Brief Report: Comparability of DSM-IV and DSM-5 ASD Research Samples
Open accessAbstract
Diagnostic and Statistical Manual (DSM-5) criteria for ASD have been criticized for being too restrictive, especially for more cognitively-able individuals. It is unclear, however, if high-functioning individuals deemed eligible for research via standardized diagnostic assessments would meet DSM-5 criteria. This study investigated the impact of DSM-5 on the diagnostic status of 498 high-functioning participants with ASD research diagnoses. The percent of participants satisfying all DSM-5-requirements varied significantly with reliance on data from the Autism Diagnostic Observation Schedule (ADOS; 33 %) versus Autism Diagnostic Interview-Revised (ADI-R; 83 %), highlighting the impact of diagnostic methodology on ability to document DSM-5 symptoms. Utilizing combined ADOS/ADI-R data, 93 % of participants met DSM-5 criteria, which suggests likely continuity between DSM-IV and DSM-5 research samples characterized with these instruments in combination.
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Using multiple sources of information together in assessment can dramatically increase the likelihood of identifying autism.
“which can dramatically increase the likelihood of identifying autism [27, 28].”
From Lobbying Autism's Diagnostic Revision in the DSM-5 (2020) · cites this paper as [28]
The Results (page not provided) show that combining ADOS and ADI-R data increased the proportion with evidence across the required DSM-5 domains compared with either measure alone. But the study assessed participants who already had ASD research diagnoses; it does not establish a dramatic increase in identifying autism in assessments generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredASAN successfully encouraged language in the DSM-5 recommending that multiple sources of information be used together in assessment to identify behaviors that do not always present clinically.
“Through our comments on confidential drafts of the diagnostic text, ASAN successfully encouraged language recommending that multiple sources of information be used together in assessment to identify behaviors that do not always present clinically, such as direct observation and interaction, interview on history, and other reports, which can dramatically increase the likelihood of identifying autis”
From Lobbying Autism's Diagnostic Revision in the DSM-5 (2020) · cites this paper as [28]
The Discussion reports that observation alone identified fewer participants meeting the proposed DSM-5 criteria than interview information did, and concludes that collateral information becomes more essential with DSM-5. It supports the value of combining information to identify symptoms missed in observation, but does not say that ASAN influenced DSM-5 wording or establish what the final diagnostic text recommended. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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“…93% who met diagnostic criteria for autism spectrum disorder (ASD) under the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R) also met criteria under the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; Mazefsky et al., 2013).”
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“Some studies demonstrate very high consistency, whereas others demonstrate more discrepancy, particularly in those previously given a PDDNOS diagnosis.(2,3) Of note, from a clinical perspective, a child diagnosed through DSM-IV need not be reevaluated for diagnostic purposes simply because of the changes in DSM-5.”
ResultPatterns of autism symptoms: hidden structure in the ADOS and ADI-R instruments
Lefort‐Besnard, J., Vogeley, K. T., Schilbach, L., Varoquaux, G. P., Thirion, B., Dumas, G., & Bzdok, D. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-00946-8 · Cited by 36 · see citing works
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“Among these, mood instability, aggression (self-directed and/or toward others), repetitive and restrictive behaviors, seizure episodes, and comorbidity with echolalia, epilepsy, sleep disorders and attention deficit/hyperactivity disorder aremarkedly common in probands with ASD (Levy et al., 2009; Grossi et al., 2012;…”
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“However, when combined ADOS/ADI-R data is used to establish an ASD diagnosis, the majority of participants (93%) meet DSM-5 criteria for ASD (Mazefsky et al., 2013).”
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“Reductions were not uniform, but were much smaller in individuals with more severe forms of ASD, but were approximately two thirds for less severe forms of Mattila et al. (2011) 54 % Reduction N=12/26 AD: 100 % reduction N=0/11 Low IQ: 0 % reduction N=4/4 IQ=50–69High IQ: 63.6 % reduction N=8/22 IQ >70 Gibbs et al. (2…”
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“The reported true positive rate for DSM-5 conforms with previous research which showed that 93% of subjects diagnosed according to the CPEA dx variable met DSM-5 criteria [52].”
ResultDSM-5 Diagnostic Criteria for Autism Spectrum Disorder With Implications for School Psychologists
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“A recent study evaluated whether the ADI-R and ADOS would adequately document DSM-5 symptoms, using a research sample of individuals with ASD carefully characterized and diagnosed according to DSM-IV criteria (Mazefsky et al., 2013).”
MethodPhillips, H., Wright, B., Allgar, V. L., McConachie, H., Sweetman, J., Hargate, R., Hodkinson, R., Bland, M., George, H. R., Hughes, A., et al. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04931-y · Cited by 22 · see citing works
Diagnostic Utility of the ADI-R and DSM-5 in the Assessment of Latino Children and Adolescents
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“1994), concerns were raised that the ADOS may not allow for observations of the complete profile of ASD characteristics and thus, may not be sufficient within the DSM-5 framework (Barton et al. 2013; Mazefsky et al. 2013).”
BackgroundMethodA Comparative Analysis of the ADOS-G and ADOS-2 Algorithms: Preliminary Findings
Dorlack, T. P., Myers, O., & Kodituwakku, P. W. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3475-3 · Cited by 21 · see citing works
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“ADI-R or ADOS were not independently diagnosed on our part, considering that there was a high degree of agreement between clinical and research diagnoses [68], thus avoiding excessive diagnosis; however, this lack of diagnosis can be seen as a limitation of the methodology.”
BackgroundHyper-Sensitivity to Pitch and Poorer Prosody Processing in Adults With Autism: An ERP Study
Haigh, S. M., Brosseau, P., Eack, S. M., Leitman, D. I., Salisbury, D. F., & Behrmann, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.844830 · Cited by 19 · see citing works
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Comparison of DSM-IV-TR and DSM-5 Criteria in Diagnosing Autism Spectrum Disorders in Singapore
Sung, M., Goh, T. J., Tan, B. L. J., Chan, J. S., & Liew, H. S. A. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3594-x · Cited by 15 · see citing works
“While we are also cognizant that the ADI-R and ADOS used to facilitate information collection were developed using the DSM-IV-TR, efforts to update these tools are underway (Barton et al. 2013; Mazefsky et al. 2013).”
MethodScientific challenges in developing biological markers for autism
Hewitson, L. C. (2013) · OA Autism · doi:10.13172/2052-7810-1-1-474 · Cited by 13 · see citing works
Kwon, H., Kim, J. I., Son, S., Jang, Y. H., Kim, B.-N., Lee, H. J., & Lee, J. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.935431 · Cited by 13 · see citing works
“Although a discrepancy in the ability of the ADOS to capture ASD symptoms cataloged in the DSM-5 has been suggested, the ADI-R is more relevant than the ADOS for encompassing the breadth of ASD symptoms as defined by DSM-5 (Mazefsky et al., 2013).”
BackgroundFischbach, A. L., Hindenach, A., van der Miesen, A. I. R., Yang, J. S., Buckley, O. J., Song, M., Campos, L., & Strang, J. F. (2024) · British Journal of Developmental Psychology · doi:10.1111/bjdp.12486 · Cited by 12 · see citing works
Validation of the Korean Childhood Autism Rating Scale-2
Lee, S., Yoon, S., & Shin, M. (2023) · Research in Autism · doi:10.1016/j.rasd.2023.102128 · Cited by 11 · see citing works
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Autism assessment tools in the transition from DSM-IV to DSM-5
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“[15] using combined ADOS and ADI-R ratings showed that 93 % of patients met the criteria for both classification systems, whereas Barton et al.”
MethodApplying Item Response Theory Modeling to Identify Social (Pragmatic) Communication Disorder
Yuan, H., & Dollaghan, C. A. (2020) · Journal of Speech Language and Hearing Research · doi:10.1044/2020_jslhr-19-00284 · Cited by 8 · see citing works
Lai, K. Y. C., Yuen, E. C. W., Hung, S. F., & Leung, P. W. L. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05079-5 · Cited by 8 · see citing works
The Evolution of Autism as a Diagnostic Concept: From Kanner to DSM-5: A commentary
Volkmar, F. R., & Reichow, B. (2014) · Autism and child psychopathology series · doi:10.1007/978-3-319-06796-4_15 · Cited by 7 · see citing works
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Abnormalities in brain systems supporting individuation and enumeration in autism
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Self-citationGardner, L. M., Erkfritz-Gay, K. N., Campbell, J. M., Bradley, T. L., & Murphy, L. E. (2016) · Autism and child psychopathology series · doi:10.1007/978-3-319-27171-2_3 · Cited by 6 · see citing works
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“Studies using ADI-R have shown that parental reports can achieve higher classifi-cation performance than the gold-standard ADOS [23], particularly leveraging question domains tailored to specific symptoms [24].”
Giorlandino, C., Margiotti, K., Fabiani, M., Mesoraca, A., D’Emidio, L., Raffio, R., Coco, C., Mastrandrea, M. L., Pasquale, C., Cupellaro, M., et al. (2025) · Brain and Behavior · doi:10.1002/brb3.71088 · Cited by 5 · see citing works
“Examinations were conducted by trained clinicians blinded to maternal FRAA results, and all diagnoses were confirmed according to DSM-5 criteria (Mazefsky et al. 2013).”
Artificial Intelligence and Learning of Students with Dyslexia: A Brief Review
Dabaghi, K., D’Urso, S., & Sciarrone, F. (2024) · Lecture notes in computer science · doi:10.1007/978-981-97-4243-1_13 · Cited by 5 · see citing works
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Adaptive Behavior Function in Autism: Association with ADHD and ASD Symptoms
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Schuch, J. B., Müller, D., Endres, R. G., Bosa, C. A., Longo, D., Schüler‐Faccini, L., Ranzan, J., Becker, M. M., Riesgo, R. D. S., & Roman, T. (2016) · Research in Autism · doi:10.1016/j.rasd.2016.03.001 · Cited by 4 · see citing works
Evidence-based medicine: A non-starter in India?
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NUEVAS FORMAS DE ABORDAJE DEL PROCESO DIAGNÓSTICO DEL TEA DESPUÉS DEL DSM-5
Sevilla, M. D. S. F., Bermúdez, M. O. E., & Sánchez, J. J. C. (2016) · International Journal of Developmental and Educational Psychology Revista INFAD de psicología · doi:10.17060/ijodaep.2014.n1.v1.367 · Cited by 3 · see citing works
DSM-5 Criteria for ASD: Research Review and Commentary
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Self-citationPatterns of Autism Symptoms: Hidden Structure in the ADOS and ADI-R instrumentsPreprint
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“Foley-Nicpon et al. [15] relied on the study by Mazefsky et al. [16] to compare the diagnosis of ASD (DSM-5) and autism (DSM-IV) using items from the ADI-R and ADOS.”
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Idiopathic Autism Spectrum Disorder
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The Adaptation of Gilliam Autism Rating Scale-2 within an Omani Context: Some Initial Findings
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“In the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition, Text Revision (DSM-V-TR) these features were reduced to two main characteristics; social communication and interaction and restricted, repetitive behavior [5].”
BackgroundPolicy Issues Affecting the Health of Older Individuals in the United States
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“The diagnosis of ASD in both the proband (ADOS-2 score = 11) and her father (ADOS-2 score = 9) was established according to DSM-5 criteria, integrating clinical observation with standardized neuropsychological assessment tools [10].”
Diagnostic tests for autism spectrum disorder (ASD) in preschool children
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DyslexIA: Empowering Dyslexic Students with Accessible Learning Through AI
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- Authors
- Mazefsky, C. A., McPartland, J. C., Gastgeb, H. Z., & Minshew, N. J.
- Affiliations
- University of Pittsburgh (US)
- Yale University (US)
- Corresponding author
- Mazefsky, C. A.
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2012-09-26
- Volume
- 43
- Issue
- 5
- Pages
- 1236-1242
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- PMC
- PMC3635090
- OpenAlex
- W2094507998
- Cited by
- 88
- References
- 28
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 1 · 2022: 6 · 2021: 8 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 7 · 2016: 9 · 2015: 12 · 2014: 12 · 2013: 7
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Pennsylvania Department of Health
- National Institutes of Health
- National Institute of Mental Health (MH086785, K23MH086785)
- National Institute of Neurological Disorders and Stroke (R01NS033355)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD060601, P01HD035469, HD35469, U19HD035469, P50HD055748, HD 055748)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- autism spectrum disorder, DSM-5 diagnostic criteria, DSM-IV, high-functioning autism, Autism Diagnostic Observation Schedule, ADI-R, diagnostic assessment instrument
- MeSH terms
- Adolescent, Adult, Child, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Male, Middle Aged, Diagnostic and Statistical Manual of Mental Disorders
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