Abstract
Our study examines the Diagnostic and Statistical Manual—Fifth Edition (DSM-5) and Diagnostic and Statistical Manual—Fourth Edition, Text Revision (DSM-IV-TR) when applied concurrently against the best estimate clinical diagnoses for 110 children (5.1–19.6 years old) referred for diagnostic assessments of Autism Spectrum Disorder (ASD) in a Singaporean outpatient speciality clinic. DSM-IV-TR performed slightly better, yielding sensitivity of 0.946 and specificity of 0.889, compared to DSM-5 (sensitivity = 0.837; specificity = 0.833). When considering the ASD sub-categories, sensitivity ranged from 0.667 to 0.933, and specificity ranged from 0.900 to 0.975. More participants with a PDD-NOS best estimate clinical diagnosis (40%) were misclassified on DSM-5. Merits and weaknesses to both classification systems, and implications for access to services and policy changes are discussed.
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Notes
Sensitivity = true positive ÷ (true positive + false negative).Specificity = true negative ÷ (true negative + false positive).Precision/positive predictive value = true positive ÷ (true positive + false positive).Accuracy = (true positive + true negative) ÷ (true positive + false positive + false negative + true negative).
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Acknowledgments
We would like to acknowledge the clinical team at IMH Department of Child and Adolescent Psychiatry for their participation and clinical input. They include but are not limited to Dr. Chin Chee Hon, Dr. Lim Choon Guan, Ms. Kheng Joo Lian, Ms. Pearl Lock Shern Xi, Mr. Oon Jit Hui, Ms. Magdalene Foo Tze Suang, Ms. Cindy Kua Shu Mei, Mr. Soh Wei Jie, and Ms. Jade Jang Leong Yeok. We would also like to express our thanks to the medical students, Ms. Hui Tian Yi and Ms. Lim Ee Wen, who helped to tabulate the data for the blind review in the paper.
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MS conceived of the study and facilitated its coordination; TJG designed the study, oversaw its execution, and conducted the statistical analysis and interpretation of the data; BLJT and JSC both assisted in the data processing and analysis. LHSA facilitated its execution and provided advice to the clinical team. All authors participated in drafting, reading, and approval of the final manuscript.
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Sung, M., Goh, T.J., Tan, B.L.J. et al. Comparison of DSM-IV-TR and DSM-5 Criteria in Diagnosing Autism Spectrum Disorders in Singapore. J Autism Dev Disord 48, 3273–3281 (2018). https://doi.org/10.1007/s10803-018-3594-x
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DOI: https://doi.org/10.1007/s10803-018-3594-x