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

J Am Acad Child Adolesc Psychiatry. 2012 Apr;51(4):368-83. doi: 10.1016/j.jaac.2012.01.007. Epub 2012 Mar 14.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asperger Syndrome / classification
  • Asperger Syndrome / diagnosis
  • Asperger Syndrome / epidemiology
  • Asperger Syndrome / psychology
  • Checklist
  • Child
  • Child Development Disorders, Pervasive / classification
  • Child Development Disorders, Pervasive / diagnosis*
  • Child Development Disorders, Pervasive / epidemiology
  • Child Development Disorders, Pervasive / psychology
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Disability Evaluation
  • Eligibility Determination / legislation & jurisprudence
  • Humans
  • Incidence
  • Mental Health Services / legislation & jurisprudence
  • Sensitivity and Specificity
  • United States