Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria

Abstract

Children diagnosed with Autistic Disorder (AD), Asperger's Disorder (AS), and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) share overlapping diagnostic criteria. As a result, there has been an enduring debate regarding the appropriateness of the current categorical classification system used to diagnose this group of disorders, commonly referred to as Autism Spectrum Disorders (ASD). Ongoing research examining the boundaries of the disorders comprising the spectrum have yielded inconsistent findings in symptom differences; therefore, the American Psychiatric Association has proposed revisions for the upcoming version of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-5). Revisions include dropping all subcategories of ASD and including one dimensional category that is all encompassing. Thus, the aim of the current study was to compare symptoms of ASD in children and adolescents who met criteria for ASD according to only the DSM-IV-TR (i.e., DSM-IV-TR group) to those who met criteria according to the forthcoming version of the DSM (i.e., DSM-5 group) and to those that were typically developing (i.e., control group). Using the Autism Spectrum Disorders-Diagnosis for Children, participants in the DSM-IV-TR and DSM-5 groups did not score significantly different from each other on overall autism symptoms, but both groups scored significantly different from the control group. Upon further investigation, the DSM-IV-TR and DSM-5 groups scored significantly different in the core domain area of Nonverbal Communication/Socialization. Additionally, different symptom profiles predicted group membership when participants were classified as ASD or typically developing according to the DSM-IV-TR versus the DSM-5 diagnostic criteria. Implications of these findings and the implications of the proposed changes to the ASD diagnostic category for the DSM-5 are discussed.

Application of the Final DSM-5 Criteria for Young Children with Autism Spectrum Disorder

“…For example, Matson et al [4] reported that 48% of toddlers with PDDs did not meet the new criterion, ASD. Several studies have also shown that a considerable percentage (8.8%~53.8%) of children with PDDs diagnoses did not meet ASD [2][3][4][5][6][7][8][9][10][11] (Table 3). Table 3: Characteristics of the previous studies *Reduction means the number (or rate) of cases who lost the ASD diagnosis in the draft or in relaxed rules.…”

“…Before the final version of DSM-5 was released in May 2013, several investigations with the proposed draft had been done [2][3][4][5][6][7][8][9][10][11]. These preliminary studies showed that a considerable percentage (8.8%~53.8%) of children with PDDs diagnoses did not meet the new criterion of ASD.…”

Transition from Pervasive Developmental Disorders to Autism Spectrum Disorder: Proposed Changes for the Upcoming DSM-5

“…[7,8,21] DSM-IV-TR'deki YGB tanı ölçütleri ile DSM-5'teki yeni otizm spektrum bozukluğu ölçütlerini karşılaştıran çalışmalar da, belirgin otizm belirtilerine sahip olmalarına karşın bazı çocuk ve ergenlerin yeni sisteme göre tanı alamayabileceğini göstermiş-tir. [16,22,23,24] DSM-5 Nörogelişimsel Bozukluklar Çalışma Grubu, bu araştırmaların bazılarını yöntemsel sınırlılıkları nedeniyle eleştirmiş ve yapıla-cak değişikliklerin otizm tanı ölçütlerinin özgüllüğünün yanı sıra duyarlılığını arttırmayı da hedeflediğini vurgulamıştır. [23,25] Yeni otizm spektrum bozukluğu tanısında toplumsal etkileşim ve iletişim güçlükleri alanlarının birleştirilmesine tamamen karşı çıkılmasa bile, bu deği-şikliğin konuşma ve dil ile ilgili sorunlara yetersiz ilgi gösterilmesi ile sonuçla-nabileceğine dair uyarılar olmuştur.…”

“…[12,15,17] Bu nedenle, DSM-5'teki otizm spektrum bozukluğu tanısının, daha kesin biçimde tanı koymayı kolaylaştıracak özgüllüğün yanı sıra, otizm belirtileri nedeniyle desteğe ihtiyaç duyan bireyleri tanı sisteminin dışında bırakmayacak duyarlılığa sahip olması da gerekmektedir. [16] Olası bir otizm spektrum bozukluğu tanısının getireceği başlıca yarar, kişinin ihtiyaç duyduğu eğitim ve sağlık hizmetlerine ulaşımını mümkün kılması ise; yol açacağı temel zarar kişinin olumsuz bir şekilde damgalanma riski ile karşı karşıya kalması-dır. [7,8] DSM'nin gözden geçirilen son versiyonunun da, getireceği yararlar açısından otizmli kişilerin yaşam kalitesinin artmasına katkı sağlayacağı umulmaktadır.…”

Autism assessment tools in the transition from DSM-IV to DSM-5

“…In a series of studies, using a variety of different diagnostic instruments and modalities, but neither ADI-R nor ADOS, Matson and colleagues showed 32 % of children [10] and 36 % of adults [11] with DSM-IV PDD did not meet the criteria for DSM-5 ASD. In a larger study on toddler with developmental disability, the same group measured a 47 % decrease in the diagnosis of a DSM-5 ASD compared to DSM-IV PDD group (24 % for the DSM-IV autistic disorder, and 88 % of the PDD-NOS) [12].…”