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.

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    • "Moreover, there are concerns that the new definition of ASD is too restrictive and will exclude many patients with AS from access to specialized treatment (Frazier et al., 2012; McPartland et al., 2012; Mayes et al., 2013). 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). "
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    • "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. "
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    • "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. "
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