Signposting for diagnosis of Autism Spectrum Disorder using the Diagnostic Interview for Social and Communication Disorders (DISCO)

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

doi:10.1016/j.rasd.2014.10.003

Abstract

Recent research has investigated the capability of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) descriptions to identify individuals who should receive a diagnosis of Autism Spectrum Disorder (ASD) using standardised diagnostic instruments. Building on previous research investigating behaviours essential for the diagnosis of DSM-5 ASD, the current study investigated the sensitivity and specificity of a set of 14 items derived from the Diagnostic Interview for Social and Communication Disorders (DISCO Signposting set) that have potential for signposting the diagnosis of autism according to both the new DSM-5 criteria for ASD and ICD-10 criteria for Childhood Autism. An algorithm threshold for the Signposting set was calculated in Sample 1 (n=67), tested in an independent validation sample (Sample 2; n=78), and applied across age and ability sub-groups in Sample 3 (n=190). The algorithm had excellent predictive validity according to best estimate clinical diagnosis (Samples 1 and 2) and excellent agreement with established algorithms for both DSM-5 and ICD-10 (all samples). The signposting set has potential to inform our understanding of the profile of ASD in relation to other neurodevelopmental disorders and to form the basis of a Signposting Interview for use in clinical practice.

Highlights

Autism has long been described as a spectrum (Wing, 1996), the condition has only recently been given the name Autism Spectrum Disorder (ASD) in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5; American Psychiatric Association, 2013)
In a recent study exploring an abbreviated algorithm for DSM-5, a small set of 14 highly discriminating items were identified from the DISCO based on their predictive validity for individuals with clinical diagnoses of autism compared with individuals with confirmed diagnoses of intellectual disability or language impairment (Carrington, Kent et al, 2014)
In the current study, we examine these 14 items further to examine whether a minimum threshold applied to this set of items might be sufficient to indicate a diagnostic outcome of either DSM-5 ASD or ICD-10 Childhood Autism

Summary

Introduction

Autism has long been described as a spectrum (Wing, 1996), the condition has only recently been given the name Autism Spectrum Disorder (ASD) in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5; American Psychiatric Association, 2013). In a recent study exploring an abbreviated algorithm for DSM-5, a small set of 14 highly discriminating items were identified from the DISCO based on their predictive validity for individuals with clinical diagnoses of autism compared with individuals with confirmed diagnoses of intellectual disability or language impairment (Carrington, Kent et al, 2014).

Results

Conclusion