Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers

Department of Psychology, University of Connecticut, Unit 1020, Storrs, CT, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.06). 03/2013; 43(5). DOI: 10.1007/s10803-013-1817-8
Source: PubMed


Autism spectrum disorder (ASD) diagnosis is based on behavioral presentation; changes in conceptual models or defining behaviors may significantly impact diagnosis and uptake of ASD-specific interventions. The literature examining impact of DSM-5 criteria is equivocal. Toddlers may be especially vulnerable to the stringent requirements of impairment in all three social-communication symptoms and two restricted/repetitive symptoms. Receiver operating characteristic (ROC) curves identified optimal cutoffs for sums of ADOS and ADI-R criteria mapped to each criterion for 422 toddlers. The optimal modification of DSM-5 criteria (sensitivity = 0.93, specificity = 0.74) required meeting the ROC-determined cutoffs for 2/3 Domain A criteria and 1 point for 1/4 Domain B criteria. This modification will help insure that ASD is identified accurately in young children, facilitating ASD-specific early intervention.

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Available from: Laura Brennan, Jun 25, 2015
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    • "Concerns have almost exclusively been directed towards changes in symptomatology criteria, and mostly used draft versions of DSM-5. The most frequently expressed hypothesis is that the application of DSM-5 will reduce diagnostic rates of ASD up to a third compared to DSM-IV/-TR, and even more at the higher functioning end of the spectrum [(summarized in Kulage et al. 2014; and in Sturmey and Dalfern 2014), see also Barton et al. (2013); Turygin et al. (2013) and Volkmar and Reichow (2013)]. The impairment criterion was not included in the first DSM-5 drafts, but was added in the January 26, 2011. "
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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.
    Full-text · Article · Jun 2015 · Journal of Autism and Developmental Disorders
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    • "In the category of restricted and repetitive behaviors, the criteria are stereotyped motor movements , adherence to routines, highly fixated interests, and altered sensory input. In order to receive a diagnosis for an ASD, the DSM-5 requires that individuals meet all three of the criteria in the category of social-communication impairments, and two of four criteria in the category of restricted and repetitive behaviors (American Psychiatric Association, 2013; Barton et al., 2013). Moreover, the DSM-5 specifies the severity levels of ASD as follow: 'Level 1' when support is required, 'Level 2' when substantial support is required, and 'Level 3' when very substantial support is required (Weitlauf et al., 2014). "
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    ABSTRACT: Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders that is among the most severe in terms of prevalence, morbidity and impact to the society. It is characterized by complex behavioral phenotype and deficits in both social and cognitive functions. Although the exact cause of ASD is still not known, the main findings emphasize the role of genetic and environmental factors in the development of autistic behavior. Environmental factors are also likely to interact with the genetic profile and cause aberrant changes in brain growth, neuronal development, and functional connectivity. The past few years have seen an increase in the prevalence of ASD, as a result of enhanced clinical tests and diagnostic tools. Despite growing evidence for the involvement of endogenous biomarkers in the pathophysiology of ASD, early detection of this disorder remains a big challenge. This paper describes the main behavioral and cognitive features of ASD, as well as the symptoms that differentiate autism from other developmental disorders. An attempt will be made to integrate all the available evidence which point to reduced brain connectivity, mirror neurons deficits, and inhibition-excitation imbalance in individuals with ASD. Finally, this review discusses the main factors involved in the pathophysiology of ASD, and illustrates some of the most important markers used for the diagnosis of this debilitating disorder. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Apr 2015 · International journal of developmental neuroscience: the official journal of the International Society for Developmental Neuroscience
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    • "Less is known about very young children, which we would like to capture early to provide early intervention services when the brain has its most plasticity, or adults, who are an understudied population in which little is known regarding best practice. A very recent study has suggested that the DSM-5 approach is overly restrictive with this age group as well and became adequate only when scoring rules were modified [31]. "
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    ABSTRACT: Background Since Kanner’s first description of autism there have been a number of changes in approaches to diagnosis with certain key continuities . Since the Fourth edition of the Diagnostic and Statistical Manual (DSM-IV) appeared in 1994 there has been an explosion in research publications. The advent of changes in DSM-5 presents some important moves forward as well as some potential challenges. Methods The various relevant studies are summarized. Results If research diagnostic instruments are available, many (but not all) cases with a DSM-IV diagnosis of autism continue to have this diagnosis. The overall efficiency of this system falls if only one source of information is available and, particularly, if the criteria are used outside the research context. The impact is probably greatest among the most cognitively able cases and those with less classic autism presentations. Conclusions Significant discontinuities in diagnostic practice raise significant problems for both research and clinical services. For DSM-5, the impact of these changes remains unclear.
    Full-text · Article · May 2013 · Molecular Autism
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