Comparisons of DSM-IV and DSM-5 Criteria for Diagnostic Outcomes When Used in Community-Based Teacch Centers

Background: The recent controversy regarding proposed revisions to the diagnostic criteria for Autism Spectrum Disorder relates to concerns about the sensitivity and specificity of the DSM-5 criteria for identifying individuals who would meet criteria for autism by DSM-IV criteria. According to several reports, diagnostic sensitivity decreased by 30 to 40% whereby individuals who met criteria for a Pervasive Developmental Disorder on the basis of DSM-IV-TR criteria no longer met criteria for ASD in accordance with DSM-5 criteria (Gibbs et al., 2012; McPartland et al., 2012). However, diagnostic disagreement between the two systems has been observed in as few as 9% of individuals (Huerta et al., 2012). Most comparisons of DSM-IV and DSM-5 criteria have been conducted through retrospective analysis of the archival data of individuals previously diagnosed with an ASD. Community based prospective studies in which clinicians concurrently assess individuals with both DSM-IV and DSM-5 criteria are necessary in order to further examine the sensitivity and specificity of DSM-5 diagnostic criteria for ASD.

Objectives: To conduct a prospective comparison of diagnostic conclusions using DSM-IV and DSM-5 criteria within a clinic setting. 

Methods: All participants were seen for diagnostic evaluation at the University of North Carolina TEACCH Autism Program across multiple centers in North Carolina. Assessments included administration of the Autism Diagnostic Observation Schedule-2 (ADOS-2), the Childhood Autism Rating Scale-2 (CARS-2), and a developmental history interview. Diagnostic conclusions were made on the basis of the direct assessment and observation, developmental history, DSM-IV-TR criteria and on the basis of clinical judgment. In addition, clinicians rated participants on DSM-5 criteria for ASD on the day of the diagnostic. Data collection is ongoing with an anticipated sample size of 150 participants by February 2013. Preliminary evidence was obtained for 14 participants. The participants are representative of a variety of socioeconomic and racial backgrounds from both rural and urban centers throughout the state. The TEACCH Center conducts diagnostic evaluation on all ages from toddlers through adults. The age range of the first 14 participants was 1.09 to 17.06 years (mean= 6.53 years; SD= 4.85).

Results: In preliminary data, 78.6% of the participants assessed received a diagnosis of ASD. All met criteria on both the proposed DSM-5 and DSM-IV criteria.

Conclusions: Preliminary findings show consistency across DSM-IV and DSM-5 diagnosis using a prospective sample suggesting that DSM-5 is not likely to result in fewer diagnoses.