Cited by 341Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesChild and Adolescent Psychosocial and Emotional Development

Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders

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Huerta, Marisela, Bishop, Somer L., Duncan, Amie, Hus, Vanessa, Lord, Catherine·2012·American Journal of Psychiatry

Abstract

OBJECTIVE: Substantial revisions to the DSM-IV criteria for autism spectrum disorders (ASDs) have been proposed in efforts to increase diagnostic sensitivity and specificity. This study evaluated the proposed DSM-5 criteria for the single diagnostic category of autism spectrum disorder in children with DSM-IV diagnoses of pervasive developmental disorders (PDDs) and non-PDD diagnoses. METHOD: Three data sets included 4,453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnoses (e.g., language disorder). Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) and clinical observation instrument (Autism Diagnostic Observation Schedule) were matched to DSM-5 criteria and used to evaluate the sensitivity and specificity of the proposed DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses. RESULTS: Based on just parent data, the proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses. Sensitivity remained high in specific subgroups, including girls and children under 4. The specificity of DSM-5 ASD was 0.53 overall, while the specificity of DSM-IV ranged from 0.24, for clinically diagnosed PDD not otherwise specified (PDD-NOS), to 0.53, for autistic disorder. When data were required from both parent and clinical observation, the specificity of the DSM-5 criteria increased to 0.63. CONCLUSIONS: These results suggest that most children with DSM-IV PDD diagnoses would remain eligible for an ASD diagnosis under the proposed DSM-5 criteria. Compared with the DSM-IV criteria for Asperger's disorder and PDD-NOS, the DSM-5 ASD criteria have greater specificity, particularly when abnormalities are evident from both parents and clinical observation.

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Crossref · 10.1176/appi.ajp.2012.12020276

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  • The shift from multiple subcategories to a single dimension resulted in improved diagnostic specificity and good diagnostic sensitivity, with over 90% of children with PDDs meeting DSM-5 ASD criteria, and the remainder likely captured by the new social communication disorder diagnosis.

    “Furthermore, the shift from multiple subcategories to a single dimension resulted in improved diagnostic specificity and good diagnostic sensitivity, with over 90% of children with PDDs meeting DSM-5 ASD criteria (Huerta et al. 2012; Mandy et al. 2012), and with the remainder likely captured by the new social communication disorder diagnosis.”

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

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  • Huerta and colleagues reported sufficient sensitivity for PDD-NOS, Asperger's disorder, girls, and children with nonverbal IQ under 70, but the corresponding specificity values varied widely and were frequently too low.

    “In addition, they report adequate sensitivity for children diagnosed with PDD-NOS and Asperger's Disorder, and for girls and children with nonverbal IQs below 70.Specificity estimates for those groups were highly variable and often unacceptably low.”

    From Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers (2013) · cites this paper as Huerta, Bishop, Duncan, Hus, and Lord (2012)

    The Results report DSM-5 sensitivity of .77–.94 for children with Asperger disorder or PDD-NOS, .88–.93 for females, and .93–.97 for children with nonverbal IQ ≤70. The Results also describe low specificity that varies by sample and assessment method, but the cited passages do not give corresponding specificity estimates for each of those diagnostic and demographic groups. Page numbers were unavailable in our copy. (LLM, conf=0.83)

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  • Retrospective analyses of large ASD data repositories indicate that the majority of individuals with DSM-IV PDD will continue to meet criteria for ASD under DSM-5.

    “Retrospective analyses of large ASD data repositories indicate that the majority of individuals with DSM-IV PDD will continue to meet criteria for ASD under DSM-5, but prospective studies are needed to understand how diagnoses of ASD and social (pragmatic) communication disorder, as well as new ASD specifiers, modifiers, and severity ratings, will function in practice.”

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

    The Conclusions (page not provided) say that the majority of children with DSM-IV PDD diagnoses would remain eligible for an ASD diagnosis under DSM-5. The Methods describe analysis of previously collected data from three large datasets. The claim says “individuals,” but the study included children aged 2–17; its Limitations explicitly call for replication in adults. (LLM, conf=0.86)

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  • Data from older children and adolescents suggested that by far the greatest majority of those with DSM-IV diagnoses of any PDD met DSM-5 social communication criteria currently.

    “The data from older children and adolescents suggested that by far the greatest majority of those with DSM-IV diagnoses of any PDD met DSM-5 social communication criteria currently (Huerta et al. 2012)”

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

    The Results (DSM-5 Domains; page unavailable) show that relatively few participants with DSM-IV PDD diagnoses failed the DSM-5 social communication domain, supporting the claim’s main point. The Methods (Statistical Analysis; page unavailable) include ages 2–17, but the cited passages do not establish this finding specifically for older children and adolescents or show that all qualifying symptoms reflected current functioning. (LLM, conf=0.82)

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  • When datasets were examined, almost all individuals with any ASD had behaviors from at least one RRB subdomain, and when history was taken into account, the vast majority had behaviors from at least two or even three of the different DSM-5 subdomains.

    “when datasets were examined, almost all individuals with any ASD (i.e., PDD-NOS, Asperger's, or autism) had behaviors from at least one RRB subdomain, and when history was taken into account, the vast majority had behaviors from at least two or even three of the different DSM-5 subdomains (Huerta et al. 2012).”

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

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Research works printed but not linked: 2

  1. Rutter M, 2003, Social Communication Questionnaire (SCQ)
  2. Constantino JN, 2005, Social Responsiveness Scale (SRS)

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Authors
Huerta, M., Bishop, S. L., Duncan, A., Hus, V., & Lord, C.
Affiliations
Cincinnati Children's Hospital Medical Center (US)
Venue
American Journal of Psychiatry
Published
2012-10
Volume
169
Issue
10
Pages
1056-1064
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2111411972
Cited by
341
References
19
Citations by year
2026: 3 · 2025: 13 · 2024: 7 · 2023: 11 · 2022: 13 · 2021: 28 · 2020: 16 · 2019: 20 · 2018: 28 · 2017: 30 · 2016: 35 · 2015: 37 · 2014: 50 · 2013: 43 · 2012: 6
FWCI
22.26
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
Funders
  • National Institutes of Health (5rc1mh089721-02)
  • National Institute of Mental Health (RC1 MH-089721, R01MH081873)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD065277)
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 › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
autism spectrum disorder, DSM-5 diagnostic criteria, DSM-IV, pervasive developmental disorders, sensitivity and specificity, Asperger syndrome, pervasive developmental disorder not otherwise specified, autistic disorder, children
MeSH terms
Adolescent, Autistic Disorder, Child, Child Development Disorders, Pervasive, Child, Preschool, Female, Humans, Male, Psychometrics, Sensitivity and Specificity, Asperger Syndrome, Diagnostic and Statistical Manual of Mental Disorders

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