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Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

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A Correction to this article was published on 29 January 2022

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Abstract

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60–.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

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Funding

Funding for the SC SUCCESS project was provided by Autism Speaks (Grant No. 7793 and 8408), Foundation for the National Institutes of Health (Grant No. UL1TR001450), and the Centers for Disease Control and Prevention (Grant No. DD10-1002). Funding for co-author (Thurm), Intramural Research Program of the NIMH (1ZICMH002961). The ADDM Network is supported by the Department of Health and Human Services, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.

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Authors and Affiliations

  1. Emory University, Atlanta, GA, USA

    C. E. Rice & M. J. Morrier

  2. Centers for Disease Control and Prevention, Atlanta, GA, USA

    C. E. Rice, M. DiRienzo, J. Baio & L. D. Wiggins

  3. Medical University of South Carolina, Charleston, SC, USA

    L. A. Carpenter & A. Boan

  4. University of California Los Angeles, Los Angeles, CA, USA

    C. Lord

  5. Washington University in St. Louis, St. Louis, MO, USA

    C. Skowyra

  6. Rutgers New Jersey Medical School, Newark, NJ, USA

    A. Fusco & W. Zahorodny

  7. University of Minnesota, Minneapolis, MN, USA

    A. Esler

  8. Independent Consultant, Keller, TX, USA

    N. Hobson

  9. Hunterdon Healthcare System, Flemington, NJ, USA

    A. Mars

  10. National Institute of Mental Health, Bethesda, MD, USA

    A. Thurm

  11. University of California San Francisco, San Francisco, CA, USA

    S. Bishop

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  1. C. E. Rice
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  2. L. A. Carpenter
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  16. L. D. Wiggins
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Contributions

CER and LAC led the first phase of the DSM-5 ASD criteria mapping and all co-authors contributed to subsequent refinements. LAC led the SC SUCCESS Project. AB analyzed the SC data and JB the ADDM Network data. The first draft of the manuscript was written by CER. All authors commented drafts of the manuscript and approved the final manuscript.

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Correspondence to C. E. Rice.

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Conflict of interest

C. Lord acknowledges royalties from diagnostic instruments from Western Psychological Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of CDC, NIH, or Autism Speaks.

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Rice, C.E., Carpenter, L.A., Morrier, M.J. et al. Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children. J Autism Dev Disord 52, 5308–5320 (2022). https://doi.org/10.1007/s10803-021-05377-y

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