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DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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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Acknowledgements

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.

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Correspondence to Lisa D. Wiggins.

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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

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Keywords

  • Autism
  • Autism spectrum disorder
  • Diagnostic and Statistical Manual of Mental Disorders (DSM)
  • Diagnostic criteria