DSM-5 Autism Spectrum Disorder: In search of essential behaviours for diagnosis

Sarah J Carrington,Rachel G Kent,Jarymke Maljaars,Ann Le Couteur,Judith Gould,Lorna Wing,Ilse Noens,Ina Van Berckelaer-Onnes,Susan R Leekam

doi:10.1016/j.rasd.2014.03.017

Abstract

The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Highly discriminating, ‘essential’ behaviours were identified from the published DSM-5 algorithm developed for the Diagnostic Interview for Social and Communication Disorders (DISCO). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. An adjusted essential item set (54 items; Study 2) had good sensitivity when applied to individuals with higher ability and performance was comparable to the published full DISCO DSM-5 algorithm. Investigation at the item level revealed that the most highly discriminating items predominantly measured social-communication behaviours. This work represents a first attempt to derive a reduced set of behaviours for DSM-5 directly from an existing standardised ASD developmental history interview and has implications for the use of DSM-5 criteria for clinical and research practice.

Highlights

The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD)
These results suggest that the capacity of the DSM-5 criteria to provide high levels of sensitivity and specificity comparable with DSM-IV-TR relies on the careful selection of appropriate items from diagnostic instruments that map onto the DSM-5 descriptions
The authors suggested that this combination of both ‘global’ and specific items facilitated the high level of correspondence between the DISCO DSM-5 algorithm output and clinical diagnosis according to DSM-IV-TR

Summary

Introduction

The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. The effect of ‘relaxing’ the DSM-5 rules such that only two rather than all three social-communication sub-domains were required decreased the specificity of the algorithm and did not significantly improve sensitivity These results suggest that the capacity of the DSM-5 criteria to provide high levels of sensitivity and specificity comparable with DSM-IV-TR relies on the careful selection of appropriate items from diagnostic instruments that map onto the DSM-5 descriptions. The authors suggested that this combination of both ‘global’ and specific items facilitated the high level of correspondence between the DISCO DSM-5 algorithm output and clinical diagnosis according to DSM-IV-TR

Objectives

Methods

Results

Conclusion