Remember how some comments in a scientific talk about the DSM 5 in Iceland was picked up by the New York Times, leading to a media and advocate firestorm of activity? The Times article was New Definition of Autism Will Exclude Many, Study Suggests.
Medpagetoday.com has another chapter in this story: Autism Criteria Critics Blasted by DSM-5 Leader. The term “blasted” doesn’t strike this reader as helping to bring some order to the discussion. The new article reports on a talk by Sue Swedo, who is a member of the DSM 5 committee. The New York Times article was focused on a talk by Fred Volkmar, who was a member of the DSM 5 committee but has since left.
PHILADELPHIA — The head of the American Psychiatric Association committee rewriting the diagnostic criteria for autism spectrum disorders took on the panel’s critics here, accusing them of bad science.
Susan Swedo, MD, of the National Institute of Mental Health, said a review released earlier this year by Yale University researchers was seriously flawed. That review triggered a wave of headlines indicating that large numbers of autism spectrum patients could lose their diagnoses and hence access to services.
Prof. Volkmar’s group analyzed data from 1993, when the DSM-IV was in development, and presents results claiming that a large fraction of autistics would not be identified under the DSM 5. Sue Swedo is quoted as responding in her talk:
Swedo said the Yale group misused the 1993 field trial data because it was inappropriate to take clinical evaluations structured a certain way to evaluate the DSM-IV criteria against DSM-III, and use them to determine how the DSM-5 criteria would perform.
“It was not just comparing apples and oranges, it was comparing apples with Apple computers,” she argued. “We [in DSM-5] were using words that hadn’t really been used in DSM-IV.”
In my opinion the main goal of the DSM 5 should be accuracy. Sue Swedo says that the field trials indicate that it is accurate, and suggests that the prevalence will not be dramatically changed with these criteria:
She pointed to the new field trial data from DSM-5 as justifying the work group’s decisions. The criteria showed excellent reliability — that is, different clinicians evaluating the same child usually came to the same diagnoses, with intraclass kappa values of 0.66 and 0.72 at the two academic centers where the criteria were tested.
Moreover, when the clinicians applied DSM-IV and DSM-5 criteria to the nearly 300 children included in the trial, the autism spectrum prevalence was not changed much.
I’m sure this isn’t the end of the discussion. One can hope that the discussion can be more data and fact driven than it has been in the recent past.