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Cited by 478Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesSchizophrenia research and treatment

Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder

Open access
McPartland, James C., Reichow, Brian, Volkmar, Fred R.·2012·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2012.01.007PMC PMC3424065
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Abstract

Objective This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). Method The study focused on a sample of 933 participants evaluated during the DSM-IV field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and specificity for proposed DSM-5 diagnostic criteria were evaluated using field trial symptom checklists as follows: individual field trial checklist items (e.g., nonverbal communication); checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication); individual DSM-5 criterion (e.g., social-communicative impairment); and overall diagnostic criteria. Results When applying proposed DSM-5 diagnostic criteria for ASD, 60.6% (95% confidence interval: 57%-64%) of cases with a clinical diagnosis of an ASD met revised DSM-5 diagnostic criteria for ASD. Overall specificity was high, with 94.9% (95% confidence interval: 92%-97%) of individuals accurately excluded from the spectrum. Sensitivity varied by diagnostic subgroup (autistic disorder = 0.76; Asperger's disorder = 0.25; pervasive developmental disorder-not otherwise specified = 0.28) and cognitive ability (IQ < 70 = 0.70; IQ ≥ 70 = 0.46). Conclusions Proposed DSM-5 criteria could substantially alter the composition of the autism spectrum. Revised criteria improve specificity but exclude a substantial portion of cognitively able individuals and those with ASDs other than autistic disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2012.01.007

Cites

32 of 32 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

1 of 12 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Among clinically diagnosed ASD cases failing DSM-5 criteria, 22% failed the RRB criterion domain.

    “and/or the RRB criterion domain (22%)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.
  • Findingown data

    The proposed DSM-5 criteria accurately excluded 262 of 276 (94.9%) individuals without a clinical ASD diagnosis.

    “the proposed DSM-5 criteria accurately excluded 262 of 276 (94.9%; 95% CI: 92–97%) individuals.”
    • Also stated in: § Discussion · boosted
      “DSM-5 criteria, however, showed excellent specificity, accurately excluding 94.9% who did not receive a clinical diagnosis of ASD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.
  • Findingown data

    Sensitivity of the proposed DSM-5 criteria differed by cognitive ability: .70 for individuals with IQ below 70 and .46 for those with IQ 70 or above.

    “Sensitivity varied by diagnostic subgroup (Autistic Disorder =.76; Asperger’s Disorder = .25; PDD-NOS = .28) and cognitive ability (IQ < 70 = .70; IQ ≥ 70 = .46).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The field trial checklist items chosen by the authors adequately represent the proposed DSM-5 diagnostic criteria.
  • Findingown data

    Among clinically diagnosed ASD cases, those with IQ < 70 were significantly more likely to meet DSM-5 criteria than those with IQ ≥ 70 (69.7% vs 46.0%, p < .001).

    “The proportion of individuals (274 of 393 cases, or 69.7%) with lower cognitive ability (i.e., IQ < 70) meeting DSM-5 criteria was significantly higher than the proportion of individuals (109 of 237 cases, or 46.0%) with higher cognitive ability (i.e., IQ ≥ 70) meeting DSM-5 criteria (X2(1)= 34.9, p < .001”
    • Also stated in: § Discussion · plain
      “Individuals with intellectual disability were more likely than cognitively able individuals to meet DSM-5 criteria (69.7% and 46.0%, respectively).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.
  • Findingown data

    Cases meeting and failing DSM-5 criteria did not differ significantly in chronological age (p = .98).

    “Those meeting and failing to meet proposed DSM-5 ASD diagnostic criteria were comparable with respect to chronological age (M = 9.15, SD = 6.92; M = 9.14, SD = 6.85, respectively; t(654) = 0.02, p = .98)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 28
  • The quote only partly states this claim. 4

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Collapsing into a spectrum eliminates the possibility of validating subtypes of ASD.

    “Collapsing into a spectrum eliminates the possibility of validating subtypes of ASD.25,34,35”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [25] Ghanizadeh, 2011, Can retaining Asperger syndrome in DSM V help establish neurobiological endophenotypes?, J Autism Dev Disord source

      The main text (p. 1) discusses interest in possible PDD subtypes and the potential value of studying endophenotypes. It does not say that collapsing diagnoses into a spectrum eliminates the possibility of validating ASD subtypes; a search for that proposition found no further passage in our copy. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [34] Baron-Cohen, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [35] Mandy, 2011, Toward specifying pervasive developmental disorder-not otherwise specified, Autism Res source

  • May combine two claims.

    Findingown data

    If two of three social communication symptoms were required instead of all three, overall sensitivity would increase from .61 to .75 and specificity would decrease from .95 to .85.

    “If two of three social communication symptoms (instead of all three) were required, overall sensitivity would increase from .61 to .75 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .84, .52, and .55, respectively), with a corresponding decrease in specificity from .95 to .85.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    Sensitivity of the proposed DSM-5 criteria differed by diagnostic subgroup: .76 for Autistic Disorder, .25 for Asperger's Disorder, and .28 for PDD-NOS.

    “Sensitivity varied by diagnostic subgroup (Autistic Disorder =.76; Asperger’s Disorder = .25; PDD-NOS = .28) and cognitive ability (IQ < 70 = .70; IQ ≥ 70 = .46).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The field trial checklist items chosen by the authors adequately represent the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    The proportion of clinically diagnosed ASD cases meeting DSM-5 criteria differed significantly across clinical diagnoses (p < .001), with 75.8% of Autistic Disorder, 25% of Asperger's Disorder, and 28.3% of PDD-NOS/atypical autism cases meeting criteria.

    “There were also significant discrepancies in cases meeting DSM-5 diagnostic criteria across clinical diagnoses (X2(2) = 138.3, p < .001); 341 of 450 (75.8%) of cases with a clinical diagnosis of Autistic Disorder, 12 of 48 (25%) of cases with Asperger’s Disorder, and 45 of 159 (28.3%) of cases with PDD-NOS or atypical autism met proposed DSM-5 diagnostic criteria for ASD.”
    • Also stated in: § Discussion · plain
      “Individuals clinically diagnosed with Autistic Disorder were more likely to pass DSM-5 diagnostic threshold than those with Asperger’s Disorder or PDD-NOS (75.8%, 25.0%, and 28.3%, respectively).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    If two social-communication criteria and zero RRB symptoms were required, sensitivity would increase from .61 to .94 and specificity would decrease from .95 to .67.

    “if two social-communication criteria and zero RRB symptoms were required (corresponding to the most lenient requirements for PDD-NOS according to DSM-IV-TR criteria), sensitivity would increase from .61 to .94 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .98, .88, and .81, respectively) with a corresponding decrease in specificity from .95 to .67.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    With a polythetic social-communication threshold (two of three) and one RRB symptom required, sensitivity would increase from .61 to .91 and specificity would decrease from .95 to .75.

    “With a polythetic threshold for social-communication (two of three criteria) and requirement of one RRB symptom, sensitivity would increase from .61 to .91 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .97, .77, and .77, respectively) with a corresponding decrease in specificity from .95 to .75.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    If zero RRB symptoms were required, sensitivity would increase from .61 to .72 and specificity would decrease from .95 to .88.

    “If zero RBB symptoms were required, sensitivity would increase from .61 to .72 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .86, .38, and .42, respectively), with a corresponding decrease in specificity from .95 to .88.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Cases meeting and failing DSM-5 criteria did not differ significantly in sex ratio (p = .59).

    “and sex ratio (60.4% of males and 63.2% of females met diagnostic criteria; X2(1)= .30, p = .59).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    If one RRB symptom were required, sensitivity would increase from .61 to .71 and specificity would decrease from .95 to .91.

    “If one RRB symptom were required, sensitivity would increase from .61 to .71 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .85, .31, and .40, respectively), with a corresponding decrease in specificity from .95 to .91.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • The quote only partly states this claim.

    Findingown data

    Among cognitively able cases failing DSM-5 criteria, 29% failed the RRB criterion domain.

    “and/or the RRB criterion domain (29%)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    In the cognitively able subgroup, if zero RRB symptoms were required, sensitivity would increase from .46 to .56 and specificity would decrease from .98 to .95.

    “If zero RBB symptoms were required, sensitivity would increase from .46 to .56 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .79, .38, and .31, respectively), with a corresponding decrease in specificity from .98 to .95.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    In the cognitively able subgroup, if one RRB symptom were required, sensitivity would increase from .46 to .54 and specificity would decrease from .98 to .96.

    “If one RRB symptom were required, sensitivity would increase from .46 to .54 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .79, .31, and .31, respectively), with a corresponding decrease in specificity from .98 to .96.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • Probably not a substantial claim: may not pass S1 (asserted), S4 (based). May combine two claims. The quote only partly states this claim.

    Findingown data

    In the cognitively able subgroup, if two of three social communication symptoms were required, sensitivity would increase from .46 to .67 and specificity would decrease from .98 to .93.

    “If two of three social communication symptoms (instead of all three) were required, overall sensitivity would increase from .46 to .67 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .81, .53, and .53, respectively), with a corresponding decrease in specificity from .98 to .93.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • The quote only partly states this claim.

    Findingown data

    Among cognitively able cases failing DSM-5 criteria, all but 5% met the onset criterion.

    “all but 5% met the onset criterion.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    Enacting the 2-of-3 social-communication change and lowering the RRB threshold to one symptom raises sensitivity to .91 but lowers specificity to .75.

    “Enacting this change and also lowering the RRB threshold to one symptom raised sensitivity to .91 but lowers specificity to .75.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    In the cognitively able subgroup, if two social-communication criteria and zero RRB symptoms were required, sensitivity would increase from .46 to .89 and specificity would decrease from .98 to .74.

    “if two social-communication criteria and zero RRB symptoms were required (corresponding to the most lenient requirements for PDD-NOS according to DSM-IV-TR criteria), sensitivity would increase from .46 to .89 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .99, .87, and .76, respectively) with a corresponding decrease in specificity from .98 to .74.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    In the cognitively able subgroup, the proportion meeting DSM-5 criteria differed significantly across clinical diagnoses (p < .001), with 68.4% of Autistic Disorder, 26.7% of Asperger's, and 22.7% of PDD-NOS cases meeting criteria.

    “There were also significant discrepancies in cases meeting DSM-5 diagnostic criteria across clinical diagnoses (X2(2) = 46.8, p < .001); 80 of 117 (68.4%) of cases with a clinical diagnosis of Autistic Disorder, 12 of 45 (26.7%) of cases with Asperger’s Disorder, and 17 of 75 (22.7%) of cases with PDD-NOS or atypical autism met proposed DSM-5 diagnostic criteria for ASD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • The quote only partly states this claim.

    Findingown data

    Among cognitively able cases failing DSM-5 criteria, 42% failed the social communication criterion.

    “Most individuals failing to meet the DSM-5 diagnostic criteria did so because of a failure to meet the social communication criterion (42%)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Findingown data

    In the cognitively able subgroup, with a polythetic social-communication threshold and one RRB symptom required, sensitivity would increase from .46 to .85 and specificity would decrease from .98 to .82.

    “With a polythetic threshold for social-communication (two of three criteria) and requirement of one RRB symptom, sensitivity would increase from .46 to .85 (specific sensitivity for Autistic Disorder, Asperger’s Disorder, and PDD-NOS would be .97, .76, and .72, respectively) with a corresponding decrease in specificity from .98 to .82.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Interpretationreasoning

    A more stringent diagnostic rubric has significant public health consequences for service eligibility and for the comparability of historical and future research.

    “A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The field trial checklist items chosen by the authors adequately represent the proposed DSM-5 diagnostic criteria.
    • Rests on an assumption: The DSM-IV field trial sample is representative of the broader population of individuals with ASD and other developmental or psychiatric disorders.

  • May combine two claims.

    Premisecitation

    Diagnoses made under the current criteria would sometimes differ from those made under the proposed criteria, which would reduce the comparability of future studies with earlier research.

    “Finally, as has been the case with previous revisions of the DSM, diagnoses issued according to current criteria would, in some cases, differ from those based on proposed criteria, reducing the comparability of future studies with prior research.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Singh, 2009, Trends in US autism research funding, J Autism Dev Disord source

  • May combine two claims.

    Study design and conductcitation

    Clinical diagnosis in the field trial had good overall sensitivity and specificity and was highly consistent with the ICD-10 criteria current at that time.

    “Clinical diagnosis demonstrated good overall sensitivity and specificity, being highly consistent with the ICD-10 criteria that were current at that time.30”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Volkmar, 2005, Issues in the classification of autism and related conditions source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    There was strong inter-clinician agreement (kappa=.95) on whether individuals met clinical diagnosis for a PDD.

    “There was also strong inter-clinician agreement (kappa=.95) on whether or not individuals met clinical diagnosis for a PDD.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Klin, 2000, Brief report: interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: results of the DSM-IV autism field trial, J Autism Dev Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The ASD and non-ASD groups differed in gender but were comparable in age and IQ.

    “Consistent with the skewed sex ratio characteristic of ASD, ASD and non-ASD groups differed in terms of gender ( X2(1)= 17.7, p < .001) but were comparable in terms of age (t (931) = .57, p > .05) and IQ ( X2(5) = 10.0, p > .05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The reduction in sensitivity is accompanied by very strong specificity, with nearly all individuals carrying non-ASD clinical diagnoses being accurately classified.

    “This ostensible reduction in sensitivity is accompanied by very strong specificity, with nearly all individuals carrying non-ASD clinical diagnoses being accurately classified.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Interpretationown data

    Most cognitively able individuals and individuals diagnosed with Asperger's Disorder and PDD-NOS would no longer meet criteria for an ASD.

    “Most cognitively able individuals and individuals diagnosed with Asperger’s Disorder and PDD-NOS would no longer meet criteria for an ASD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Interpretationown data

    Under the proposed criteria, cognitively able individuals and those with ASDs other than Autistic Disorder would be less likely to receive an autism spectrum diagnosis.

    “According to the proposed criteria, cognitively able individuals and those with ASDs other than Autistic Disorder would be less likely to receive a diagnosis on the autism spectrum.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • May combine two claims.

    Interpretationown data

    The reduced sensitivity is associated with stronger specificity, with nearly all individuals carrying non-ASD clinical diagnoses being accurately excluded from the spectrum.

    “This reduced sensitivity is associated with stronger specificity, with nearly all individuals carrying non-ASD clinical diagnoses being accurately excluded from the spectrum.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.
    • Rests on an assumption: The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    SCD as written is a loosely defined residual diagnosis and is potentially vulnerable to the same problems encountered with PDD-NOS, such as poor inter-rater agreement, limited insight into associated phenotypic characteristics, and disagreement on precise symptom constellation.

    “A potential problem with SCD as written is that, like PDD-NOS in DSM-IV-TR, it is a loosely defined residual diagnosis and is potentially vulnerable to the same problems encountered with PDD-NOS, such as poor inter-rater agreement on diagnosis, limited insight into associated phenotypic characteristics (e.g., cognitive or neuropsychological function), and disagreement on precise symptom constell”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Mandy, 2011, Toward specifying pervasive developmental disorder-not otherwise specified, Autism Res source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The DSM-5 descriptor 'early childhood' is more vague and may include a wider range of children whose difficulties manifest after age three.

    “The descriptor of “early childhood” proposed in DSM-5, because it is more vague, may include a wider range of children whose difficulties manifest after age three.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    DSM-5 ASD offers 11 combinations of criteria, whereas DSM-IV Autistic Disorder offers 2,027 combinations.

    “with DSM-5 ASD offering 11 combinations of criteria and DSM-IV Autistic Disorder offering 2,027 combinations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    These changes could exert detrimental effects on service eligibility and the ability of researchers to integrate information from autism research to-date with that conducted under the proposed criteria.

    “These changes could exert detrimental effects on service eligibility and the ability of researchers to integrate information from autism research to-date with that conducted under the proposed criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The sample was one of convenience, based on referral for differential diagnosis of ASD and related disorders, and was skewed towards individuals with ASD.

    “Our sample of convenience was based specifically on referral for differential diagnosis of ASD and related disorders and was skewed towards individuals with ASD.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    It is likely that a number of individuals failing to meet DSM-5 criteria for ASD will meet criteria for SCD.

    “it is likely that a number of individuals failing to meet DSM-5 criteria for ASD will meet criteria for SCD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    These issues could lead to a considerable loss of information given the quantity of research conducted using the current diagnostic system.

    “These issues could lead to a considerable loss of information given the quantity of research conducted using the current diagnostic system.6”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Ghaziuddin, 2010, Should the DSM V drop Asperger syndrome?, J Autism Dev Disord source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Elimination of diagnostic subcategories may be harmful to those who have found a diagnosis important for service acquisition or self-directed insight.

    “Elimination of diagnostic subcategories may be harmful to those who have found a diagnosis important in terms of service acquisition or self-directed insight.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kaland, 2011, Brief report: Should Asperger syndrome be excluded from the forthcoming DSM-V?, Res Autism Spect Disord source

  • May combine two claims.

    Interpretationreasoning

    The proposed diagnostic taxon is incompatible with ICD-10 criteria (and possibly ICD-11), rendering it unreliable in future work to compare studies conducted outside the US with those conducted according to APA standards.

    “Another obvious challenge of the proposed diagnostic taxon is incompatibility with ICD-10 criteria (and possibly criteria for ICD-11, currently in preparation), rendering it unreliable in future work to compare studies conducted outside of the US with those conducted according to the APA’s standards.”
    Quote in the paperSubstantial claim
37 of 37

  • The paper relies on this without support.

    The field trial checklist items chosen by the authors adequately represent the proposed DSM-5 diagnostic criteria.

    “we developed an algorithm using individual items from this symptom set to correspond to the proposed DSM-5 diagnostic criteria for ASD”
    “each author independently selected items from the checklist to correspond to DSM-5 criteria, and all authors met as a group to develop a consensus algorithm”

  • The paper relies on this without support.

    The DSM-IV field trial sample is representative of the broader population of individuals with ASD and other developmental or psychiatric disorders.

    “This re-analysis focused on 933 cases, omitting individuals diagnosed with non-autistic PDDs (Rett’s Disorder, n=13; Childhood Disintegrative Disorder, n=16), as well as individuals missing data required for the present analyses (n=15).”

  • The paper relies on this without support.

    The clinical diagnosis of ASD in the DSM-IV field trial is a valid reference standard for evaluating the proposed DSM-5 criteria.

    “we contrasted 657 who had been clinically diagnosed with an ASD and a comparison sample of 276 individuals who received a clinical diagnosis not on the autism spectrum.”

  • The paper relies on this without support.

    The algorithm created from the 61 field trial checklist items adequately represents the proposed DSM-5 diagnostic criteria.

    “From 61 individual checklist items rated by these field trial evaluators, we created an algorithm analogous to proposed DSM-5 criteria”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The DSM-5 committee decided not to intentionally tighten the criteria in order to decrease prevalence.

    “the DSM-5 committee decided not to intentionally tighten the criteria in order to decrease prevalence, even though this has been claimed (McPartland et al. 2012).”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as McPartland et al. 2012

    The citation follows “even though this has been claimed,” so it is offered for the alleged intentional tightening, not for the citing authors’ statement that the committee decided against it. The Discussion (page not available) says the proposed criteria appear more stringent and may address concerns about increased prevalence, but it does not say the committee intended to reduce prevalence. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Overall DSM 5 ASD was reported to have high specificity but there is variability in specificity when it comes to different diagnostic subgroups.

    “Overall DSM 5 ASD was reported to have high specificity but there is variability in specificity when it comes to different diagnostic subgroups [15].”

    From Comparison of the diagnostic criteria for Autism spectrum disorder (ASD) using Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD): A study from North India (2021) · cites this paper as [15]

    The Results report high overall specificity for the proposed DSM-5 ASD criteria: 94.9% of individuals without an ASD diagnosis were accurately excluded. The variation across ASD diagnostic subgroups concerns sensitivity, not specificity; the paper reports different proportions meeting the criteria for Autistic Disorder, Asperger’s Disorder, and PDD-NOS. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Studies that used more limited datasets, such as the DSM-IV checklist or the ADDM reviews of existing reports, found less evidence of repetitive behaviors in children with PDD-NOS.

    “Studies that used more limited datasets, such as the DSM-IV checklist or the ADDM reviews of existing reports (Maenner et al. 2014, McPartland et al. 2012), found less evidence of repetitive behaviors in children with PDD-NOS, which suggests that it is very important that clinicians collect adequate information about these behaviors.”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as McPartland et al. 2012

    The Method and Discussion (page unavailable) show that this study reanalysed DSM-IV field-trial checklist items, not ADDM report reviews. The Results (page unavailable) show low DSM-5 sensitivity for PDD-NOS and improved sensitivity when fewer repetitive-behavior symptoms were required. They do not establish that the limited dataset caused repetitive behaviors to be underdocumented in children with PDD-NOS. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Nearly 80% of the Asperger's and PDD-NOS groups appeared likely to lose their diagnostic label and thus potential eligibility for services.

    “Nearly 80% of the latter two groups appeared likely to lose their diagnostic label and thus potential eligibility for services (McPartland et al. 2012).”

    From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as McPartland et al. 2012

  • McPartland and colleagues reported results of a data reanalysis of cases from the DSM-IV field trial and reported dramatically reduced diagnostic rates not only in cases with clinical diagnoses of autism, but particularly in those with previous diagnoses of Asperger's and PDD-NOS.

    “This study was quickly followed by a study from McPartland and colleagues (McPartland et al. 2012) that reported results of a data reanalysis of cases from the DSM-IV field trial and reported dramatically reduced diagnostic rates not only in cases with clinical diagnoses of autism, but particularly in those with previous diagnoses of Asperger’s and PDD-NOS.”

    From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as McPartland et al. 2012

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(1) = 17.7reported p < .001 · recomputed p < .001

    “X2(1)= 17.7, p < .001”

  • Consistentt(931) = 0.57reported p > .05 · recomputed p = .569

    “t (931) = .57, p > .05”

  • Consistentχ²(5) = 10reported p > .05 · recomputed p = .075

    “X2(5) = 10.0, p > .05”

  • Consistentχ²(1) = 34.9reported p < .001 · recomputed p < .001

    “X2(1)= 34.9, p < .001”

  • Consistentχ²(2) = 138.3reported p < .001 · recomputed p < .001

    “X2(2) = 138.3, p < .001”

  • Consistentt(654) = 0.02reported p = .98 · recomputed p = .984

    “t(654) = 0.02, p = .98”

  • Consistentχ²(1) = 0.3reported p = .59 · recomputed p = .584

    “X2(1)= .30, p = .59”

  • Consistentχ²(2) = 46.8reported p < .001 · recomputed p < .001

    “X2(2) = 46.8, p < .001”

8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Sample size is stated as 977 and 933 in different parts of the paper

    Minor

    The abstract/method summary says the study sample was 977 participants, but the detailed Method states the re-analysis focused on 933 cases after exclusions. Both cannot describe the same analyzed sample without clarification.

1 of 1

Cites

Flagged first, then by citations

3 of the 35 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Klin, 2000, Brief report: interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: results of the DSM-IV autism field trial, J Autism Dev Disord, 30, 163, 10.1023/a:1005415823867 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
McPartland, J. C., Reichow, B., & Volkmar, F. R.
Affiliations
Yale University (US)
Corresponding author
McPartland, James C.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2012-04
Volume
51
Issue
4
Pages
368-383
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2012.01.007
PMC
PMC3424065
OpenAlex
W2024803279
Cited by
476
References
35
Citations by year
2026: 6 · 2025: 7 · 2024: 11 · 2023: 31 · 2022: 19 · 2021: 22 · 2020: 24 · 2019: 28 · 2018: 36 · 2017: 26 · 2016: 40 · 2015: 39 · 2014: 72 · 2013: 79 · 2012: 36
FWCI
36.99
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (K23MH086785, P50MH081756)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50HD003008, P01HD003008)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
autism spectrum disorder, DSM-5 diagnostic criteria, sensitivity and specificity, autistic disorder, Asperger syndrome, pervasive developmental disorder not otherwise specified, nonverbal communication, cognitive ability, diagnostic criteria revision
MeSH terms
Adolescent, Child, Child Development Disorders, Pervasive, Child, Preschool, Cross-Sectional Studies, Diagnosis, Differential, Disability Evaluation, Eligibility Determination, Humans, Mental Health Services, Sensitivity and Specificity, United States, Incidence, Asperger Syndrome, Diagnostic and Statistical Manual of Mental Disorders, Checklist

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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