Validation of Proposed DSM-5 Criteria for Autism Spectrum Disorder

Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, OH, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 01/2012; 51(1):28-40.e3. DOI: 10.1016/j.jaac.2011.09.021
Source: PubMed


The primary aim of the present study was to evaluate the validity of proposed DSM-5 criteria for autism spectrum disorder (ASD).
We analyzed symptoms from 14,744 siblings (8,911 ASD and 5,863 non-ASD) included in a national registry, the Interactive Autism Network. Youth 2 through 18 years of age were included if at least one child in the family was diagnosed with ASD. Caregivers reported symptoms using the Social Responsiveness Scale and the Social Communication Questionnaire. The structure of autism symptoms was examined using latent variable models that included categories, dimensions, or hybrid models specifying categories and subdimensions. Diagnostic efficiency statistics evaluated the proposed DSM-5 algorithm in identifying ASD.
A hybrid model that included both a category (ASD versus non-ASD) and two symptom dimensions (social communication/interaction and restricted/repetitive behaviors) was more parsimonious than all other models and replicated across measures and subsamples. Empirical classifications from this hybrid model closely mirrored clinical ASD diagnoses (90% overlap), implying a broad ASD category distinct from non-ASD. DSM-5 criteria had superior specificity relative to DSM-IV-TR criteria (0.97 versus 0.86); however sensitivity was lower (0.81 versus 0.95). Relaxing DSM-5 criteria by requiring one less symptom criterion increased sensitivity (0.93 versus 0.81), with minimal reduction in specificity (0.95 versus 0.97).
Results supported the validity of proposed DSM-5 criteria for ASD as provided in Phase I Field Trials criteria. Increased specificity of DSM-5 relative to DSM-IV-TR may reduce false positive diagnoses, a particularly relevant consideration for low base rate clinical settings. Phase II testing of DSM-5 should consider a relaxed algorithm, without which as many as 12% of ASD-affected individuals, particularly females, will be missed. Relaxed DSM-5 criteria may improve identification of ASD, decreasing societal costs through appropriate early diagnosis and maximizing intervention resources.

Download full-text


Available from: Eric Youngstrom,
  • Source
    • "It consists of five so-called 'treatment scales': social awareness, social cognition, social communication, social motivation and autistic mannerisms. By applying factor-analysis Frazier et al. (2012) demonstrated that a 2-factor model, dividing SRS social and autistic mannerisms scales consistent with DSM-5 'social communication/interaction' and RRBIs domains, best explains the variance in SRS scores. Accordingly, we summed the scores of the 'social' scales to obtain one index of social (communication and interaction) ASD symptoms, while the score on the autistic mannerisms scale was taken as an index of RRBIs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Local and global visual processing abilities and processing style were investigated in individuals with autism spectrum disorder (ASD) versus typically developing individuals, children versus adolescents and boys versus girls. Individuals with ASD displayed more attention to detail in daily life, while laboratory tasks showed slightly reduced global processing abilities, intact local processing abilities, and a more locally oriented processing style. However, the presence of these group differences depended on particular task and sample (i.e., age and gender) characteristics. Most measures of local and global processing did not correlate with each other and were not associated with processing style. Significant associations between local-global processing and ASD symptom severity were observed, but the causality of these associations remains unclear.
    Journal of Autism and Developmental Disorders 08/2015; DOI:10.1007/s10803-015-2526-2 · 3.06 Impact Factor
  • Source
    • "interaction and communication impairment symptoms (SoCom) and the second factor describing autistic mannerisms (Frazier et al., 2012). In a recent study Frazier, Constantino and colleagues (2014) have analysed SRS-data in a more heterogeneous population, comprising a wider age range and combining both multiplex (at least two affected family members) and simplex (one affected family member) ASD families. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Several studies have focused on the underlying symptom structure of Autism Spectrum Disorders (ASD), but results have been equivocal. We performed a confirmatory factor analysis on data of the Developmental, Dimensional and Diagnostic Interview of 275 participants with ASD between 3 and 23 years of age, aimed at strengthening the empirical evidence of previously published factor structure solutions using the same instrument. As none of these hypothesised models fitted our data, an exploratory factor analysis was undertaken. Results pointed towards a five factor model. A ‘Restricted and Repetitive Behaviour and Interest’ factor could be separated from ‘Shaking and Nodding’, ‘Emotional Reciprocity’ and two other factors that both represented deficits in social interaction and communication. Although not completely confirming, our results are generally in favour of the present DSM-5 criteria. By showing that the items did not fully segregate according to theoretically postulated subdomains, we offer a possible explanation for the heterogeneity in proposed factor structures for ASD.
    Research in Autism Spectrum Disorders 04/2015; 12. DOI:10.1016/j.rasd.2014.11.002 · 2.96 Impact Factor
  • Source
    • "Given the evidence that DSM-IV criteria lacked specificity (Frazier et al., 2012; Huerta et al., 2012), it is likely that ASD was being overdiagnosed. Although at least three studies have found sensitivity commensurate with DSM-IV and improved specificity (Frazier et al., 2012; Huerta et al., 2012; Kent et al., 2013), concerns about sensitivity have been raised by many. One of the main implications of the changes to the DSM-5 is that evaluations will need to provide greater detail on a child's array of symptoms, as well as their symptom history, to document symptoms necessary for diagnosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Changes to the diagnosis of autism spectrum disorder (ASD) within the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 20132. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental Disorders (5th ed.). Arlington, VA: Author.[CrossRef]View all references) have important implications for school psychologists responsible for evaluating children with ASD, interpreting results to caregivers, and informing policy makers of needed revisions to eligibility criteria based on empirical understanding. The primary purpose of this review is to describe changes to the DSM-5 and the empirical evidence behind the modifications. A secondary goal is to describe implications for best practices in school evaluations for ASD. Given the concerns about the DSM-5 expressed by caregivers and individuals with ASD during the revision process, school psychologists who are aware of the rationale for and implications of the changes will be better positioned to assist local policy makers regarding diagnostic evaluations for ASD and address parental concerns regarding the evaluation process and service implications for their child.
    02/2015; 3(1):1-15. DOI:10.1080/21683603.2014.890148
Show more