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Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Devel

Posted Oct 02 2012 7:27pm

With much attention focused on the change from DSM-IV to DSM-5 criteria for diagnosing autism, it is good to see more data coming out. As noted only a yesterday ( Brief Report: Comparability of DSM-IV and DSM-5 ASD Research Samples ) a large number of papers on the effect of the change have been published in 2012.

Add another to the list today: Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders . This paper includes Catherine Lord as one of the authors and includes a large number of individuals (both autistic and non-autistic), with ” 4,453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnoses (e.g., language disorder)”. In addition, the full paper is available online.

This may be the largest study so far, especially in that it uses recent DSM-5 criteria (earlier studies have used earlier versions).

The current study claims that the “proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses”. In other words, the large majority of children who are or would be diagnosed autistic under the DSM-IV would be diagnosed autistic under the DSM-5.

I am still unaware of any studies applying the DSM-5 to adults.

Here is the conclusion paragraph:

To our knowledge, this study is the most comprehensive assessment to date of the newly proposed DSM-5 ASD criteria. Based on symptom extraction from previously collected data, our findings indicate that the majority of children with DSM-IV PDD diagnoses would continue to be eligible for an ASD diagnosis under DSM-5. Additionally, these results further suggest that the revisions to the criteria, when applied to records of children with non-PDD diagnoses, yield fewer misclassifications. Our findings also contribute to literature that supports the use of both parent report and clinical observation for optimal classification accuracy.

Here is the 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.


By Matt Carey



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