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Cited by 2Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesBehavioral and Psychological Studies

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

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Kalra, Priyanka, Arun, Priti, Chavan, B.S., Gupta, Nitin·2021·Journal of Indian Association for Child and Adolescent Mental Health
DOI 10.1177/0973134220210103
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Abstract

Background:The significant changes in the DSM 5 diagnostic criteria for ASD need to be assessed in an Indian population by comparing it with ICD-10 DCR and DSM-IV TR.There are very few studies that look at the concordance between the criteria and practically none fromIndia.An understanding on the diagnostic concordance will help in reliable diagnoses, service delivery and not miss out on any previously diagnosed child with ASD.Aim: To compare the diagnostic criteria for ASD using DSM 5, DSM-IV-TR and ICD-10 (DCR-10) Methods: Hundred children in age of 2.5-16 years without any co-morbid severe/profound mental retardation and any one symptom suggestive of ASD, presenting consecutively to the outpatient department were assessed using DSM 5, ICD-10 (DCR-10) and DSM-IV-TR manuals It was a cross sectional study in which agreement analysis between the diagnostic criteria was done using Cohen's Kappa coefficient (κ') using IBM SPSS Statistics 20.Results: Agreement analysis revealed DSM-5 ASD showed κ' = 0.846 and 0.874 with DSM-IV-TR, ICD 10 (DCR-10) respectively for childhood autism/autistic disorder.This agreement dropped for the analysis between DSM 5 ASD criteria and the DSM-IV-TR ASD (κ' =0.699 ); and ICD 10 (DCR-10) ASD(κ' = 0.703).DSM-5 ASD criteria overall had specificity values as 1 and 0.961 when compared with DSM-IV-TR ASD and ICD 10 (DCR-10) ASD. Conclusions:The diagnosis of autism will not be missed.Some children will no longer meet criteria for ASD under DSM-5 and will most likely be those diagnosed with Atypical Autism/PDD NOS, but possibly would meet criteria for DSM-5 SCD.

Integrity signals

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Crossref · 10.1177/0973134220210103

Cites

0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 28 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    There have been very few studies that have looked at the concordance between the diagnostic criteria for ASD.

    “there have been very few studies [21][22][23] which have looked at the concordance between the criteria.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [21] 21. Frazier TW, Youngstrom EA, Speer L, Embacher R, Law P, Constantino J, et al: Validation of proposed DSM-5 criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2012, 51:28-40. source
    • cites [22] 22. Ohashi K, Mizuno Y, Miyachi T, Asai T, Imaeda M, Saitoh S: Concordance of classifications using DSM-5 and DSM-IV-TR criteria for autism spectrum disorder. Pediatr Int Off J Jpn Pediatr Soc 2015, 57:1097-100. source
    • cites [23] 23. Mattila ML, Kielinen M, Linna SL, Jussila K, Ebeling H, Bloigu R, et al: Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. J Am Acad Child Adolesc Psychiatry 2011, 50:583-592. source
  • Premisecitation

    Earlier studies consisted of patients who were already carrying a diagnostic label and were tried to be fit into DSM-5 ASD criteria.

    “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.”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [17] 17. Huerta M, Bishop SL, Duncan A, Hus V, Lord C: Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. Am J Psychiatry 2012, 169:1056-64. source
    • cites [18] 18. Mayes SD, Black A, Tierney CD: DSM-5 under-identifies PDDNOS: Diagnostic agreement between the DSM-5, DSM-IV, and Checklist for Autism Spectrum Disorder. Res Autism Spectr Disord 2013, 7:298-306. source
    • cites [20] 20. Taheri A, Perry A: Exploring the proposed DSM-5 criteria in a clinical sample. J Autism Dev Disord 2012, 42:1810-7. source
    • cites [26] 26. Beighley JS, Matson JL, Rieske RD, Jang J, Cervantes PE, Goldin RL: Comparing challenging behavior in children diagnosed with autism spectrum disorders according to the DSM-IV-TR and the proposed DSM-5. Dev Neurorehabilitation 2013, 16:375-81. source
    • cites [44] 44. Matson JL, Hattier M a, Williams LW: How does relaxing the algorithm for autism affect DSM-V prevalence rates? J Autism Dev Disord 2012, 42:1549-56. source
  • Interpretationreasoning

    Children with high functioning Autism and Asperger's syndrome may be at risk of losing a diagnostic label under DSM-5, despite having received a diagnosis under DSM-IV-TR or ICD-10 (DCR-10).

    “For the children with high functioning Autism and Asperger's syndrome, this, in turn, has a major impact as they might have received the diagnosis as per DSM-IV-TR or ICD 10 (DCR-10)[15] but they may be at risk of losing a diagnostic label.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] 15. McPartland JC, Reichow B, Volkmar FR: Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2012, 51:368-83. source
  • Premisecitation

    Many studies have used clinical records as the information source rather than clinical interview.

    “Additionally, many studies have used the clinical records as the information source and not the clinical interview [15,16,18,23,28]”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [15] 15. McPartland JC, Reichow B, Volkmar FR: Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2012, 51:368-83. source

      The Method section (page unavailable) says this study reanalysed DSM-IV field-trial symptom checklists completed by clinicians. Our copy does not say that clinical records, rather than clinical interviews, supplied the information, or that many studies used that approach. Searches for clinical records, chart review, and interviews found no passage establishing the claim. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [16] 16. Gibbs V, Aldridge F, Chandler F, Witzlsperger E, Smith K: Brief report: an exploratory study comparing diagnostic outcomes for autism spectrum disorders under DSM-IV-TR with the proposed DSM-5 revision. J Autism Dev Disord 2012, 42:1750-6. source
    • cites [18] 18. Mayes SD, Black A, Tierney CD: DSM-5 under-identifies PDDNOS: Diagnostic agreement between the DSM-5, DSM-IV, and Checklist for Autism Spectrum Disorder. Res Autism Spectr Disord 2013, 7:298-306. source
    • cites [23] 23. Mattila ML, Kielinen M, Linna SL, Jussila K, Ebeling H, Bloigu R, et al: Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. J Am Acad Child Adolesc Psychiatry 2011, 50:583-592. source
    • cites [28] 28. You Y, Wu BL, Shen Y: A pilot study on the diagnostic performance of DMS-IV and DMS-V for autism spectrum disorder. North Am J Med Sci 2011, 4:116-23. source
  • Findingown data

    DSM-5 ASD criteria had sensitivity 0.829 when compared with DSM-IV-TR ASD.

    “Sensitivity, 0.838 0.829”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 6

  • May combine two claims.

    Premisecitation

    In meta-analyses by Smith et al., Kulage et al., and Sturmey and Dalfren, re-diagnosing previously diagnosed DSM-IV-TR cases under DSM-5 ASD resulted in reductions of 25-50%, 31%, and 37%, respectively.

    “In the meta analyses by Smith et al [41], Kulage et al [42] and Sturmey and Dalfren [43], there was a 25-50%, 31% and 37% reduction when previously diagnosed cases on DSM-IV-TR were re-diagnosed under DSM 5 ASD.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [41] 41. Smith IC, Reichow B, Volkmar FR: The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 2015, 45:2541-52. source
    • cites [42] 42. Kulage KM, Smaldone AM, Cohn EG: How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. J Autism Dev Disord 2014, 44:1918-32. source
    • cites [43] 43. Sturmey P, Dalfern S: The Effects of DSM5 Autism Diagnostic Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorders: A Systematic Review. Rev J Autism Dev Disord 2014, 1:249-52. source

      The Results report a median 36.97% reduction across 12 studies, supporting the cited 37% figure. But the Procedure and Results do not describe all cases as previously diagnosed under DSM-IV-TR: some samples included people meeting clinical criteria or only likely to have ASD, and one study used a heterogeneous sample. The paper calls itself a systematic review and reports a median, rather than a pooled meta-analysis. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] 15. McPartland JC, Reichow B, Volkmar FR: Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 2012, 51:368-83. source

      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

  • The quote only partly states this claim.

    Findingown data

    Poor agreement was observed between ICD-10 DCR-10 Atypical autism, Other childhood disintegrative disorder, Asperger's syndrome and DSM-5 ASD.

    “However, the “poor” agreement between ICD-10 (DCR-10) Atypical autism, Other childhood disintegrative disorder, Asperger's syndrome.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    DSM-5 ASD has maximum agreement with Autistic Disorder or Childhood Autism and agreement values decrease when subcategories are lumped together.

    “It was observed in our study that DSM-5 ASD has maximum agreement with Autistic Disorder or Childhood Autism and the agreement values keep decreasing if the subcategories are lumped together.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When comparing sensitivity and specificity, DSM-5 ASD has maximum specificity when compared with DSM-IV-TR ASD, while specificity decreases when DSM-5 ASD is compared with DSM-IV-TR autistic disorder.

    “While comparing sensitivity and specificity, DSM-5 ASD has maximum specificity when compared with DSM-IV-TR ASD, while the specificity decreases when DSM 5 ASD is compared with DSM-IV-TR autistic disorder.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    DSM-5 appears to have good agreement with DSM-IV-TR and ICD-10 (DCR-10), with agreement observed as 'very good' to 'good'.

    “To conclude, as per our study DSM 5 appears to have good agreement with DSM-IV-TR, ICD-10 (DCR-10).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The findings were similar when comparing DSM-5 and ICD-10 (DCR-10): higher specificity when compared with ICD-10 (DCR-10) ASD and comparatively lesser specificity with ICD-10 (DCR-10) childhood autism.

    “The findings were similar while comparing DSM-5 and ICD-10 (DCR-10) i.e. a higher specificity when compared with ICD-10 (DCR-10) ASD and comparatively lesser specificity with ICD-10 (DCR-10) childhood autism.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    DSM-5 is seen to have high specificity and relatively good sensitivity when compared with DSM-IV-TR and ICD-10 (DCR-10).

    “DSM 5 is seen to have high specificity and relatively good sensitivity when compared with DSM-IV-TR and ICD-10 (DCR-10).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The diagnosis of ASD mainly relies on behaviour dimensions because there is a lack of a specific 'autism gene' or any other biochemical marker.

    “These debates arise because of the lack of a specific 'autism gene' or any other biochemical marker to help in the diagnosis of ASD [9].Hence the diagnosis mainly relies on behaviour dimensions”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Geschwind DH: Genetics of autism spectrum disorders. Trends Cogn Sci 2011, 15:409- 16.

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

  • Classified as probably not a substantial claim.

    Premisecitation

    Participants with severe and profound co-morbid mental retardation were excluded because making a diagnosis of ASD becomes difficult in such cases.

    “Participants with severe and profound co-morbid mental retardation were excluded as making a diagnosis of ASD becomes difficult in such cases [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] 37. Kar N, Khanna R, Kar GC: Autistic features in children with mental retardation. Indian J Psychiatry 1997, 39:304-8.

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

  • Classified as probably not a substantial claim.

    Premisecitation

    The DSM-5 ASD category has lumped all diagnostic entities which were earlier separately diagnosed, becoming an umbrella term including early infantile autism, childhood autism, Kanner's autism, high functioning autism, atypical autism, PDD NOS, CDD, and Asperger's Disorder.

    “The DSM-5 ASD category has lumped all diagnostic entities which were earlier separately diagnosed, it becomes an umbrella term which includes early infantile autism, childhood autism, Kanner's autism, high functioning autism, atypical autism, pervasive developmental disorder not otherwise specified, Childhood Disintegrative Disorder, and Asperger's Disorder [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] 7. American Psychiatric Association, American Psychiatric Association. DSM-5: Diagnostic and statistical manual of mental disorders, text revision. Washington, DC:American Psychiatric Association; 2013.

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

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To minimize a potential concordance bias, a period of one day was kept between application of DSM-IV-TR/ICD-10 (DCR-10) and DSM-5.

    “To minimize a potential concordance bias, a period of one day was kept between application of DSM-IV-TR/ICD-10 (DCR-10) and DSM-5.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The diagnosis of autism will not be missed; children with more typical features of autism will certainly receive a diagnosis on applying DSM-5 ASD.

    “Conclusions: The diagnosis of autism will not be missed.”
    • Also stated in: § Discussion · boosted
      “Hence, the children with more typical features of Autism will certainly receive a diagnosis on applying DSM-5 ASD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The present study used a prospective sample of participants with suspected autism and applied the final DSM-5 ASD criteria, not the draft criteria.

    “While in the present study, the prospective sample of participants was taken with suspected autism and we have used the DSM 5 ASD criteria and not the draft criteria”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Because the present study used a prospective sample with suspected autism, participants were not carrying any diagnostic label, which minimized bias.

    “Hence the participants were not carrying any diagnostic label, thus making best effort to do away with any kind of bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisenone given

    Most studies that have done agreement analysis compared DSM-5 ASD with DSM-IV-TR ASD/ICD-10 (DCR-10) ASD, and there is no such study from India.

    “Of the few studies that have done the agreement analysis, most studies have compared DSM-5 ASD with DSM IV-TR ASD/ICD-10 (DCR-10) ASD and there is no such study from India.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    An understanding of the new diagnostic direction will have great implications for diagnosis, service delivery, and insurance coverage worldwide.

    “an understanding of this new diagnostic direction will have great implications for diagnosis, service delivery and insurance coverage over the world.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    An effort was made to minimize bias by applying DSM-5 ASD criteria the following day after listening to the audio interview and recalling the clinical assessment, but a potential bias cannot be ruled out.

    “Although an effort was made to minimize the bias, by applying DSM-5 ASD criteria the following day, after listening to the audio interview and recalling the clinical assessment; still a potential bias cannot be ruled out.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    When DSM-5 ASD is applied to children with a previous DSM-IV-TR diagnosis, there will be very few false positives and almost all children will receive a diagnostic label under DSM-5.

    “This indicates that when DSM-5 ASD is applied on children who have previous diagnosis on DSM-IV-TR, there will be very few false positives and almost all children will receive a diagnostic label under DSM 5.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    No formal scales or tests were used in this study.

    “No formal scales or tests were used in this study.”
    Quote in the paperSubstantial claim
20 of 20

  • The paper relies on this without support.

    No study has examined the concordance of ASD using the complete DSM-5 ASD criteria and PDD using DSM-IV-TR and ICD-10 within an Indian sample.

    “To the best of our knowledge, no study has examined the concordance of ASD using the complete DSM-5 ASD criteria and Pervasive Developmental Disorder, PDD using DSM-IV-TR criteria and ICD-10 (DCR-10) criteria within an Indian sample.”
1 of 1

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.

  • Some previously identified autism cases did not meet DSM-5 ASD criteria

    Major

    The conclusion says autism diagnoses will not be missed, but only 62 of the 68 participants meeting DSM-IV-TR criteria for autistic disorder met DSM-5 ASD criteria. That leaves six who did not.

  • Comorbidity percentage uses a different denominator from the sample

    Minor

    The table lists 52 participants with no comorbidity as 70.3%, although 52 of the study's 100 participants is 52%. The listed comorbidity counts total only 74, with no missing-data category shown.

    Reported 70.3 · recomputed 52

  • Reported age range falls below the eligibility minimum

    Minor

    The minimum eligible age was 2.5 years, or 30 months, but the reported participant age range begins at 28 months.

3 of 3

Cites

The publisher hasn’t deposited this paper’s reference list.

Research works printed but not linked: 14

  1. [1]1. Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al: Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years -Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morb Mortal Wkly Rep Surveill Summ 2018, 67:1-23.
  2. [5]5. Arun P: Prevalence of autism spectrum disorder in semiurban community in South India. Ann Epidemiol 2017, 27:296.
  3. [6]6. Kim SK: Recent update of autism spectrum disorders. Korean J Pediatr 2015, 58:8-14.
  4. [8]8. Wing L, Gould J, Gillberg C: Autism spectrum disorders in the DSM-V: better or worse than the DSM-IV? Res Dev Disabil 2013, 32:768-73.
  5. [9]9. Geschwind DH: Genetics of autism spectrum disorders. Trends Cogn Sci 2011, 15:409- 16.
  6. [11]11. Cantwell DP: Classification of Child and Adolescent Psychopathology. J Child Psychol Psychiatry 1996, 37:3-12.
  7. [12]12. Sponheim E: Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC. J Autism Dev Disord 1996, 26:513-25.
  8. [31]31. Laor N: Toward liberal guidelines for clinical research with children. Med Law 1987, 6(2):127-37.
  9. [33]33. Malin A: Malin's Intelligence Scale for Children (MISIC). Indian J Ment Retard 1969, 4 :15-25.
  10. [34]34. Bhatia CM: Performance intelligence test battery. Bombay: Oxford University Press; 1995.
  11. [35]35. Bharatraj J: AIISH norms on Seguin Form Board with Indian children. J India Inst Speech Hear 1971, 2:117-27.
  12. [36]36. Raven J, Raven JC, Court JH: Manual for Raven's progressive matrices and vocabulary scales. Oxford: Oxford Psychologists Press; 1998.
  13. [37]37. Kar N, Khanna R, Kar GC: Autistic features in children with mental retardation. Indian J Psychiatry 1997, 39:304-8.
  14. [38]38. Williams JR: The Declaration of Helsinki and public health. Bull World Health Organ 2008, 86:650-2.

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Authors
Kalra, P., Arun, P., Chavan, B. S., & Gupta, N.
ORCID
Venue
Journal of Indian Association for Child and Adolescent Mental Health
Publisher
SAGE Publications
Published
2021-01
Volume
17
Issue
1
Pages
25-47
ISSN
  • 0973-1342 (ISSN-L)
  • 2754-6349
DOI
10.1177/0973134220210103
OpenAlex
W4286558282
Cited by
2
References
0
Citations by year
2026: 1 · 2024: 1
FWCI
0.13
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
Journal of Indian Association for Child and Adolescent Mental Health (publishedVersion)
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, diagnostic criteria, DSM-5, DSM-IV-TR, diagnostic agreement, atypical autism, pervasive developmental disorder not otherwise specified, social communication disorder, children, North India

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