DSM-IV Pervasive Developmental Disorder Research Articles

Autism Spectrum Disorder Diagnosis in Diagnostic and Statistical Manual of Mental Disorders-5 Compared to Diagnostic and Statistical Manual of Mental Disorders-IV.

Objectives:The objective of this study was to investigate the concordance of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5) diagnostic criteria for autism spectrum disorder (ASD).Methods:We retrospectively reviewed the medical records of 170 subjects (age range: 3–23, 140 boys) with developmental delay or social deficit from January 2011 to July 2016 at the Department of Psychiatry of Asan Medical Center. The Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), and intelligence tests were performed for each subject. Diagnosis was reviewed and confirmed for each subject with DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 ASD criteria, respectively.Results:Fifty-eight of 145 subjects (34.1%) who were previously diagnosed as having PDD in DSM-IV did not meet DSM-5 ASD criteria. Among them, 28 (48.3%) had Asperger’s disorder based on DSM-IV. Most algorithm scores on ADOS and all algorithm scores on ADI-R were highest in subjects who met both DSM-IV PDD criteria and DSM-5 ASD criteria (the Convergent group), followed by subjects with a DSM-IV PDD diagnosis who did not have a DSM-5 ASD diagnosis (the Divergent group), and subjects who did not meet either DSM-IV PDD or DSM-5 ASD criteria (the non-PDD group). Intelligence quotient was lower in the Convergent group than in the Divergent group.Conclusion:The results of our study suggest that ASD prevalence estimates could be lower under DSM-5 than DSM-IV diagnostic criteria. Further prospective study on the impact of new DSM-5 ASD diagnoses in Koreans with ASD is needed.

Autism Spectrum Disorder in the DSM-5: Diagnostic Sensitivity and Specificity in Early Childhood.

Changes to the DSM-5 Autism Spectrum Disorder (ASD) criteria raised concerns among parents and practitioners that the criteria may exclude some children with Pervasive Developmental Disorder (PDD). Few studies have examined DSM-5 sensitivity and specificity in children less than 5years of age. This study evaluated 185 children aged 20-55months with DSM-IV PDD or developmental delay. Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) data was assigned to DSM-5 subdomains. Children displaying the required symptomatology were classified with DSM-5 ASD. DSM-IV clinical diagnoses were compared to DSM-5 classifications. Using combined ADI-R/ADOS information, sensitivity was .84 and specificity was .54. Comorbid behaviour and emotional problems were significantly lower in children with PDD that did not meet DSM-5 criteria.

Asperger syndrome in males over two decades: stability and predictors of diagnosis.

To examine the diagnostic stability of a childhood diagnosis of Asperger Syndrome (AS) into adulthood in a prospective longitudinal study, and identify the predictors of stability. One hundred males with AS diagnosed in childhood (T0) according to Gillberg's AS criteria, were followed up prospectively into adulthood over an average of 19years (range 13-26years). Fifty males (mean age 30years) participated in this second follow-up (T2) of the cohort. Seventy-six had participated in a previous follow-up (T1) at mean age 22years (47 participated in both follow-ups). Diagnosis at T2 was assessed using three sets of diagnostic criteria (Gillberg's AS criteria, DSM-IV Pervasive Developmental Disorder (PDD) and DSM-5 Autism Spectrum Disorder (ASD) criteria) and compared to previous assessments. Background predictors of diagnostic stability were analyzed. General functioning at T2 was assessed and compared to T1. There was a decline in the stability of AS diagnosis over time, the rate dropping from 82% at T1 to 44% at T2, when using the Gillberg criteria. There was also a significant decrease in the rate of cases fulfilling any PDD diagnosis according to the DSM-IV, from 91% at T1 to 76% at T2 in the 47 cases followed up twice. Severity of autism spectrum symptoms at T1 was the main predictor of diagnostic stability at T2. Twenty percent of those meeting criteria for a PDD diagnosis according to DSM-IV, did not meet DSM-5 ASD criteria although they had marked difficulties in everyday life. Asperger Syndrome, when considered as an ASD/PDD diagnosis, was fairly stable into adulthood, but there was a significant increase over time in cases no longer meeting criteria for an ASD diagnosis according to the DSM-IV, or AS according to the Gillberg criteria. Cases with a stable diagnosis showed significantly more core ASD symptoms in adolescence/young adulthood.

A Comparison of DSM-IV Pervasive Developmental Disorder and DSM-5 Autism Spectrum Disorder Prevalence in an Epidemiologic Sample

Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria. The target population was all children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria. DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77-3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder. Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services.

Autism assessment tools in the transition from DSM-IV to DSM-5

Autism is a heterogeneous disorder with considerable clinical diversity, aetiological heterogeneity, and multiple accompanying disorders. Conceptualization of the core autistic symptoms has evolved from the single criteria of DSM III [1] to a combination of multiple criteria in the traditional dimensions of disturbances in social relation and communication, restricted interests and repetitive behaviours of more recent classification systems. With time, empiric research leads to changes in the combination of dimensions and specific criteria: from 3 dimension with a combination of 12 criteria for autistic disorder of the DSMIV [2], the new DSM-5 [3] defines the two dimensions (social relation/communication and restricted interests/ repetitive behaviours), with 7 criteria for the ‘‘Autism spectrum disorder’’ (ASD). From five previously independent disorders grouped as pervasive developmental disorders (PDD) in DSM-IV, DSM-5, still provisional at the time this editorial was written, defines a single Autism spectrum disorder, and creates the new diagnostic category of Social Communication Deficit describing patients with social communication impairment without significant restricted interest or repetitive behaviours. To manage autism phenotypic complexity and to assist the diagnostic and severity assessment, significant efforts have been devoted in developing reliable instruments able to accurately define and quantify specific autistic symptoms domains as well as behavioural and historical information from different sources. In this Issue, Falkmer and co-workers [4] systematically reviewed the accuracy, reliability, validity and utility of a series of accurately designed instruments and tools, including four observational schedules, six parent/carer interviews, two screening tools and four Asperger syndrome specific instruments, all supported by adequate validity and reliability data. They report that combined ADOS and ADI-R show the best correct classification rate for both DSM-IV autistic disorder and the more broad ‘‘Autism Spectrum Disorder’’ (similar to DSM-IV PDD-NOS); different versions of these instruments have been shown to be able to capture information needed to formulate the diagnosis in different ages of life, including very young children, and in patients with very different developmental levels. Many other instruments are analysed in the paper, showing that they were either lacking important information on sensitivity and specificity or did not have a large evidence-base from sufficient independent studies. Others, such as the CARS, are based mainly on clinical judgement rather than on clearly operationalized procedures. All the instruments analysed in the paper were developed using DSM-IV constructs: interpretation of these results should consider recent papers on the use of the same diagnostic instruments in evaluating the impact of the DSM-5 criteria for the diagnosis of the ‘‘new’’ ASD and the need of accurate evaluation of their quantitative algorithm. Indeed, preliminary finding suggests that a significant portion of patients currently diagnosed by DSM-IV-TR criteria may not be diagnosed by the new criteria, raising the concerns over the danger that, in many countries, these patients may lose access to services, causing significant suffering to them and their families [5]. In an epidemiological study, Mattila et al. [6] found that using the new DSM-5 criteria, only 46 % of the 26 children with DSM-IV PDD (all with full scale IQ higher than 50) were identified as ASD; similar results (only 60.6 % of A. Zuddas (&) Department of Biomedical Sciences, University of Cagliari and Child Neuropsychiatry, Cagliari University Hospital, Via Ospedale 119, 09124 Cagliari, Italy e-mail: azuddas@unica.it

Commentary on the Application of DSM-5 Criteria for Autism Spectrum Disorder

Back to table of contents Previous article Next article Communications and UpdatesFull AccessCommentary on the Application of DSM-5 Criteria for Autism Spectrum DisorderEdward R. Ritvo, M.D., and Riva Ariella Ritvo, Ph.D.Edward R. RitvoSearch for more papers by this author, M.D., and Riva Ariella RitvoSearch for more papers by this author, Ph.D.Published Online:1 Apr 2013https://doi.org/10.1176/appi.ajp.2013.12101376AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In the introduction of the article by Huerta et al. in the October 2012 issue of the Journal (1), the authors cite several published studies indicating that the proposed DSM-5 criteria for autism spectrum disorder (ASD) would exclude approximately 10%–50% of patients currently meeting DSM-IV criteria. These patients would become ineligible for services if clinics required a rediagnosis meeting the new criteria (a common occurrence), and a similar proportion of newly diagnosed patients would be “dropped out” and denied services.To assess this serious issue, Huerta et al. set out to determine the sensitivity and specificity of the proposed DSM-5 criteria relative to the DSM-IV criteria. They utilized three data sets including 4,453 children with a DSM-IV clinical diagnosis of pervasive developmental disorder (PDD) and 690 with non-PDD diagnoses (e.g., language disorder). They reported an overall sensitivity of 0.91 and a specificity of 0.53 for the proposed DSM-5 criteria.The authors concluded, “Our findings indicate that the majority of children with DSM-IV PDD diagnoses would continue to be eligible for an ASD diagnosis under DSM-5,” thus implying that their data support instituting the proposed DSM-5 changes.We respectfully disagree with their opinion regarding the usefulness of the proposed DSM-5 criteria based on their data. Abandoning criteria that have been in worldwide use for decades for new ones that may eliminate from 9% (their data) to >40% (prior reports) of previously diagnosed patients is neither scientifically nor morally justified.Also, the specificity values they computed for the new criteria averaged only 0.53. This figure is unacceptably low by typical medical test standards.It is also important to point out that the data set used by the authors contained only 238 case subjects with Asperger’s disorder among all 4,453 children meeting DSM-IV criteria. Thus, only a small number (0.53%) of those compared with the DSM-5 criteria were those most likely to be eliminated according to the prior studies they cited. This makes the observed specificity and sensitivity higher than they would have been if those known to be most likely to be excluded were in fact excluded before the study began.We also wish to point out another serious unintended consequence of instituting the proposed DSM-5 criteria—the obvious problem posed to all researchers when selection criteria for subjects are changed. We have amassed large, detailed, uniformly diagnosed subject pools at great effort and expense over the past four decades. Changing diagnostic criteria would make those subject data pools incompatible and unusable for studies involving individuals diagnosed by new criteria who will be enrolled in our ongoing and future clinical and biomedical research projects.In conclusion, the results presented by the authors do not support instituting the DSM-5 criteria and can cause harm to our patients and research projects. Furthermore, the proposed changes rest on clinical data, and any changes should be postponed until new, replicable biomedical data warrant such a major undertaking.From the Neuropsychiatric Institute, University of California Los Angeles, and the Yale Child Study Center, New Haven.The authors report no financial relationships with commercial interests.Reference1 Huerta M, Bishop SL, Duncan A, Hus V, Lord C: Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. Am J Psychiatry 2012; 169:1056–1064Link, Google Scholar FiguresReferencesCited byDetailsCited ByPerinatal issues for women with high functioning autism spectrum disorderWomen and Birth, Vol. 30, No. 2Journal of Autism and Developmental Disorders, Vol. 47, No. 9Update on diagnostic classification in autismCurrent Opinion in Psychiatry, Vol. 27, No. 2A novel conceptual framework for psychiatry: vertically and horizontally integrated approaches to redundancy and pleiotropism that co-exist with a classification of symptom clusters based on DSM-530 July 2013 | Molecular Psychiatry, Vol. 18, No. 8BMC Medicine, Vol. 11, No. 1 Volume 170Issue 4 April 2013Pages 444a-445 Metrics PDF download History Accepted 1 January 2013 Published online 1 April 2013 Published in print 1 April 2013

The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study.

BackgroundA subgroup of persons with anorexia nervosa (AN) have been proposed to have sociocommunicative problems corresponding to autism spectrum disorders [ASDs, i.e. DSM-IV pervasive developmental disorders (PDDs): autistic disorder, Asperger's disorder, PDD not otherwise specified (NOS)]. Here, clinical problems, personality traits, cognitive test results and outcome are compared across 16 subjects (32%) with teenage-onset AN who meet or have met ASD criteria (AN+ASD), 34 ASD-negative AN subjects and matched controls from a longitudinal Swedish study including four waves of independent assessments from the teens to the early thirties.MethodThe fourth wave included the Structured Clinical Interview for DSM-IV (SCID)-I and the SCID-II (cluster C, i.e. ‘anxious’ PDs) interviews, the Asperger Syndrome Diagnostic Interview, self-assessments by the Autism Spectrum Quotient and the Temperament and Character Inventory, neurocognitive tests by subscales from the Wechsler scales, continuous performance tests, Tower of London, and Happé's cartoons.ResultsThe ASD assessments had substantial inter-rater reliability over time (Cohen's κ between 0.70 and 0.80 with previous assessments), even if only six subjects had been assigned a diagnosis of an ASD in all four waves of the study, including retrospective assessments of pre-AN neurodevelopmental problems. The AN+ASD group had the highest prevalence of personality disorders and the lowest Morgan–Russell scores. The non-ASD AN group also differed significantly from controls on personality traits related to poor interpersonal functioning and on neurocognitive tests.ConclusionsA subgroup of subjects with AN meet criteria for ASDs. They may represent the extreme of neurocognitive and personality problems to be found more generally in AN.

How to deal with the transition from Pervasive Developmental Disorders in DSM‐IV to Autism Spectrum Disorder in DSM‐V

How to deal with the transition from Pervasive Developmental Disorders in DSM‐IV to Autism Spectrum Disorder in DSM‐V

Risperidone versus haloperidol in children and adolescents with AD

The aim of the study was to compare safety, efficacy and tolerability of risperidone with haloperidol in the treatment of Autistic Disorder (AD). This study was designed as a double-blind, prospective, for a 12-week period. A total of 30 subjects, between the ages of 8 and 18 with AD based on DSM IV criteria, were included in the study. Behavioral Rating Scales were performed by the investigators and the parents. Safety assessment included vital signs, electrocardiogram, electroencephalogram, adverse events, laboratory tests, extrapyramidal symptoms and the side effects. Both treatments were applied in a once daily dosage regimen of 0.01-0.08 mg/kg/day. The reduction from baseline in Ritvo-Freeman Real Life Rating Scale (RF-RLRS), sensory motor (subscale I) and language (subscale V) scores were significant in risperidone group (P < 0.05). Compared to haloperidol, risperidone led to a significantly greater reduction in the Aberrant Behavior Checklist (ABC) and Turgay DSM-IV Pervasive Developmental Disorder (PDD) scale scores (P < 0.05 and P < 0.01). There was a greater increase of prolactin in the risperidone group, while alanine amino transferase (ALT) had further increased in the haloperidol group. Sensory motor behaviors (subscale I) and language at the end of the 12th week, RF-RLRS sensory motor and language subscale scores decreased in the risperidone group further than the other group (P < 0.05). Risperidone was found to be more effective than haloperidol in the treatment of behavioral symptoms, impulsivity, language skills, and impaired social relations in children with AD. These results demonstrated that both drugs were safe and well tolerated in the treatment of AD.

Comparison of long-term efficacy and safety of risperidone and haloperidol in children and adolescents with autistic disorder

The aim of the study was to investigate safety, efficacy and tolerability of risperidone in comparison with haloperidol in the long-term treatment of autistic disorder. This was an open-label continuation study of the randomized, double-blind, controlled trial of risperidone and haloperidol study for 12 week in autistic children and adolescents. A total of 28 subjects between 8 and 18 ages with autistic disorder were enrolled to the open label phase of the study. Behavioral rating scales (Clinical Global Impression Scale [CGI-I], Ritvo-Freeman Real Life Rating Scale [RF-RLRS]), Aberrant Behavior Checklist [ABC], Turgay DSM-IV Pervasive Developmental Disorder Rating Scale [TPDDRS]) and safety assessment scales (Extrapyramidal Symptoms Rating Scale [ESRS], UKU-Side Effect Rating Scale) were performed at 12, 16, 20 and 24 weeks, following the 12 week double-blind phase. Risperidone and haloperidol treatments were applied with a once daily dosage regimen as 0.01-0.08 mg/kg/day. Risperidone led to a significant greater reduction on CGI scale. There was significant improvement on RF-RLRS sensory motor and language subscale and ABC scores in risperidone group. Weight gain was observed more frequently in the haloperidol group at week 24. These results demonstrate that risperidone is more efficacious and well tolerated than haloperidol in the long-term maintenance treatment of autistic disorder.