The criteria for autism spectrum disorder (ASD) were revised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The objective of this study was to compare the sensitivity and specificity of DSM-IV-Text Revision (DSM-IV-TR) and DSM-5 definitions of ASD in a community-based sample of preschool children.
Children between 2 and 5 years of age were enrolled in the Study to Explore Early Development-Phase 2 (SEED2) and received a comprehensive developmental evaluation. The clinician(s) who evaluated the child completed two diagnostic checklists that indicated the presence and severity of DSM-IV-TR and DSM-5 criteria. Definitions for DSM-5 ASD, DSM-IV-TR autistic disorder, and DSM-IV-TR Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) were created from the diagnostic checklists.
773 children met SEED2 criteria for ASD and 288 met criteria for another developmental disorder (DD). Agreement between DSM-5 and DSM-IV-TR definitions of ASD were good for autistic disorder (0.78) and moderate for PDD-NOS (0.57 and 0.59). Children who met DSM-IV-TR autistic disorder but not DSM-5 ASD (n = 71) were more likely to have mild ASD symptoms, or symptoms accounted for by another disorder. Children who met PDD-NOS but not DSM-5 ASD (n = 66), or vice versa (n = 120) were less likely to have intellectual disability and more likely to be female. Sensitivity and specificity were best balanced with DSM-5 ASD criteria (0.95 and 0.78, respectively).
The DSM-5 definition of ASD maximizes diagnostic sensitivity and specificity in the SEED2 sample. These findings support the DSM-5 conceptualization of ASD in preschool children.
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American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington
Buescher A, Cidav Z, Knapp M, Mandell DS (2014) Cost of autism spectrum disorders in the United Kingdom and United States. JAMA Pediatrics 168:721–728
Hock R, Ahmedani B (2012) Parent perceptions of autism severity: exploring the social ecological context. Dis Heal J 5:298–304
Jang J, Matson JL (2015) Autism severity as a predictor of comorbid conditions. J Dev Phys Disabil 27:405–415
Boyd BA, Odom SL, Humphreys BP, Sam AM (2010) Infants and toddlers with autism spectrum disorder: early identification and early intervention. J Earl Intervent 32:75–98
Corsello C (2005) Early intervention in autism. Inf Youn Children 18:74–85
Johnson CP, Myers SM, American Academy of Pediatrics, Council on Children with Disabilities (2007) Identification and evaluation of children with autism spectrum disorders. Pediatrics 120:1183–1215
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, text revision). Washington, DC
First MD, Pincus HA (2002) The DSM-IV text revision: rationale adn potential impact on clinical practice. Psych Serv 53:588–592
Volkmar FR, Shaffer D, First M (2000) PDDNOS in DSM-IV. J Autism Dev Disord 30:74–75
Levy SE, Giarelli E, Lee LC, Schieve L, Kirby R, Cunniff C et al (2010) Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Beh Pediatrics 31(4):267–275
Zwaigenbaum L, Bauman ML, Stone WL, Yirmiya N, Estes A, Harman R et al (2015) Early identification of autism spectrum disorder: implications for practice and research. Pediatrics 136:S10–S40
Swedo SE, Baird G, Cook EH, Happé FG, Harris JC, Kaufmann WE et al (2012) Commentary from the DSM-5 workgroup on neurodevelopmental disorders. J Amer Acad Child Adoles Psychiatry 51(4):347–349
Maenner MJ, Rice CE, Arneson CL, Cunniff C, Schieve LA, Carpenter LA et al (2014) Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates. JAMA Psychiatry 71(3):292–300
Mattila ML, Kielinen M, Linna SL, Jussila K, Ebeling H, Bloigu R et al (2011) Autism spectrum disorder according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. J Am Acad Child Adoles Psychiatry 50:583–592
Tsai LY (2014) Impact of DSM-5 on epidemiology of autism spectrum disorder. Res Aut Spec Disorders 8(11):1454–1470
Schendel D, DiGuiseppi C, Croen L, Fallin D, Reed P, Schieve L et al (2012) The Study to Explore Early Development (SEED): a multi-site epidemiologic study of autism by the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) Network. J Autism Dev Disord 42:2121–2140
DiGuiseppi C, Daniels J, Fallin D, Rosenberg S, Schieve L, Thomas K et al (2016) Demographic profile of families and children in the Study to Explore Early Development (SEED): case–control study of autism spectrum disorder. Dis Heal J 9:544–551
Rutter MA, Bailey A, Lord C (2003) The social communication questionnaire. Western Psychological Services, Los Angeles
Mullen E (1995) Mullen Scales of early learning. Pearson, San Antonio
Lord C, Rutter M, Le Couteur AL (1994) Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Aut Dev Disord 24:659–685
Gotham K, Risi S, Pickles A, Lord C (2007) The autism diagnostic observation schedule: revised algorithms for improved diagnostic validity. J Aut Dev Disord 37:613–627
Lord C, Rutter M, DiLavore PC, Risi S (1999) Autism diagnostic observation schedule. Western Psychological Services, Los Angeles
Sparrow S, Balla D, Cicchetti D (2005) Vineland adaptive behavior scales, 2nd edn. Pearson, San Antonio
Gray K, Tonge B, Sweeney D (2008) Using the autism diagnostic interview-revised and the autism diagnostic observation schedule with young children with developmental delay: evaluating diagnostic validity. J Aut Dev Disord 38:657–667
The Ohio State University (OSU) Research Unit on Pediatric Psychopharmacology (2005) OSU Autism Rating Scale (OARS; adapted for SEED) and Clinical Global Impression (CGI; adapted for SEED). Retrieved August 30, 2010 from http://psychmed.osu.edu/resources.htm
Constantino J (2002) The social responsiveness scale. Western Psychological Services, Los Angeles
Achenbach T (1992) Child behavior checklist. Achenbach System of Empirically Based Assessment, Burlington
Wiggins LD, Reynolds A, Rice C, Moody EJ, Bernal P, Blaskey L et al (2015) Using standardized diagnostic instruments to classify children with autism in the Study to Explore Early Development. J Aut Dev Disord 45:1271–1280
Mazurek MO, Lu F, Symecko H, Butter E, Bing NM, Hundley RJ et al (2017) A prospective study of the concordance of DSM-IV and DSM-5 diagnostic criteria of autism spectrum disorder. J Aut Dev Disord 47:2783–2794
Constantino J, Todd R (2003) Autistic traits in the general population: a twin study. Arch Gen Psychiatry 60:524–530
Wiggins LD, Levy SE, Daniels J, Schieve L, Croen LA, DiGuiseppi C et al (2015) Symptoms of autism spectrum disorder among children enrolled in the Study to Explore Early Development. J Aut Dev Disord 45:3183–3194
Rivet TT, Matson JL (2011) Review of gender differences in core symptomatology in autism spectrum disorders. Res Aut Spect Disord 5:957–976
Dworzynski K, Ronald A, Bolton R, Happe F (2012) How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? J Am Acad Chil Adoles Psychiatry 51:788–797
Frazier TW, Georgiades S, Bishop SL, Hardan AY (2014) Behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection. J Am Acad Chil Adoles Psychiatry 53:329–340
The investigators acknowledge the contributions made to this study by project staff and enrolled families. This publication was supported by six cooperative agreements from the Centers for Disease Control and Prevention (CDC): Cooperative Agreement Number U10DD000180, Colorado Department of Public Health; Cooperative Agreement Number U10DD000181, Kaiser Foundation Research Institute (CA); Cooperative Agreement Number U10DD000182, University of Pennsylvania; Cooperative Agreement Number U10DD000183, Johns Hopkins University; Cooperative Agreement Number U10DD000184, University of North Carolina at Chapel Hill; and Cooperative Agreement Number U10DD000498, Michigan State University and the Health Services and Resources Administration (HRSA) Maternal Child Health Bureau, Leadership Education in Neurodevelopmental Disabilities (LEND) Grant Award #T73MC11044. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Wiggins, L.D., Rice, C.E., Barger, B. et al. DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children. Soc Psychiatry Psychiatr Epidemiol 54, 693–701 (2019). https://doi.org/10.1007/s00127-019-01674-1
- Autism spectrum disorder
- Diagnostic and Statistical Manual of Mental Disorders (DSM)
- Diagnostic criteria