specificity. This study evaluated the proposed DSM-5 criteria for the single diagnostic category of autism spectrum disorder in children with DSM-IV diagnoses of pervasive developmental disorders (PDDs) and non-PDD diagnoses.

Three data sets included 4,453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnoses (e.g., language disorder). Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) and clinical observation instrument (Autism Diagnostic Observation Schedule) were matched to DSM-5 criteria and used to evaluate the sensitivity and specificity of the proposed DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses.

Based on just parent data, the proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses. Sensitivity remained high in specific subgroups, including girls and children under 4. The specificity of DSM-5 ASD was 0.53 overall, while the specificity of DSM-IV ranged from 0.24, for clinically diagnosed PDD not otherwise specified (PDD-NOS), to 0.53, for autistic disorder. When data were required from both parent and clinical observation, the specificity of the DSM-5 criteria increased to 0.63.

These results suggest that most children with DSM-IV PDD diagnoses would remain eligible for an ASD diagnosis under the proposed DSM-5 criteria. Compared with the DSM-IV criteria for Asperger's disorder and PDD-NOS, the DSM-5 ASD criteria have greater specificity, particularly when abnormalities are evident from both parents and clinical observation.

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    • "Because DSM-5 criteria for autism spectrum disorder encompass all pervasive developmental disorders (PDDs) except for Rett's Syndrome, the findings of this study apply to a subset of individuals who would be diagnosed with ASD under DSM-5—namely, high functioning individuals with more severe symptoms. Thus, given that about 91 % of individuals who meet DSM-IV criteria for PDDs other than Rett's also meet DSM-5 criteria for autism spectrum disorder (Huerta et al. 2014), it may be the case that not all of the participants would be diagnosed with autism spectrum disorder under DSM-5 criteria. Using DSM-IV-TR criteria, diagnoses were confirmed in the ASD group and ruled out of the TD group using the ADI-R (Lord et al. 1994) and the ADOS (Lord et al. 2000). "
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    ABSTRACT: This study disentangled the influences of language and social processing on communication in autism spectrum disorder (ASD) by examining whether gesture and speech production differs as a function of social context. The results indicate that, unlike other adolescents, adolescents with ASD did not increase their coherency and engagement in the presence of a visible listener, and that greater coherency and engagement were related to lesser social and communicative impairments. Additionally, the results indicated that adolescents with ASD produced sparser speech and fewer gestures conveying supplementary information, and that both of these effects increased in the presence of a visible listener. Together, these findings suggest that interpersonal communication deficits in ASD are driven more strongly by social processing than language processing.
    Journal of Autism and Developmental Disorders 11/2015; DOI:10.1007/s10803-015-2645-9 · 3.06 Impact Factor
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    • "Rationale for the assessment of the DSM-5: indices were created with items of the ADOS-2 and ADI-R combined as to cover the 3 parts of the DSM-5 criterion A and the 4 parts of the criterion B. A code of at least 1 on any instrument was considered sufficient to meet the criterion for each part of the criterion according to the procedure of Huerta et al. 2012. The indices were composed as follows: Criterion A1) Deficits in social-emotional reciprocity ADOS-2: A2, A6, B2, B5, B6, B8, B9, B10, B12 (module1) or A5, "
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    ABSTRACT: The possible effect of the DSM-5 impairment criterion on diagnosing autism spectrum disorder (ASD) in young children was examined in 127 children aged 20-47 months with a DSM-IV-TR clinical consensus diagnosis of ASD. The composite score of the Vineland Adaptive Behavior Scales (VABS) served as a proxy for the DSM-5 impairment criterion. When applying a mild level of impairment (cutoff: 1 SD below the mean on the VABS), 88 % of the cases fulfilled the impairment criterion. Sixty-nine percent fulfilled the impairment criterion at a moderate level (1.5 SDs) and 33 % at a severe level (2 SDs). Findings indicate that a strict application of the new DSM-5 impairment criterion might compromise early diagnosis of ASD.
    Journal of Autism and Developmental Disorders 06/2015; 45(11). DOI:10.1007/s10803-015-2512-8 · 3.06 Impact Factor
    • "The external validity is sensitive to many factors, for instance, setting of the trial, selection of participants, characteristics of included participants, differences between the protocol and routine practice, choice of outcome measures, followup timing, providers' characteristics and training, treatment fidelity, number of participants, and trainer ratio (Rothwell, 2006). Traditionally, the main target of systematic reviews is on the determinants of internal validity (i.e. the quality of design, conduct, and analysis), to ensure that the results are valid for the study population and setting (Higgins and Green, 2011). External validity, however, often receives insufficient attention in primary research studies and systematic reviews (Rothwell, 2006). "
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    ABSTRACT: Systematic reviews have traditionally focused on internal validity, while external validity often has been overlooked. In this study, we systematically reviewed determinants of external validity in the accumulated randomized controlled trials of social skills group interventions for children and adolescents with autism spectrum disorder. We extracted data clustered into six overarching themes: source population, included population, context, treatment provider, treatment intervention, and outcome. A total of 15 eligible randomized controlled trials were identified. The eligible population was typically limited to high-functioning school-aged children with autism spectrum disorder, and the included population was predominantly male and Caucasian. Scant information about the recruitment of participants was provided, and details about treatment providers and settings were sparse. It was not evident from the trials to what extent acquired social skills were enacted in everyday life and maintained over time. We conclude that the generalizability of the accumulated evidence is unclear and that the determinants of external validity are often inadequately reported. At this point, more effectiveness-oriented randomized controlled trials of equally high internal and external validity are needed. More attention to the determinants of external validity is warranted when this new generation of randomized controlled trials are planned and reported. We provide a tentative checklist for this purpose. © The Author(s) 2015.
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