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Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers

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Abstract

Autism spectrum disorder (ASD) diagnosis is based on behavioral presentation; changes in conceptual models or defining behaviors may significantly impact diagnosis and uptake of ASD-specific interventions. The literature examining impact of DSM-5 criteria is equivocal. Toddlers may be especially vulnerable to the stringent requirements of impairment in all three social-communication symptoms and two restricted/repetitive symptoms. Receiver operating characteristic (ROC) curves identified optimal cutoffs for sums of ADOS and ADI-R criteria mapped to each criterion for 422 toddlers. The optimal modification of DSM-5 criteria (sensitivity = 0.93, specificity = 0.74) required meeting the ROC-determined cutoffs for 2/3 Domain A criteria and 1 point for 1/4 Domain B criteria. This modification will help insure that ASD is identified accurately in young children, facilitating ASD-specific early intervention.

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References

  • American Academy of Pediatrics, Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children with Special Needs Project Advisory Committee. (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118, 405–420.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Arlington, VA: American Psychiatric Association.

  • American Psychiatric Association Proposed Revision. (2011). Available at www.dsm5.org/ProposedRevisions/pages/proposedrevision.aspx?rid=94.

  • Ben-Itzchak, E., Lahat, E., Burgin, R., & Zachor, A. (2008). Cognitive, behavioral and intervention outcome in young children with autism. Research in Developmental Disabilities, 29, 447–458.

    Article  PubMed  Google Scholar 

  • Bishop, S. L., Richler, J., & Lord, C. (2006). Association between restricted and repetitive behaviors and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychology, 12(4–5), 247–267.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders—Autism and developmental disabilities monitoring network, United States, 2008. Morbidity and Mortal Weekly Report, 61(SS03), 1–19.

    Google Scholar 

  • Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2009). Randomized, controlled trial of an intervention for toddlers with autism: The early start Denver model. Pediatrics, 25(1), e17–e23.

    Google Scholar 

  • Fein, D., Barton, M., Eigsti, I.-M., Kelley, E., Naigles, L., Schultz, R., et al. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychiatry and Psychology, 54(2), 195–205.

    Article  Google Scholar 

  • Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J., et al. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 28–40.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M. (2010). Should the DSM-5 drop Asperger syndrome? Journal of Autism and Developmental Disorders, 40, 1146–1148.

    Article  PubMed  Google Scholar 

  • Gibbs, V., Aldridge, F., Chandler, F., Witslsperger, E., & Smith, K. (2012). Brief Report: An exploratory study comparing diagnostic outcomes for autism spectrums disorders under DSM-IV-TR with the proposed DSM-5 revision. Journal of Autism and Developmental Disorders, 42(8), 1750–1756.

    Article  PubMed  Google Scholar 

  • Happe, F. (2011). Criteria, categories and continua: autism and related disorders in DSM-5. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 540–542.

    Article  PubMed  Google Scholar 

  • Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., et al. (2008). Can children with autism recover? If so, how? Neuropsychology Reviews, 18, 339–366.

    Article  Google Scholar 

  • Huerta, M., Bishop, S., Duncan, A., Hus, V., & Lord, C. (2012). Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorder. American Journal of Psychiatry, 169, 1056–1064.

    Article  PubMed  Google Scholar 

  • LeCouteur, A., Rutter, M., Lord, C., & DiLavore, P. (2004). Toddler research autism diagnostic interview, revised edition. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • LeCouteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., et al. (1989). Autism diagnostic interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19, 363–387.

    Article  Google Scholar 

  • Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36(8), 1365–1382.

    Article  PubMed  Google Scholar 

  • Lord, C., Petkova, E., Hus, V., Gan, W. J., Lu, F., Martin, D. M., et al. (2012). A multi-site study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry, 69, 306–313.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule (ADOS). Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview, revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Mandy, W. P., Charman, T., & Skuse, D. H. (2012). Testing the construct validity of proposed criteria for DSM5 autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 41–50.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Belva, B. C., Horovitz, M., & Bamburg, J. (2012a). Comparing symptoms of autism spectrum disorders in a developmentally disabled adult population using the current DSM-IV-TR diagnostic criteria and the proposed DSM-5 diagnostic criteria. Journal of Developmental and Physical Disabilities, 24(4), 403–414.

    Article  Google Scholar 

  • Matson, J. L., Boisjoli, J. A., & Wilkins, J. (2007). The Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). Baton Rouge, LA: Disability Consultants, LLC.

    Google Scholar 

  • Matson, J. L., & Gonzalez, M. L. (2007). Autism spectrum disorders—Diagnosis—Child version. Baton Rouge, LA: Disability Consultants, LLC.

    Google Scholar 

  • Matson, J. L., Hattier, M. A. & Williams, L. W. (2012b). How does relaxing the algorithm for autism affect DSM V prevalence rates? Journal of Autism and Developmental Disorders (online first, June 26, 2012).

  • Matson, J. L., Kozlowski, A. M., Hattier, M. A., Horovitz, M., & Sipes, M. (2012c). DSM-IV versus DSM-5 diagnostic criteria for toddlers with autism. Developmental Neurorehabilitation, 15(3), 185–190.

    Article  PubMed  Google Scholar 

  • McPartland, J. C., Reichow, B., & Volkmar, F. R. (2012). Sensitivity and specificity of proposed DSM5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 368–383.

    Article  PubMed  Google Scholar 

  • Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism, 7(1), 47–63.

    PubMed  Google Scholar 

  • Newborg, J., Stock, J. R., Wnek, L., et al. (1988). Battelle developmental inventory. Allen, TX: DLM.

    Google Scholar 

  • Robins, D. L., Fein, D., & Barton, M. (1999). The modified checklist for autism in toddlers (M-CHAT). Self-published.

  • Rogers, S., & Vismara, L. (2008). Evidence-based comprehensive treatment for early autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8–38.

    PubMed  Google Scholar 

  • Rutter, M., Le Couteur, A., & Lord, C. (1991).Autism diagnostic interview, revised, research (3rd ed., Toddler Form). Unpublished.

  • Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism diagnostic interview, revised manual. Los Angeles, CA: Western Psychological Services.

    Google Scholar 

  • Skuse, D., Warrington, R., Bishop, D., Chowdbury, U., Lau, J., Mandy, W., et al. (2004). The developmental, dimensional and diagnostic interview (3DI): A novel computerized assessment for autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 548–558.

    Article  PubMed  Google Scholar 

  • Stone, W., Lee, E., Ashford, L., Brissie, J., Hepburn, S., Coonrud, E., et al. (1999). Can autism be diagnosed accurately in children under 3 years? Journal of Child Psychiatry and Psychology, 40(2), 219–226.

    Article  Google Scholar 

  • Swedo, S., Baird, G., Cook, E., Happe, F., Harris, J., Kaufmann, W., et al. (2012). Commentary from the DSM-5 work group on neurodevelopmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 347–349.

    Article  PubMed  Google Scholar 

  • Tsai, L. (2012). Sensitivity and specificity: DSM-IV versus DSM-5 criteria for autism spectrum disorder. American Journal of Psychiatry, 169(10), 1009–1011.

    Article  PubMed  Google Scholar 

  • Wiggins, L. D., Robins, D. L., Adamson, L. B., Bakeman, R., & Henrich, C. (2012). Support for a dimensional view of autism spectrum disorders in toddlers. Journal of Autism and Developmental Disorders, 42, 191–200.

    Article  PubMed  Google Scholar 

  • Wing, L. (1981). Language, social and cognitive impairments in autism and severe mental retardation. Journal of Autism and Developmental Disorders, 10, 31–44.

    Article  Google Scholar 

  • Worley, J. A., & Matson, J. L. (2012). Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR criteria and the proposed DSM V diagnostic criteria. Research in Autism Spectrum Disorders, 6, 965–970.

    Article  Google Scholar 

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Acknowledgments

We acknowledge the support of the National Institute of Child Health and Human Development, R01HD039961, for this study. We thank Karís Casagrande for assistance with the data. We also thank all of the families who participated in our study, and the physicians, medical staff, early intervention providers, and research staff who contributed to the study.

Conflict of interest

Diana L. Robins receives royalties from licensees developing electronic versions of the M-CHAT through M-CHAT, LLC. No royalties were received in relation to any of the data collected in this study.

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Authors and Affiliations

  1. Department of Psychology, University of Connecticut, Unit 1020, Storrs, CT, USA

    Marianne L. Barton, Dasal Jashar, Laura Brennan & Deborah Fein

  2. Department of Psychology, Georgia State University, PO Box 5010, Atlanta, GA, 30302-5010, USA

    Diana L. Robins

Authors
  1. Marianne L. Barton
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  2. Diana L. Robins
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  3. Dasal Jashar
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  4. Laura Brennan
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  5. Deborah Fein
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Correspondence to Diana L. Robins.

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Barton, M.L., Robins, D.L., Jashar, D. et al. Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers. J Autism Dev Disord 43, 1184–1195 (2013). https://doi.org/10.1007/s10803-013-1817-8

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