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Journal of Autism and Developmental Disorders

, Volume 45, Issue 11, pp 3634–3643 | Cite as

The New DSM-5 Impairment Criterion: A Challenge to Early Autism Spectrum Disorder Diagnosis?

  • Eric Zander
  • Sven Bölte
Original Paper

Abstract

The possible effect of the DSM-5 impairment criterion on diagnosing autism spectrum disorder (ASD) in young children was examined in 127 children aged 20–47 months with a DSM-IV-TR clinical consensus diagnosis of ASD. The composite score of the Vineland Adaptive Behavior Scales (VABS) served as a proxy for the DSM-5 impairment criterion. When applying a mild level of impairment (cutoff: 1 SD below the mean on the VABS), 88 % of the cases fulfilled the impairment criterion. Sixty-nine percent fulfilled the impairment criterion at a moderate level (1.5 SDs) and 33 % at a severe level (2 SDs). Findings indicate that a strict application of the new DSM-5 impairment criterion might compromise early diagnosis of ASD.

Keywords

Classification Psychiatry Assessment Adaptive functioning Neurodevelopmental disorders 

Notes

Acknowledgments

We sincerely thank Per-Olof Björck, head of the southeastern part of the Division of Child and Adolescent Psychiatry in Stockholm, for facilitating the realization of this study. Sven Bölte was supported by the Swedish Research Council. This study was supported by the Swedish Research Council in partnership with FAS, FORMAS and VINNOVA (cross-disciplinary research program concerning children’s and youth’s mental health), Riksbankens Jubileumsfond and Jerringfonden.

References

  1. American Psychiatric Association (APA). (1980). Diagnostic and statistical manual of mental disorders. DSM-III (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders. DSM-IV-TR (4th ed., text revision ed.). Washington, DC: American Psychiatric Association.Google Scholar
  3. American Psychiatric Association (APA) (. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association.Google Scholar
  4. Barton, M. L., Robins, D. L., Jashar, D., Brennan, L., & Fein, D. (2013). Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. Journal of Autism and Developmental Disorders, 43(5), 1184–1195.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Bernier, R. (2012). How do we measure autism severity? SFARI Viewpoints. http://sfari.org/news-and-opinion/viewpoint/2012/how-do-we-measure-autism-severity. Accessed July 2012.
  6. Bolduc, M. E., Du Plessis, A. J., Sullivan, N., Khwaja, O. S., Zhang, X., Barnes, K., et al. (2011). Spectrum of neurodevelopmental disabilities in children with cerebellar malformations. Developmental Medicine and Child Neurology, 53(5), 409–416.CrossRefPubMedGoogle Scholar
  7. Bölte, S., de Schipper, E., Holtmann, M., Karande, S., de Vries, P. J., Selb, M., et al. (2014). Development of ICF core sets to standardize assessment of functioning and impairment in ADHD: The path ahead. European Child and Adolescent Psychiatry, 23(12), 1139–1148.Google Scholar
  8. Bölte, S., de Schipper, E., Robison, J. E., Wong, V. C., Selb, M., Singhal, N., et al. (2013). Classification of functioning and impairment: The development of ICF core sets for autism spectrum disorder. Autism Research, 7(1), 167–172.CrossRefPubMedGoogle Scholar
  9. Bölte, S., & Poustka, F. (2002). The relation between general cognitive level and adaptive behavior domains in individuals with autism with and without co-morbid mental retardation. Child Psychiatry and Human Development, 33(2), 165–172.CrossRefPubMedGoogle Scholar
  10. Bolton, D. (2013). Overdiagnosis problems in the DSM-IV and the new DSM-5: Can they be resolved by the distress-impairment criterion? Canadian Journal of Psychiatry, 58(11), 612–617.Google Scholar
  11. Canino, G. J. (2013). Assessing child impairment in functioning in different contexts: Implications for use of services and the classification of psychiatric disorders. Open Journal of Medical Psychology, 03(01), 29–34.CrossRefGoogle Scholar
  12. Fabiano, G. A., & Pelham, W. E, Jr. (2009). Impairment in children. In S. Goldstein & J. A. Naglieri (Eds.), Assessing impairment: From theory to practice. Dordrecht: Springer.Google Scholar
  13. Fenton, G., D’Ardia, C., Valente, D., Del Vecchio, I., Fabrizi, A., & Bernabei, P. (2003). Vineland adaptive behavior profiles in children with autism and moderate to severe developmental delay. Autism, 7(3), 269–287.CrossRefPubMedGoogle Scholar
  14. Fulton, E., Eapen, V., Crncec, R., Walter, A., & Rogers, S. (2014). Reducing maladaptive behaviors in preschool-aged children with autism spectrum disorder using the early start denver model. Frontiers in Pediatrics, 2, 40.PubMedCentralCrossRefPubMedGoogle Scholar
  15. Gan, S. M., Tung, L. C., Yeh, C. Y., & Wang, C. H. (2013). ICF-CY based assessment tool for children with autism. Disability and Rehabilitation, 35(8), 678–685.CrossRefPubMedGoogle Scholar
  16. Gathje, R. A., Lewandowski, L. J., & Gordon, M. (2008). The role of impairment in the diagnosis of ADHD. Journal of Attention Disorders, 11(5), 529–537.PubMedGoogle Scholar
  17. Goldstein, S., & Naglieri, J. A. (2009). Defining the evolving concept of impairment. In S. Goldstein & J. A. Naglieri (Eds.), Assessing impairment: From theory to practice. Dordrecht: Springer.Google Scholar
  18. Harris, S. L., Handleman, J. S., Belchic, J., & Glasberg, B. (1995). The Vineland adaptive behavior scales for young children with autism. Special Services in the Schools, 10(1), 45–54.CrossRefGoogle Scholar
  19. Hedvall, A., Westerlund, J., Fernell, E., Holm, A., Gillberg, C., & Billstedt, E. (2014). Autism and developmental profiles in preschoolers: Stability and change over time. Acta Paediatrica, 103(2), 174–181.CrossRefPubMedGoogle Scholar
  20. Hofmann, S. G. (2014). Toward a cognitive-behavioral classification system for mental disorders. Behavior Therapy, 45(4), 576–587.PubMedCentralCrossRefPubMedGoogle Scholar
  21. Huerta, M., Bishop, S. L., Duncan, A., Hus, V., & Lord, C. (2012). Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. American Journal of Psychiatry, 169(10), 1056–1064.CrossRefPubMedGoogle Scholar
  22. Hus, V., Gotham, K., & Lord, C. (2014). Standardizing ADOS domain scores: Separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders, 44(10), 2400–2412.PubMedCentralCrossRefPubMedGoogle Scholar
  23. Idring, S., Lundberg, M., Sturm, H., Dalman, C., Gumpert, C., Rai, D., et al. (2015). Changes in prevalence of autism spectrum disorders in 2001-2011: Findings from the stockholm youth cohort. Journal of Autism and Developmental Disorders, 45(6), 1766–1773.CrossRefPubMedGoogle Scholar
  24. Ijichi, S., Ijichi, N., Ijichi, Y., Hirotaki, K., Sameshima, H., Kawaike, Y., et al. (2013). Quantitative Nature of social vulnerability and autism: An important paradigm shift in the DSM-5 for autism spectrum disorder. ISRN Neurology, 2013, 201719.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Joyce, D. P., & Dempsey, A. G. (2009). The DSM model of impairment. In S. Goldstein & J. A. Naglieri (Eds.), Assessing impairment: From theory to practice. Dordrecht: Springer.Google Scholar
  26. Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41(8), 1007–1018.CrossRefPubMedGoogle Scholar
  27. Kim, Y. S., Leventhal, B. L., Koh, Y. J., Fombonne, E., Laska, E., Lim, E. C., et al. (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 168(9), 904–912.CrossRefPubMedGoogle Scholar
  28. Kim, S. H., & Lord, C. (2012a). Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. Journal of Child Psychology and Psychiatry, 53(2), 143–151.PubMedCentralCrossRefPubMedGoogle Scholar
  29. Kim, S. H., & Lord, C. (2012b). New autism diagnostic interview-revised algorithms for toddlers and young preschoolers from 12 to 47 months of age. Journal of Autism and Developmental Disorders, 42(1), 82–93.CrossRefPubMedGoogle Scholar
  30. Klin, A., Saulnier, C., Chawarska, K., & Volkmar, F. R. (2008). Case studies of infants first evaluated in the second year of life. In K. Chawarska, A. Klin, & F. Volkmar (Eds.), Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment (pp. 141–169). New York: Guilford.Google Scholar
  31. Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007). Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: The Vineland and the ADOS. Journal of Autism and Developmental Disorders, 37(4), 748–759.CrossRefPubMedGoogle Scholar
  32. Kraijer, D. (2000). Review of adaptive behavior studies in mentally retarded persons with autism/pervasive developmental disorder. Journal of Autism and Developmental Disorders, 30(1), 39–47.CrossRefPubMedGoogle Scholar
  33. Kuhlthau, K., Orlich, F., Hall, T. A., Sikora, D., Kovacs, E. A., Delahaye, J., et al. (2010). Health-related quality of life in children with autism spectrum disorders: Results from the autism treatment network. Journal of Autism and Developmental Disorders, 40(6), 721–729.CrossRefPubMedGoogle Scholar
  34. Kulage, K. M., Smaldone, A. M., & Cohn, E. G. (2014). How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. Journal of Autism and Developmental Disorders, 44(8), 1918–1932.CrossRefPubMedGoogle Scholar
  35. Lewandowski, L. J., Lovett, B. J., & Gordon, M. (2009). Measurement of symptom severity and impairment. In S. Goldstein & J. A. Naglieri (Eds.), Assessing impairment : From theory to practice (pp. 5–14). Dordrecht: Springer.CrossRefGoogle Scholar
  36. Liss, M., Harel, B., Fein, D., Allen, D., Dunn, M., Feinstein, C., et al. (2001). Predictors and correlates of adaptive functioning in children with developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 219–230.CrossRefPubMedGoogle Scholar
  37. Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition (ADOS-2). Manual (Part I). Torrance, CA: Western Psychological Services.Google Scholar
  38. Maenner, M. J., Rice, C. E., Arneson, C. L., Cunniff, C., Schieve, L. A., Carpenter, L. A., et al. (2014). Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates. JAMA Psychiatry, 71(3), 292–300.PubMedCentralCrossRefPubMedGoogle Scholar
  39. Majnemer, A., Limperopoulos, C., Shevell, M., Rohlicek, C., Rosenblatt, B., & Tchervenkov, C. (2012). Gender differences in the developmental outcomes of children with congenital cardiac defects. Cardiology in the Young, 22(5), 514–519.CrossRefPubMedGoogle Scholar
  40. Mullen, E. M. (1995). Mullen scales of early learning (AGS ed.). Circle Pines, MN: American Guidance Service.Google Scholar
  41. Naglieri, J. A. (2009). Psychometric issues in the assessment of impairment. In S. Goldstein & J. A. Naglieri (Eds.), Assessing impairment. Dordrecht: Springer.Google Scholar
  42. Nah, Y. H., Young, R. L., Brewer, N., & Berlingeri, G. (2014). Autism detection in early childhood (ADEC): Reliability and validity data for a level 2 screening tool for autistic disorder. Psychological Assessment, 26(1), 215–226.CrossRefPubMedGoogle Scholar
  43. Ness, S., Todd, M. J., Wang, S., Eerdekens, M., Nye, J. S., & Ford, L. (2012). Adaptive behavior outcomes in infants treated with adjunctive topiramate. Pediatric Neurology, 46(6), 350–358.CrossRefPubMedGoogle Scholar
  44. Papazoglou, A., Jacobson, L. A., & Zabel, T. A. (2013). Sensitivity of the BASC-2 adaptive skills composite in detecting adaptive impairment in a clinically referred sample of children and adolescents. Clinical Neuropsychologist, 27(3), 386–395.CrossRefPubMedGoogle Scholar
  45. Park, C. J., Yelland, G. W., Taffe, J. R., & Gray, K. M. (2012). Brief report: The relationship between language skills, adaptive behavior, and emotional and behavior problems in pre-schoolers with autism. Journal of Autism and Developmental Disorders, 42(12), 2761–2766.CrossRefPubMedGoogle Scholar
  46. Paul, R., Loomis, R., & Chawarska, K. (2011). Adaptive behavior in toddlers under two with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 264–270.CrossRefGoogle Scholar
  47. Paul, R., Miles, S., Cicchetti, D., Sparrow, S., Klin, A., Volkmar, F., et al. (2004). Adaptive behavior in autism and pervasive developmental disorder-not otherwise specified: Microanalysis of scores on the Vineland adaptive behavior scales. Journal of Autism and Developmental Disorders, 34(2), 223–228.CrossRefPubMedGoogle Scholar
  48. Perry, A., Flanagan, H. E., Dunn Geier, J., & Freeman, N. L. (2009). Brief report: the Vineland adaptive behavior scales in young children with autism spectrum disorders at different cognitive levels. Journal of Autism and Developmental Disorders, 39(7), 1066–1078.CrossRefPubMedGoogle Scholar
  49. Rapee, R. M., Bőgels, S. M., van der Sluis, C. M., Craske, M. G., & Ollendick, T. (2012). Annual research review: Conceptualising functional impairment in children and adolescents. Journal of Child Psychology and Psychiatry, 53(5), 454–468.CrossRefPubMedGoogle Scholar
  50. Ray-Subramanian, C. E., Huai, N., & Ellis Weismer, S. (2011). Brief report: Adaptive behavior and cognitive skills for toddlers on the autism spectrum. Journal of Autism and Developmental Disorders, 41(5), 679–684.PubMedCentralCrossRefPubMedGoogle Scholar
  51. Roid, G. H., & Sampers, J. L. (2005). Merrill-Palmer—Revised scales of development (Swedish version). Wood Dale: Stoelting.Google Scholar
  52. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R. Autism Diagnostic Interview Revised. Los Angeles, CA: Western Psychological Services.Google Scholar
  53. Saulnier, C. A., & Klin, A. (2007). Brief report: Social and communication abilities and disabilities in higher functioning individuals with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 37(4), 788–793.CrossRefPubMedGoogle Scholar
  54. Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231.CrossRefPubMedGoogle Scholar
  55. Sparrow, S., Balla, D. A., & Cichetti, D. V. (1984). Vineland adaptive behavior scales (Vineland ABS). Circle Pine, MN: American Guidance Service.Google Scholar
  56. Sparrow, S., Cichetti, D. V., & Balla, D. A. (2005). Vineland-II. Vineland adaptive behavior scales (2ed ed.). Circle Pines, MN: AGS Publishing.Google Scholar
  57. Sturmey, P., & Dalfern, S. (2014). The Effects of DSM5 autism diagnostic criteria on number of individuals diagnosed with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders, 1(4), 249–252.CrossRefGoogle Scholar
  58. Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., Barton, M., et al. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 98–107.CrossRefPubMedGoogle Scholar
  59. Szatmari, P., Bryson, S. E., Boyle, M. H., Streiner, D. L., & Duku, E. (2003). Predictors of outcome among high functioning children with autism and Asperger syndrome. Journal of Child Psychology and Psychiatry, 44(4), 520–528.CrossRefPubMedGoogle Scholar
  60. Tomanik, S. S., Pearson, D. A., Loveland, K. A., Lane, D. M., & Bryant Shaw, J. (2007). Improving the reliability of autism diagnoses: Examining the utility of adaptive behavior. Journal of Autism and Developmental Disorders, 37(5), 921–928.CrossRefPubMedGoogle Scholar
  61. Turygin, N., Matson, J. L., Beighley, J., & Adams, H. (2013). The effect of DSM-5 criteria on the developmental quotient in toddlers diagnosed with autism spectrum disorder. Developmental Neurorehabilitation, 16(1), 38–43.CrossRefPubMedGoogle Scholar
  62. Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., et al. (2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88(11), 815–823.PubMedCentralCrossRefPubMedGoogle Scholar
  63. Volkmar, F. R., & Reichow, B. (2013). Autism in DSM-5: Progress and challenges. Molecular Autism, 4(1), 13.PubMedCentralCrossRefPubMedGoogle Scholar
  64. Wechsler, D. (2004). Wechsler preschool and primary scale of intelligence–Third edition (Swedish version 2005). Stockholm: Pearson Assessment.Google Scholar
  65. Weitlauf, A. S., Gotham, K. O., Vehorn, A. C., & Warren, Z. E. (2014). Brief report: DSM-5 “levels of support:” A comment on discrepant conceptualizations of severity in ASD. Journal of Autism and Developmental Disorders, 44(2), 471–476.PubMedCentralCrossRefPubMedGoogle Scholar
  66. White, S. W., Smith, L. A., & Schry, A. R. (2014). Assessment of global functioning in adolescents with autism spectrum disorders: Utility of the developmental disability-child global assessment scale. Autism, 18(4), 362–369.CrossRefPubMedGoogle Scholar
  67. World Health Organisation (WHO). (1993). The ICD-10 classification of mental and behavioural disorders : Diagnostic criteria for research. Geneva: WHO.Google Scholar
  68. World Health Organisation (WHO). (2001). The international classfication of functioning, disability and health: ICF. Geneva: World Health Organization.Google Scholar
  69. World Health Organization (WHO). (2007). World Health Organization, “international classification of impairments, disabilities, and handicaps—Version for children and youth (ICF-CY). Geneva: World Health Organization.Google Scholar
  70. Zander, E., Sturm, H., & Bölte, S. (2015). The added value of the combined use of the Autism diagnostic interview-revised and the autism diagnostic observation schedule: Diagnostic validity in a clinical Swedish sample of toddlers and young preschoolers. Autism, 19(2), 187–199.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Pediatric Neuropsychiatry Unit, Department of Children’s and Women’s Health, Center of Neurodevelopmental Disorders (KIND)Karolinska InstitutetStockholmSweden
  2. 2.Child and Adolescent Psychiatry, Centre for Psychiatry ResearchStockholm County CouncilStockholmSweden

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