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

Abstract

Objective This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). Method This study focused on a sample of 977 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: (a) individual field trial checklist items (e.g., nonverbal communication), (b) checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication), (c) individual DSM-5 criterion (e.g., social-communicative impairment), and (d) 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 =.76; Asperger’s Disorder = .25; PDD-NOS = .28) and cognitive ability (IQ < 70 = .70; IQ ≥ 70 = .46). Conclusions Proposed DSM-5 criteria 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.

Infants and toddlers with autism: The promise and the challenges

“…Yet another complication arises, as Camarata (2014) notes, from recent changes in nomenclature. These changes have been much debated (e.g., Huerta, Bishop, Duncan, Hus, & Lord, 2012;McPartland, Reichow, & Volkmar, 2012) and, although one of the rationales for change from DSM-IV/ICD-10 was concern about diagnosis in younger children, several studies now suggest that the new diagnostic guidelines may be overly stringent for young children as well as older and higher functioning ones (see Barton, Robins, Jashar, Brenna, & Fein, in press;Matson, Kozlowski, Hattier, Horovitz, & Sipes, 2012). As noted elsewhere, the increased awareness of genetic risk has presented issues of added urgency to screening in high risk populations, and the study of such populations, i.e., infant siblings of children with autism, has led to a substantive body of research (Szatmari, Jones, Holden, Bryson, Mahoney, Tuff, et al, 1996;Warren, Foss-Feig, Malesa, Lee, Taylor, Newsom, et al, 2012;Yirmiya, Gamliel, Pilowsky, Feldman, Baron-Cohen, & Sigman, 2006).…”

A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care: prevalence, treatment, risk assessment and other clinical considerations

“…Impairment to these two core areas varies across individuals in terms of symptoms and levels of severity. There has been much criticism over the proposed changes and final changes made in the DSM-V's new criteria for ASD (see Waterhouse, 2013;Wing, Gould, & Gillberg, 2011;McPartland, Reichow, & Volkmar, 2012;Ritvo, 2012;Fernell et al, 2012). However, a thorough discussion of this is outside the scope of this review.…”

Relationships between Sense of Coherence, Coping Strategies and Quality of Life of Parents of Children with Autism in Malaysia: A Case Study among Chinese Parents

“…The prevalence rate of ASD has been increasing dramatically over the past two decades, which may be due to change of diagnostic criteria, policy and practice changes, and greater awareness of the disorder (Levy et al, 2009;McPartland et al, 2012). It is estimated that about 1 in 110 children have been diagnosed with ASD, and more males have been diagnosed than females, with the sex ratio being about 4 males:1 female (Giarelli et al, 2010).…”