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

3 Oct

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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One Response to “Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders”

  1. RAJ October 3, 2012 at 20:18 #

    There are two Diagnostic Manuals currently under revision, DSM-5 and ICD-11. In the past the working groups for autism in both groups collaborated closely to insure that both manuals would be consistent with respect to diagnostic criteria and reach agreement on the publication dates for both manuals. This has not happened this time. The announced publication dates are not the same, DSM-5 will be published a year or more earlier than the new ICD-11 manual. There is a dispute between these two groups. Sir Michael Rutter, the chair of the ICD-11 working group on autism has explained the difference:

    ‘At the moment there are important differences between proposals for DSM-5 and ICD-11. For the most part, there is broad agreement on the overall concepts but there are difficulties with respect to the details. That arises most especially because the DSM-5 starts with dealing with research criteria before considering the concepts and WHO does it the opposite way round. That is to say, the starting point with WHO is the clinical conceptualisation and the clinical criteria. At a later point, of course, research criteria have to be developed but that comes secondarily. In my view, that is the most appropriate way round’

    The DSM-5 working group is reflecting the views of the majority who are behavioral geneticists who see autism as dimensional rather than categorical. Unlike ICD which is a medical manual published by the World Health Organization, DSM is a manual of mental disorders. Many members of the DSM5 working group on autism are not medical doctors but rather psychologists (Francesca Happe, Catherine Lord, Sally Rogers and Amy Wetherby) whose backgrounds suggest a bias towards seeing autism through their own research.

    Thomas Frazier who also commented on this study is also not a medical doctor but holds a PHD.

    http://my.clevelandclinic.org/staff_directory/staff_display.aspx?DoctorID=7668

    http://www.dsm5.org/MeetUs/Pages/Neurodevelopmental%20Disorders.aspx

    http://itasd.org/index.php?option=com_content&view=article&id=38%3Amichaelrutterinterview&catid=8&lang=en

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