Article

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

ABSTRACT

Objective:
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.

Method:
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.

Results:
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.

Conclusions:
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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    • "Recently, Wall and colleagues[58]identified seven items from the ADI-R (past items) that distinguished ASD from typical development with >90 % accuracy: Comprehension of Simple Language , Reciprocal Conversation, Imaginative Play, Imaginative Play with Peers, Direct Gaze, Group Play with Peers, and Age when Abnormality First Evident[58]. Although only Reciprocal Conversation was mapped to DSM-5 diagnostic criteria for our sample[30], all of these items were endorsed in >60 % of our ADHD sample, with the exception of Comprehension of Simple Language (endorsed in 36 % of the ADHD sample)[58]. Thus, even if adequate differentiation between ASD and typically developing children is possible using abbreviated measures, the ability to distinguish between ASD and other childhood disorders may be minimal. "
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