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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    • "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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    • "In fact, field trials showed that DSM-5 ASD has improved specificity at the cost of excluding more cognitively able individuals, including up to 75% of those previously diagnosed with AS (Frazier et al., 2012;Huerta et al., 2012;McPartland et al., 2012;Mayes et al., 2013). Concerns were further fueled by the inclusion of a new diagnosis of Social Communication Disorder in DSM-5, as this was felt by many to imply that higher functioning AS subjects would now migrate from the autistic spectrum to this new residual, consolation-prize category (Huerta et al., 2012). Others feel that the term AS should have continued to be mentioned in the manual as an admissible label for a particular group of patients within ASD, offering a clinical description of the syndrome but no diagnostic criteria (Wing et al., 2011). "
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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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