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

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Objective

This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD).

Method

The study focused on a sample of 933 participants evaluated during the DSM-IV field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and specificity for proposed DSM-5 diagnostic criteria were evaluated using field trial symptom checklists as follows: individual field trial checklist items (e.g., nonverbal communication); checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication); individual DSM-5 criterion (e.g., social-communicative impairment); and overall diagnostic criteria.

Results

When applying proposed DSM-5 diagnostic criteria for ASD, 60.6% (95% confidence interval: 57%–64%) of cases with a clinical diagnosis of an ASD met revised DSM-5 diagnostic criteria for ASD. Overall specificity was high, with 94.9% (95% confidence interval: 92%–97%) of individuals accurately excluded from the spectrum. Sensitivity varied by diagnostic subgroup (autistic disorder = 0.76; Asperger's disorder = 0.25; pervasive developmental disorder—not otherwise specified = 0.28) and cognitive ability (IQ < 70 = 0.70; IQ ≥ 70 = 0.46).

Conclusions

Proposed DSM-5 criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively able individuals and those with ASDs other than autistic disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.

Section snippets

Method

The data for the analyses in this study were obtained from the multisite field trial of the DSM-IV.28 In the context of the field trial, 977 patients were evaluated for possible PDD. This re-analysis focused on 933 cases, omitting individuals diagnosed with non-autistic PDDs (Rett's disorder, n = 13; childhood disintegrative disorder, n = 16), as well as individuals with missing data required for the present analyses (n = 15). Characteristics of the sample are presented in Table 1. The sample

Results

Sensitivity and specificity for the DSM-5 algorithm are displayed in Table 2, with 95% confidence intervals (CI) displayed in Table 4. Based on DSM-5 diagnostic criteria for ASD, 398 of 657 clinically diagnosed cases (60.6%; 95% CI = 57%–64%) met the proposed criteria for ASD, with 259 cases (39.4%) failing to meet diagnostic threshold. In terms of specificity, the proposed DSM-5 criteria accurately excluded 262 of 276 individuals (94.9%; 95% CI = 92%–97%). Exploratory analyses were conducted

Discussion

The current study examined the impact of the proposed changes to the diagnostic criteria for ASD in DSM-5. We focused on 933 cases referred for evaluation for the presence of a PDD in the DSM-IV field trial. From this sample, we contrasted 657 who had been clinically diagnosed with an ASD and a comparison sample of 276 individuals who received a clinical diagnosis not on the autism spectrum. From 61 individual checklist items rated by these field trial evaluators, we created an algorithm

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    This article was reviewed under and accepted by Deputy Editor Douglas K. Novins, MD.

    The study was supported by National Institute of Mental Health (NIMH) grants K23MH086785 (JCM) and P50MH081756 (FRV), a National Alliance for Research on Schizophrenia and Depression Atherton Young Investigator Award (JCM), and National Institute of Child Health and Human Development grant P50HD003008 (FRV).

    This article is discussed in an editorial by Dr. David H. Skuse on page 344 and in a commentary by Dr. Susan E. Swedo and colleagues on page 347.

    Disclosure: Dr. McPartland has received research support from the National Institute of Child Health and Human Development, the Simons Foundation, the National Alliance for Research on Schizophrenia and Depression, and the National Institute of Mental Health. He has received royalties from Guilford Press and Lambert Academic Publishing. He has received lecture honoraria for presentations on autism. Dr. Volkmar has received lecture honoraria for presentations on autism. He receives book royalties from several publishers and serves as the editor of the Journal of Autism and Developmental Disorders. He is also supported by federal grants, including Autism Center of Excellence (P50 MH081756), on which he serves as Principal Investigator. Dr. Reichow has served as a consultant for the Institute of Education Sciences – Small Business Innovation Research. He has received royalties from Springer and Henry Stewart Talks. He has received lecture honoraria for presentations on autism.

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