A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder
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The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger’s disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance.
KeywordsAutism spectrum disorder DSM-5 Concordance Sensitivity Specificity
The authors are extremely grateful to all the families and clinicians who participated in this study. This Network activity was supported by Autism Speaks and cooperative agreement UA3 MC11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. This work was conducted through the Autism Speaks Autism Treatment Network.
This project was supported by Autism Speaks and cooperative agreement UA3 MC11054 through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program to the Massachusetts General Hospital. This work was conducted through the Autism Speaks Autism Treatment Network.
MOM and BLH conceptualized and designed the study and drafted the initial manuscript. FL performed the statistical analyses and helped to draft the manuscript. EAM participated in the design of the study and guided statistical analyses. HS helped coordinate multi-site research processes and protocol development. EB, NMB, RJH, MP, and SMK collaborated in project development and data collection, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
Dr. Mazurek has received research support from National Institute of Mental Health (NIMH), Autism Speaks, and Health Resources and Services Administration (HRSA). Ms. Lu has received research support from Autism Speaks and HRSA. Dr. Butter has received research funding from NIMH, the Maternal and Child Health Bureau, Autism Speaks, the Simons Foundation for Autism Research, and the United State Department of Defense and has received fees as a training consultant from Roche Products, Ltd. Dr. Hundley has received speaker fees from Western Psychological Services. Dr. Macklin serves as a DSMB member for Acorda Therapeutics and Shire Human Genetic Therapies and receives research support from Adolph Coors Foundation, ALS Association, ALS Finding a Cure, Autism Speaks, Biotie Therapies, Michael J Fox Foundation, FDA, HRSA, NIH, and PCORI. Dr. Handen has received research support from Curemark, Neuropharm, Lilly, Forest, Bristol Myers Squibb, Roche, Pediamed, Pfizer and Autism Speaks.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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