Final DSM-5 under-identifies mild Autism Spectrum Disorder: Agreement between the DSM-5, CARS,CASD, and clinical diagnoses |
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| Institution: | 1. Center for Autism Spectrum Disorders, Children’s Research Institute, Children’s National Health System, 15245 Shady Grove Rd., Ste 350, Rockville, MD 20850, United States;2. Child and Family Psychological Associates, 110 Hartwell Ave, Suite 330, Lexington, MA 02421, United States;1. Child Study Center, Yale University, New Haven, CT, the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, and Yonsei University, Seoul, South Korea;2. Oregon Health and Science University, Portland, OR;3. Korea Institute for Children''s Social Development (“Rudolph”), Seoul, South Korea;4. University of Washington, Seattle, WA;5. Yonsei University, Seoul, South Korea;6. Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, Yonsei University, Seoul, South Korea, and the University of Illinois, Chicago, IL;1. Wales Autism Research Centre, School of Psychology, Cardiff University, UK;2. University of Leuven (KU Leuven), Belgium;3. Leiden University, The Netherlands;4. Institute of Health and Society, Newcastle University, UK;5. Lorna Wing Centre, National Autistic Society, Elliot House, Bromley, UK;1. Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Assistance Publiques-Hôpitaux de Paris, GH Pitié-Salpétrière, Paris, France;2. Department of Child and Adolescent Psychiatry, Université de Strasbourg, Strasbourg, France;3. Department of Psychology, Brandeis University, Waltham, MA, USA;4. Division of Child Neuropsychiatry, University Hospital of Siena, Italy;5. Institut des Systèmes Intelligents et Robotiques (ISIR), CNRS UMR 7222, Université Pierre et Marie Curie, Paris, France;1. College of Electronic & Information Engineering, Hebei University, Baoding, China;2. Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China;3. State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China |
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| Abstract: | Agreement between the final DSM-5 ASD criteria, Childhood Autism Rating Scale (CARS), and Checklist for Autism Spectrum Disorder (CASD) was assessed in 143 children with ASD and other disorders (e.g., ADHD, intellectual disability, and oppositional defiant disorder). Diagnostic agreement between the CARS and CASD was high (94%), but their agreement with the DSM-5 was lower (84% and 88%). Agreement between the DSM-5 and both the CARS and CASD increased to 94% and diagnostic accuracy increased from 92% to 96% when one less DSM-5 social communication and interaction symptom was required for a diagnosis. Children with ASD not meeting DSM-5 criteria most often did not have criterion A2 (deficits in nonverbal social communication). Total scores on the DSM-5, CASD, and CARS were far higher for children with mild ASD (formerly PDDNOS) than no ASD, indicating that these children are clearly on the autism spectrum and are quite different from children with other disorders. However, only one child with mild ASD was identified by the DSM-5. This study and 11 others show that the DSM-5 under-identifies children with ASD, particularly children at the mild end of the spectrum. This can be rectified by requiring one less social communication and interaction symptom for a diagnosis. |
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| Keywords: | DSM-5 Checklist for Autism Spectrum Disorder Childhood Autism Rating Scale |
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