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Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders
Open accessAbstract
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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“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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“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)
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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, 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
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“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
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“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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“there is some overlap between criterion A 1 and criterion A 3 (Huerta et al., 2012)”
From Sensitivity and Specificity of Proposed DSM-5 Criteria for Autism Spectrum Disorder in Toddlers (2013) · cites this paper as Huerta et al., 2012
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“They report that the new DSM-5 criteria identified 91% of the children with DSM-IV-TR diagnoses of PDD with specificity estimated at .53.”
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)
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“However, another substantially large retrospective study using data from three existing datasets found few differences between the two systems in sensitivity [15].”
From Subgrouping the Autism Spectrum: Reflections on DSM-5 (2013) · cites this paper as [15]
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“a large study using major databases found that more than four times as many autistic children failed to meet the social communication domain requirement only (more than 6.2%) as compared to the restricted and repetitive behavior domain (less than 1.5%; Huerta et al. [35]).”
From Lobbying Autism's Diagnostic Revision in the DSM-5 (2020) · cites this paper as [35]
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“Earlier studies [17,18,20,26,44] consisted of patients who were already carrying a diagnostic label and were tried to be fit into DSM-5 ASD criteria.”
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“Moreover, analyses that include both ASD and non-ASD participants highlight the poor specificity that is achieved when only symptom counts (from DSM-IV or DSM-5) are considered (e.g., 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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“An investigation of large datasets that included multiple questions about behavior, such as the ADI-R or the Social Responsiveness Scale (Constantino & Gruber 2005), indicated that few children with any former PDD diagnosis (including PDD-NOS) would fail to meet ASD criteria (Frazier et al. 2012, 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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“and poor predictive ability of later outcome based on these subtypes [17,18]”
From DSM-5 and autism spectrum disorders (ASDs): an opportunity for identifying ASD subtypes (2013) · cites this paper as [18]
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Citations
Cites
Lord, C., Rutter, M., & Le Couteur, A. (1994) · Journal of Autism and Developmental Disorders · doi:10.1007/bf02172145 · Cited by 9,065
Self-citationLord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000) · Journal of Autism and Developmental Disorders · doi:10.1023/a:1005592401947 · Cited by 7,520
Self-citationAutism Diagnostic Interview-Revised
Rutter, M., LeCouteur, A., & Lord, C. (2016) · PsycTESTS Dataset · doi:10.1037/t18128-000 · Cited by 1,627
Self-citationStandardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders
Gotham, K., Pickles, A., & Lord, C. (2009) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-008-0674-3 · Cited by 1,605
Self-citationThe Autism Diagnostic Observation Schedule: Revised Algorithms for Improved Diagnostic Validity
Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0280-1 · Cited by 1,161 · cited 2×
“All groups have been previously described in detail (4, 15, 16).”
BackgroundMethodSelf-citationThe Simons Simplex Collection: a resource for identification of autism genetic risk factors
Fischbach, G. D., & Lord, C. (2010) · Neuron · doi:10.1016/j.neuron.2010.10.006 · Cited by 725 · cited 2×
“All groups have been previously described in detail (4, 15, 16).”
BackgroundMethodSelf-citationCombining Information From Multiple Sources in the Diagnosis of Autism Spectrum Disorders
RISI, S., LORD, C., GOTHAM, K., CORSELLO, C., CHRYSLER, C., SZATMARI, P., COOK, E. H., LEVENTHAL, B. L., & PICKLES, A. (2006) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000227880.42780.0e · Cited by 581
Self-citationA Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders
Lord, C. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.148 · Cited by 516
Self-citationCognitive profiles and social‐communicative functioning in children with autism spectrum disorder
Joseph, R. M., Tager‐Flusberg, H., & Lord, C. (2002) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00092 · Cited by 503
Self-citationAutism Diagnostic Observation Schedule--Generic
Lord, C., Rutter, M. L., DiLavore, P. C., & Risi, S. (1999) · PsycTESTS Dataset · doi:10.1037/t17256-000 · Cited by 487
Self-citation
Research works printed but not linked: 2
- Rutter M, 2003, Social Communication Questionnaire (SCQ)
- Constantino JN, 2005, Social Responsiveness Scale (SRS)
Cited by
Sorted by citations
What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis
Loomes, R., Hull, L., & Mandy, W. P. L. (2017) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2017.03.013 · Cited by 2,804
Identification, Evaluation, and Management of Children With Autism Spectrum Disorder
Hyman, S. L., Levy, S. E., Myers, S. M., COUNCIL ON CHILDREN WITH DISABILITIES, S. O. D. A. B. P., Kuo, D. Z., Apkon, S., Davidson, L. F., Ellerbeck, K. A., Foster, J. E. A., Noritz, G. H., et al. (2020) · Pediatrics · doi:10.1542/peds.2019-3447 · Cited by 1,798
Autism spectrum disorder: Definition, epidemiology, causes, and clinical evaluation
Hodges, H., Fealko, C., & Soares, N. (2020) · Translational Pediatrics · doi:10.21037/tp.2019.09.09 · Cited by 1,127
“One study found that with parental report of ASD symptoms alone, the DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses (8).”
BackgroundAutism Spectrum Disorder: Classification, diagnosis and therapy
Sharma, S., Gonda, X., & Tarazi, F. I. (2018) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2018.05.007 · Cited by 745
Hus, V., Gotham, K., & Lord, C. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-012-1719-1 · Cited by 568
Self-citation
Metadata
- 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
- PMC
- PMC6003412
- OpenAlex
- W2111411972
- Semantic Scholar
- ce429d77f9bbe9de7d0d8aa97f126480971490e9
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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