Brief Report: DSM-5 “Levels of Support:” A Comment on Discrepant Conceptualizations of Severity in ASD
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Proposed DSM-5 revisions to the diagnosis of autism spectrum disorder (ASD) include a “severity” marker based on degree of impairment. Although qualitative differences between support levels are described, quantitative methods or practice recommendations for differentiating between levels remain undetermined. This leaves the field vulnerable to potential discrepancies between severity categorizations that may have inadvertent service implications. We examined overlap between mild, moderate, and severe impairment classifications based on autism symptoms, cognitive skills, and adaptive functioning in 726 participants (15 months—17 years) with ASD. Participants with mild, moderate, and severe autism symptoms demonstrated varying levels of adaptive and cognitive impairment. These discrepancies highlight the need for a clearly elucidated method of classifying level of support in ASD diagnosis.
KeywordsAutism Severity Diagnosis DSM-5
This study was supported by a Grant from the Vanderbilt Kennedy Center and the Marino Autism Research Institute. This includes core support from NCRR/NIH (UL1 RR024975-01), NICHD (P30HD15052), and NIMH (T32-MH18921). We gratefully acknowledge the contribution of the parents and children who took part in this study and the support of the clinical research staff of the Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders.
Conflict of interest
Katherine O. Gotham receives royalties for the Autism Diagnostic Observation Schedule, 2nd edition; all royalties from clinics and projects in which she is involved are donated to charity.
- American Psychatric Association. (2012). DSM-5 Development: Autistic disorder. Retrieved 10 July 2012 from http://www.dsm5.org/ProposedRevisions/.
- American Psychatric Association. (2013). DSM-5 Frequently asked questions: can you describe the dimensional assessments that are being considered for DSM-5? Retrieved 10 March 2013 from http://www.dsm5.org/about/Pages/faq.aspx#3.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th ed., tr). Washington, DC: Author.Google Scholar
- Bayley, N. (1993). Bayley scales of infant development (2nd ed.). San Antonio, TX: The Psychological Corporation.Google Scholar
- Bernier, R. (2012). How do we measure autism severity? SFARI Viewpoints. Retrieved July 2012 from http://sfari.org/news-and-opinion/viewpoint/2012/how-do-we-measure-autism-severity.
- Elliott, C. D. (2007). Differential ability scales (2nd ed.). San Antonio, TX: Harcourt Assessment.Google Scholar
- Hus, V., Gotham, K., & Lord, C. (2012). Standardizing ADOS Domain scores: Separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-012-1719-1.
- Kaufman, A. S., & Kaufman, N. L. (1990). Kaufman brief intelligence test: Manual. Circle Pines, MN: American Guidance Service.Google Scholar
- Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr, Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.Google Scholar
- Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. L. (2012a). Autism diagnostic observation schedule (ADOS-2): manual (2nd ed.). Los Angeles: Western Psychological Services.Google Scholar
- Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service.Google Scholar
- Roid, G. H. (2003). Stanford-binet intelligence scales, examiner manual (5th ed.). Itasca, IL: Riverside.Google Scholar
- Roid, G. M., & Miller, L. J. (1997). Leiter international performance scale—revised: Examiners manual . Wood Dale, IL: Stoelting Co.Google Scholar
- Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales, (Vineland-II). Circle Pines, MN: American Guidance Services.Google Scholar
- Warren, Z. E., & Stone, W. L. (2011). Clinical best practices: Diagnosis and assessment of young children. In D. Amaral, G. Dawson, & D. Gerschwind (Eds.), Autism spectrum disorders (pp. 1269–1280). New York: Oxford University Press.Google Scholar
- Wechsler, D. (2002). Wechsler preschool and primary scale of intelligence (3rd ed.). San Antonio, TX: Harcourt Assessment, Inc.Google Scholar
- Wechsler, D. (2003). Wechsler intelligence scale for children—fourth edition administration & scoring manual. San Antonio, TX: Psychological Corporation.Google Scholar