DSM-5 Update: Field Testing
from Autism Speaks Chief Science Officer
8 May 2012
I’m pleased to report on the latest findings from field trials using the proposed new DSM-5 diagnostic criteria for autism spectrum disorder (ASD). The preliminary results suggest that the DSM-5 does not appear to reduce the number of children who receive an ASD diagnosis.
As many of you are aware, Autism Speaks is playing a proactive role in monitoring the effect of the planned revisions to the definition of ASD in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for publication in spring 2013. (Please see my previous DSM-5 Update, Autism Speaks Statement on Proposed Revisions to the DSM Definition of Autism Spectrum Disorder and Frequently Asked Questions about DSM-5.)
This week brought the first results of field trials conducted with nearly 300 children at four pediatric autism clinics to assess differences in diagnosis rates using DSM-IV versus DMS-5 criteria. The encouraging news is that the vast majority of children diagnosed with ASD using the old criteria retained their diagnosis under the proposed new criteria.
Approximately 5 to 10 percent received a different diagnosis. Some of these received the new diagnosis of “social communication disorder.” Others received a primary diagnosis of attention deficit and hyperactivity disorder (ADHD).
Notably, the proposed DSM-5 criteria also “captured” some children who did not meet the definition of autism using the old DSM-IV criteria. This could be because there are some symptoms included in the new criteria (e.g. sensory sensitivities) that were not included in the old criteria. As a result, the overall rate of ASD diagnosis did not change between the DSM-IV and DSM-5 definitions of ASD.
In the coming weeks, the committee in charge of the revisions for neurodevelopmental disorders will be reviewing the videotapes of all the children involved in the field trials. They are doing so to examine the accuracy of the DSM-IV and DSM-5 diagnoses as they were applied to the children’s symptoms. The goal is to ensure that no child is being missed.
Overall, the field trial findings do not support the idea that the proposed changes will exclude high-functioning individuals with autism, though further refinements may still be necessary. Additional studies with larger samples that include all ages in the testing are needed. It will be important to ensure that neither language barriers, ethnic disparities nor gender biases are interfering with diagnosis.
In summary, the preliminary results of the DSM-5 committee’s field trials are encouraging. They suggest that the proposed changes will not reduce the number of children who receive a diagnosis of ASD. Autism Speaks is funding both retrospective and prospective studies to determine how the revisions to the diagnostic criteria could affect how diagnoses are made and who can receive services. We want to ensure that all who struggle with autism symptoms will receive the treatment and services they need under future revisions. We are also dedicated to ensuring that autism is recognized as a lifelong condition for most persons, with evolving needs for services across their lifespans.
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