Validation of Proposed DSM-5 Criteria for Autism Spectrum Disorder

Abstract

Objective The primary aim of the present study was to evaluate the validity of proposed DSM-5 criteria for Autism Spectrum Disorder (ASD). Method We analyzed symptoms from 14,744 siblings (8,911 ASD; 5,863 non-ASD) included in a national registry, the Interactive Autism Network. Youth aged 2–18 were included if at least one child in the family was diagnosed with ASD. Caregivers reported symptoms using the Social Responsiveness Scale and the Social Communication Questionnaire. The structure of autism symptoms was examined using latent variable models that included categories, dimensions, or hybrid models specifying categories and sub-dimensions. Diagnostic efficiency statistics evaluated the proposed DSM-5 algorithm in identifying ASD. Results A hybrid model that included both a category (ASD vs. non-ASD) and two symptom dimensions (social communication/interaction and restricted/repetitive behaviors) was more parsimonious than all other models and replicated across measures and sub-samples. Empirical classifications from this hybrid model closely mirrored clinical ASD diagnoses (90% overlap), implying a broad ASD category distinct from non-ASD. DSM-5 criteria had superior specificity relative to DSM-IV-TR criteria (.97 vs. .86), however sensitivity was lower (.81 vs. .95). Relaxing DSM-5 criteria by requiring one less symptom criterion increased sensitivity (.93 vs. .81), with minimal reduction in specificity (.95 vs. .97). Conclusions Results supported the validity of proposed DSM-5 criteria for ASD as provided in Phase I field trials criteria. Increased specificity of DSM-5 relative to DSM-IV-TR may reduce false positive diagnoses, a particularly relevant consideration for low base rate clinical settings. Phase II testing of DSM-5 should consider a relaxed algorithm, without which as many as 12% of ASD-affected individuals, particularly females, will be missed. Relaxed DSM-5 criteria may improve identification of ASD, decreasing societal costs through appropriate early diagnosis and maximizing intervention resources.

Are Autistic Traits Measured Equivalently in Individuals With and Without An Autism Spectrum Disorder? An Invariance Analysis of the Autism Spectrum Quotient Short Form

“…The key difference is that those with a clinical diagnosis of ASD cross a threshold beyond which functioning is significantly impaired, whereas those high on ALTs but without a clinical diagnosis of ASD remain able to cope with the social interaction demands of society (Lundstro¨m et al 2012). This hypothesis has been addressed by examining the latent distribution of ASD measures across those with and without ASD using taxometric or latent class analysis methods, with the evidence at present pointing to ASD as a distinct category from ALTs (Frazier et al 2010(Frazier et al , 2012. Again, this line of research depends on measuring autistic traits in individuals without a clinical diagnosis of ASD.…”

What can autism teach us about the role of sensorimotor systems in higher cognition? New clues from studies on language, action semantics, and abstract emotional concept processing

“…Given the importance of early vocalisations for building sensorimotor links, this may offer some explanation for the early language and babbling deficits of ASC; although, notably, 11 Though we do recognise changes to nosology: DSM-IV (APA, 2000) had a three-factor model specifying impairments in the domains of 'social interaction', 'communication' (involving language criteria) and restricted and repetitive behaviours and interests, but DSM-5 combines the first two factors into a single factor called 'social communication'. The two-factor model better fits the symptom presentation of people with autism (Frazier et al, 2012;Mandy, Charman, & Skuse, 2012). This downplaying of language symptoms implies that these are no longer an essential aspect of diagnosis, but in fact, gold-standard diagnostic tools, the ADOS-G (Lord et al, 2000) and the ADI-R (Le Couteur et al, 2003), have not been yet adapted to the new DSM criteria and so language abnormalities (such as pronoun reversal and many more) remain central to diagnosis.…”

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5): What is new for the Pediatrician?

“…There has been some concern in recent publications on the implications of these changes, especially related to the more stringent ASD diagnostic criteria [5], but some positive aspects have also been identified [6]. Field studies have shown that for autism and ADHD, clinicians in general agree with which patients meet DSM-5 diagnostic criteria; though, for some other conditions there is less agreement [7].…”