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Journal of Autism and Developmental Disorders

, Volume 43, Issue 8, pp 1784–1797 | Cite as

Empirically Based Phenotypic Profiles of Children with Pervasive Developmental Disorders: Interpretation in the Light of the DSM-5

  • Kirstin Greaves-LordEmail author
  • Mart L. J. M. Eussen
  • Frank C. Verhulst
  • Ruud B. Minderaa
  • William Mandy
  • James J. Hudziak
  • Mark Peter Steenhuis
  • Pieter F. de Nijs
  • Catharina A. Hartman
Original Paper

Abstract

This study aimed to contribute to the Diagnostic and Statistical Manual (DSM) debates on the conceptualization of autism by investigating (1) whether empirically based distinct phenotypic profiles could be distinguished within a sample of mainly cognitively able children with pervasive developmental disorder (PDD), and (2) how profiles related to diagnoses and co-occurring behavioral and emotional problems. Six classes with distinct profiles were discerned. Three classes showed profiles not completely in line with the proposed DSM-5 conceptualization of autism. These classes included relatively many cognitively able individuals with PDD-not otherwise specified. However, profiles seemed to suit other diagnostic categories, such as social communication disorder. These alternative diagnoses could retain eligibility for services, and might adequately fit more specifically targeted interventions.

Keywords

Autism spectrum disorders DSM-5 Phenotypic profiles Comorbidity 

Notes

Acknowledgments

The authors thank all children and parents who participated in the study. The project was supported financially by all participating centres. We thank all our research colleagues for their helpful suggestions.

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edition TR). Washington D.C.: American Psychiatric Press.Google Scholar
  3. American Psychiatric Association (2012). DSM-5 Development. Proposed Revision A 05 Autism Spectrum Disorder. www.dsm5.org/ProposedRevisions. Accessed 30th Sept 2012.
  4. Axelson, D. A., Birmaher, B., Findling, R. L., Fristad, M. A., Kowatch, R. A., Youngstrom, E. A., et al. (2011). Concerns regarding the inclusion of temper dysregulation disorder with dysphoria in the diagnostic and statistical manual of mental disorders, fifth edition. Journal of Clinical Psychiatry, 72(9), 1257–1262.PubMedCrossRefGoogle Scholar
  5. Bishop, D. V. M., & Norbury, C. F. (2002). Exploring the borderlands of autistic disorder and specific language impairment: a study using standardized diagnostic instruments. Journal of Child Psychology and Psychiatry, 43(7), 917–929.PubMedCrossRefGoogle Scholar
  6. Blijd-Hoogewys, E. M., van Geert, P. L., Serra, M., & Minderaa, R. B. (2008). Measuring theory of mind in children. Psychometric properties of the ToM Storybooks. Journal of Autism and Developmental Disorders, 38, 1907–1930.PubMedCrossRefGoogle Scholar
  7. Buitelaar, J. K., Van der Gaag, R., Klin, A., & Volkmar, F. (1999). Exploring the boundaries of pervasive developmental disorder not otherwise specified: Analyses of data from the DSM-IV autistic disorder field trial. Journal of Autism and Developmental Disorders, 29, 33–43.PubMedCrossRefGoogle Scholar
  8. Carey, B. (2012). New definition of autism will exclude many, study suggests. New York: New York Times.Google Scholar
  9. Cohen, J. (1988). Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates, Inc.Google Scholar
  10. Constantino, J. N. (2009). How continua converge in nature: Cognition, social competence, and autistic syndromes. Journal of American Academic Child Adolescence Psychiatry, 48(2), 97–98.CrossRefGoogle Scholar
  11. De Bildt, A., Serra, M., Luteijn, E., Kraijer, D., Sytema, S., & Minderaa, R. B. (2005). Social skills in children with intellectual disabilities with and without autism. Journal of Intellectual Disability Research, 49, 317–328.PubMedCrossRefGoogle Scholar
  12. De Bildt, A., Mulder, E. J., Hoekstra, P. J., Van Lang, N. D., Minderaa, R. B., & Hartman, C. A. (2009). Validity of the children’s social behavior questionnaire (CSBQ) in children with mental retardation: comparing the CSBQ with ADI-R, ADOS, and clinical DSM-IV-TR classification. Journal of Autism and Developmental Disorders, 39, 1464–1470.PubMedCrossRefGoogle Scholar
  13. De Bruin, E. I., & Verheij, F. (2012). Social skills training in children with PDD-NOS: An exploratory study. International Journal of Psychiatry Clinical Practice, 16(1), 60–67.CrossRefGoogle Scholar
  14. De Bruin, E. I., Ferdinand, R. F., Meester, S., De Nijs, P. F. A., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders, 37, 877–886.PubMedCrossRefGoogle Scholar
  15. Eagle, R. F., Romanczyk, R. G., & Lenzensweger, M. F. (2010). Classification of children with autism spectrum disorders: A finite mixture modelling approach to heterogeneity. Research in Autism Spectrum disorders, 4(4), 772–781.CrossRefGoogle Scholar
  16. Excoffier, E., Vila, G., Taupiac, E., Mouren-Simeoni, M. C., & Bouvard, M. P. (2007). Dimensional approach of social behaviour deficits in children. Preliminary validation study of the French version of the Children’s Social Behaviour Questionnaire (CSBQ). Encephale, 33(4), 585–591.PubMedCrossRefGoogle Scholar
  17. Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J. N., et al. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 28–40.PubMedCrossRefGoogle Scholar
  18. Gadow, K. D., De Vincent, C. J., Pomeroy, J., & Azizian, A. (2004). Psychiatric symptoms in preschool children with PDD and clinic and comparison samples. Journal of Autism and Developmental Disorders, 34, 379–393.PubMedCrossRefGoogle Scholar
  19. Geurts, H. M., Luman, M., & van Meel, C. S. (2008). What’s in a game: The effect of social motivation on interference control in boys with ADHD and autism spectrum disorders. Journal of Child Psychology and Psychiatry, 49, 848–857.PubMedCrossRefGoogle Scholar
  20. Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37, 613–627.PubMedCrossRefGoogle Scholar
  21. Gotham, K., Risi, S., Dawson, G., Tager-Flusberg, H., Joseph, R., Carter, A., et al. (2008). A replication of the autism diagnostic observation schedule (ADOS) revised algorithm. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 642–651.PubMedCrossRefGoogle Scholar
  22. Happé, F., & Ronald, A. (2008). The ‘fractionable autism triad’: A review of evidence from behavioral, genetic, cognitive and neural research. Neuropsychological Review, 18, 287–304.CrossRefGoogle Scholar
  23. Happé, F., Ronald, A., & Plomin, R. (2006). Time to give up on a single explanation for autism. Nature Neuroscience, 9(10), 1218–1220.PubMedCrossRefGoogle Scholar
  24. Hartman, C. A., Luteijn, E., Serra, M., & Minderaa, R. (2006). Refinement of the children’s social behavior questionnaire (CSBQ): An instrument that describes the diverse problems seen in milder forms of PDD. Journal of Autism and Developmental Disorders, 36, 325–342.PubMedCrossRefGoogle Scholar
  25. Hartman, C. A., Luteijn, E., Moorlag, A., de Bildt, A., & Minderaa, R. (2007). Manual for the CSBQ [Handleiding voor de VISK]. Amsterdam: Harcourt.Google Scholar
  26. Jaspers, M., de Winter, A. F., Buitelaar, J. K., Verhulst, F. C., Reijneveld, S. A., & Hartman, C. A. (2012). Early childhood assessments of community pediatric professionals predict autism spectrum and attention deficit hyperactivity problems. Journal of Abnormal Child Psychology (accepted).Google Scholar
  27. Kaland, N. (2011). Should Asperger syndrome be excluded from the forthcoming DSM-V? Research in Autism Spectrum Disorders, 5(3), 984–999.CrossRefGoogle Scholar
  28. Kamp-Becker, I., Smidt, J., Ghahreman, M., Heinzel-Gutenbrunner, M., Becker, K., & Remschmidt, H. (2010). Categorical and dimensional structure of autism spectrum disorders: The nosologic validity of asperger syndrome. Journal of the Autism and Developmental Disorders, 40(8), 291–299.Google Scholar
  29. Kanne, S. K., Abachi, A. M., & Constantino, J. N. (2009). Multi-informant ratings of psychiatric symptom severity in children with autism spectrum disorders: The importance of environmental context. Journal of Autism and Developmental Disorders, 39, 856–864.PubMedCrossRefGoogle Scholar
  30. Kass, R. E., & Wasserman, L. (1995). A reference Bayesian test for nested hypotheses and its relationship to the Schwarz criterion. Journal of the American Statistical Association, 90, 928–934.CrossRefGoogle Scholar
  31. Klin, A., Lang, J., Cicchetti, D. V., & Volkmar, F. R. (2000). Brief report: Interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: Results of the DSM-IV autism field trial. Journal of Autism and Developmental Disorders, 30, 163–167.PubMedCrossRefGoogle Scholar
  32. Krol, N. P. C. M., De Bruyn, E. E. J., Coolen, J. C., & van Aarle, E. J. M. (2006). From CBCL to DSM: A comparison of two methods to screen for DSM-IV diagnoses using CBCL Data. Journal of Clinical Child and Adolescent Psychology, 35(1), 127–135.PubMedCrossRefGoogle Scholar
  33. Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861.Google Scholar
  34. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule-WPS (ADOS-WPS). Los Angeles: Western Psychological Services.Google Scholar
  35. Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 Years of Age. Archives of General Psychiatry, 63, 694–701.PubMedCrossRefGoogle Scholar
  36. Lord, C., Petkova, E., Hus, V., Gan, W., Lu, F., Martin, D. M., et al. (2011). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry, 69(3), 306–313.PubMedCrossRefGoogle Scholar
  37. Luteijn, E. F., Jackson, A. E., Volkmar, F. R., & Minderaa, R. B. (1998). The development of the Children’s Social Behavior Questionnaire: Preliminary data. Journal of Autism and Developmental Disorders, 28, 559–565.PubMedCrossRefGoogle Scholar
  38. Luteijn, E. F., Luteijn, F., Jackson, A. E., Volkmar, F. R., & Minderaa, R. B. (2000a). The children’s social behavior questionnaire for milder variants of PDD problems: Evaluation of the psychometric characteristics. Journal of Autism and Developmental Disorders, 30, 317–330.PubMedCrossRefGoogle Scholar
  39. Luteijn, E. F., Serra, M., Jackson, A. E., Steenhuis, M. P., Althaus, M., Volkmar, F. R., et al. (2000b). How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified? A study of social problems in children with PDDNOS and or ADHD. European Child and Adolescent Psychiatry, 9, 168–179.PubMedCrossRefGoogle Scholar
  40. Mandy, W. P., Charman, T., Gilmour, J., & Skuse, D. H. (2011). Towards specifying pervasive developmental disorder-not otherwise specified. Autism Research, 4, 1–11.CrossRefGoogle Scholar
  41. Mandy, W. P., Charman, T., & Skuse, D. H. (2012). Testing the construct validity of proposed criteria for DSM-5 autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 41–50.PubMedCrossRefGoogle Scholar
  42. Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28, 341–352.PubMedCrossRefGoogle Scholar
  43. McPartland, J. C., Reichow, B., & Volkmar, F. R. (2012). Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 368–383.PubMedCrossRefGoogle Scholar
  44. Mooney, E. L., Gray, K. M., Tonge, B. J., Sweeney, D. J., & Taffe, J. R. (2009). Factor analytic study of repetitive behaviours in young children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 39, 765–774.PubMedCrossRefGoogle Scholar
  45. Muthén, L. K., & Muthén, B. O. (2007). Mplus. statistical analyses with latent variables. User’s guide (4th ed.). Los Angeles: Muthén & Muthén.Google Scholar
  46. Nijmeijer, J. S., Hoekstra, P. J., Minderaa, R. B., Buitelaar, J. K., Altink, M. E., Buschgens, C. J., et al. (2008). PDD Symptoms in ADHD, an Independent Familial Trait? Journal of Abnormal Child Psychology, 37, 443–453.CrossRefGoogle Scholar
  47. Nijmeijer, J. S., Hartman, C. A., Rommelse, N. J., Altink, M. E., Buschens, C. J. M., Fliers, E., et al. (2010). Perinatal risk factors interacting with Catechol O-Methyltransferase and the serotonin transporter gene predict ASD symptoms in Children With ADH). Journal of Child Psychology and Psychiatry, 51, 1242–1250.PubMedCrossRefGoogle Scholar
  48. Nijmeijer, J. S., Hartman, C. A., Rommelse, N. N., Altink, M. E., Buschgens, C. J., Fliers, E. A., et al. (2011). Perinatal risk factors interacting with catechol O-methyltransferase and the serotonin transporter gene predict ASD symptoms in children with ADHD. Journal of Child Psychology and Psychiatry, 51(11), 1242–1250.CrossRefGoogle Scholar
  49. Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analyses and growth mixture modelling: A monte carlo simulation study. Structural Equation Modelling, 14(4), 535–569.CrossRefGoogle Scholar
  50. Pearson, D. A., Loveland, K. A., Lachar, D., Lane, D. M., Reddoch, S. L., Manosur, R., et al. (2006). A Comparison of behavioral and emotional functioning in children and adolescents with autistic disorder and PPD NOS. Child Neuropsychology, 1, 321–333.CrossRefGoogle Scholar
  51. Robins, E., & Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126(7), 983–987.PubMedGoogle Scholar
  52. Rommelse, N., Altink, M. E., Fliers, E. A., Martin, N. C., Buschgens, C. J., & Hartman, C. A. (2009). Comorbid problems in ADHD: Degree of association, shared endophenotypes, and formation of distinct subtypes. Implications for a future DSM. Journal of Abnormal Child Psychology, 37, 793–804.PubMedCrossRefGoogle Scholar
  53. Ronald, A., Happé, F., & Plomin, R. (2005). The genetic relationship between individual differences in social and non-social behaviors characteristic of autism. Developmental Science, 8, 444–458.PubMedCrossRefGoogle Scholar
  54. Rutter, M., Le Couteur, A., & Lord, C. (2003). The Autism Diagnostic Interview-Revised: Manual. Los Angeles: CA: Western.Google Scholar
  55. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.Google Scholar
  56. Skuse, D. H. (2012). DSM-5’s conceptualization of autistic disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 344–346.Google Scholar
  57. Snow, A. V., & Lecavalier, L. (2011). Comparing autism, PDD-NOS, and other developmental disabilities on parent-reported behavior problems: Little evidence for ASD subtype validity. Journal of Autism and Developmental Disorders, 41, 302–310.PubMedCrossRefGoogle Scholar
  58. Stevens, M. C., Fein, D. A., Dunn, M., Allen, D., Waterhouse, L. H., Feinstein, C., et al. (2000). Subgroups of children with autism by cluster analysis: a longitudinal examination. Journal of American Academic Child Adolescence Psychiatry, 39(3), 246–352.Google Scholar
  59. ‘t Hart-Kerkhoffs, L. A., Jansen, L. M., Doreleijers, T. A., Vermeiren, R. A., Minderaa, R. B., & Hartman, C. A. (2009). Autism spectrum disorder symptoms in juvenile suspects of sex offenses. The Journal of Clinical Psychiatry, 70, 266–272.PubMedCrossRefGoogle Scholar
  60. Vander Steene, G., Van Haasen, P. P., De Bruyn, E. E. J., Coetsier, P., Pijl, Y. J., Poortinga, Y. H., et al. (1986). Verantwoording WISC-R, Nederlandse uitgave (Justification WISC-R, Dutch release). Lisse: Swets & Zeitlinger.Google Scholar
  61. Verhulst, F.C, Ende van der, J., & Koot, H.M. (1996). Manual for the Child Behvior Checklist (in Dutch). Rotterdam, the Netherlands: Department of Child and Adolescent Psychiatry, ErasmusMC/Sophia Children’s Hospital.Google Scholar
  62. Walker, D. R., Thompson, A., Zwaigenbaum, L., Goldberg, J., Bryson, S. E., et al. (2004). Specifying PDD-NOS: A comparison of PDD-NOS, Asperger syndrome, and autism. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 172–180.PubMedCrossRefGoogle Scholar
  63. Witwer, A. N., & Lecavalier, L. (2008). Examining the validity of autism spectrum disorder subtypes. Journal of Autism and Developmental Disorders, 38, 1611–1624.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Kirstin Greaves-Lord
    • 1
    • 2
    Email author
  • Mart L. J. M. Eussen
    • 2
    • 1
  • Frank C. Verhulst
    • 1
  • Ruud B. Minderaa
    • 3
  • William Mandy
    • 4
  • James J. Hudziak
    • 5
  • Mark Peter Steenhuis
    • 3
  • Pieter F. de Nijs
    • 1
  • Catharina A. Hartman
    • 3
  1. 1.Department of Child and Adolescent Psychiatry/PsychologyErasmus Medical Center Rotterdam/Sophia Children’s HospitalRotterdamThe Netherlands
  2. 2.Yulius AcademyYulius Mental HealthDordrechtThe Netherlands
  3. 3.Department of PsychiatryUniversity Medical Center GroningenGroningenThe Netherlands
  4. 4.Division of Psychology & Language Sciences, Faculty of Brain SciencesUniversity College LondonLondonUK
  5. 5.Department of Psychiatry, Divisions of Child Psychiatry and Behavioral GeneticsUniversity of VermontBurlingtonUSA

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