When only symptoms rated with the Autism Diagnostic Interview were used to identify children with ASD, the sensitivity of the DSM-5 criteria (0.91) was similar to that of the DSM-IV criteria for autistic disorder (0.91) in the combined study groups. Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview–Revised) and from a clinical observation instrument (Autism Diagnostic Observation Schedule) were matched to DSM-IV and DSM-5 criteria and then used to evaluate the sensitivity and specificity of the DSM-IV and DSM-5 criteria when compared with the clinical best-estimate diagnoses. The study participants, ages 2 to 17, were obtained from three large data sets, resulting in 4,453 subjects with DSM-IV clinical diagnoses of (PDDs) (equivalent to ASD) and 690 subjects with non-PDD diagnoses (e.g., language disorder, attention deficit hyperactivity disorder). The study was also designed to provide supportive data to the DSM-5 ASD criteria. ( 4) report a study designed to demonstrate the different rates of sensitivity and specificity based on the DSM-IV and DSM-5 ASD criteria. In this issue of the Journal, Huerta et al. The work group, however, also recognized that the group’s early analyses had limitations that would be addressed through the ongoing efforts to produce reliable, valid diagnostic criteria for DSM-5 that should be effective in identifying the broad array of individuals with ASD. had too many inherent limitations for assessment of the criteria proposed for DSM-5, particularly in regard to sensitivity and specificity (i.e., ability to correctively identify those without the disease or disorder). The work group members considered that the archived data used in the analyses by McPartland et al. ( 2), when the first draft of the DSM-5 criteria for ASD were applied to a data set of 657 participants in a DSM-IV field trial evaluating clinical diagnoses of PDDs, 60.6% of those with a clinical diagnosis of a PDD would meet the DSM-5 criteria for ASD, indicating that 39.4% would not.Ī commentary by the DSM-5 Neurodevelopmental Disorders Work Group ( 3) addressed serious methodological flaws in the study by McPartland and colleagues. ( 1), which compared the sensitivity (i.e., ability to correctively identify those with the disease or disorder) of DSM-IV-TR and the first draft of the DSM-5 criteria for ASD, 12 (46%) of the 26 subjects with DSM-IV-TR PDDs (and full-scale IQs above 50) were identified as having ASD according to the DSM-5 criteria. In the epidemiological study of Finnish children by Mattila et al. This concern arose subsequent to some published reports. One of the major concerns of some mental health professionals and consumers is that the proposed DSM-5 new category of “autism spectrum disorder” (ASD) may exclude a substantial proportion of cognitively able individuals with pervasive developmental disorders (PDDs) other than autistic disorder, i.e., Asperger’s disorder or PDD not otherwise specified (PDD-NOS). Now DSM-5 is being developed and most likely will be rolled out in 2013. The expectation of DSM-III and the subsequent DSM-III-R and DSM-IV was that DSM-based research would identify the underlying etiologies of the disorders included in the manuals, which would allow greater refinement of the criteria and ultimately their validation by biological measures and etiologies. In 1980, DSM-III moved from a descriptive or conceptual approach to an operationalized, criteria-defining approach to enable clinicians to make diagnoses on the basis of whether a patient's symptoms matched the diagnostic criteria. Initially DSM was developed for psychiatrists who were interested in describing and understanding the frequency with which mental illnesses develop in our society.
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