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Asd diagnosis dsm 54/15/2024 0.81), with minimal reduction in specificity (0.95 vs. Requiring one less symptom criterion increased DSM-5 sensitivity (0.93 vs. 0.86), whereas sensitivity was lower (0.81 vs. Frazier and co-workers, on the other hand, using caregiver-reported symptoms collected with the Social Responsiveness Scale and the Social Communication Questionnaire found that DSM-5 criteria had superior specificity relative to DSM-IV-TR criteria (0.97 vs. decreasing to two from three the criteria needed for persistent deficit in social interaction or also decreasing to two the criteria for social deficit and to one from the two criteria needed for restrictive, repetitive pattern of behaviour or interests) the difference between the two DSMs was significantly reduced. On the same sample the authors also showed that by relaxing the algorithm (i.e. In a larger study on toddler with developmental disability, the same group measured a 47 % decrease in the diagnosis of a DSM-5 ASD compared to DSM-IV PDD group (24 % for the DSM-IV autistic disorder, and 88 % of the PDD-NOS). In a series of studies, using a variety of different diagnostic instruments and modalities, but neither ADI-R nor ADOS, Matson and colleagues showed 32 % of children and 36 % of adults with DSM-IV PDD did not meet the criteria for DSM-5 ASD. Similarly contrasting data have been reported by research groups who actually re-assessed samples of children and adolescents. Others, such as the CARS, are based mainly on clinical judgement rather than on clearly operationalized procedures. 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. 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. In this Issue, Falkmer and co-workers 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. 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. 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. 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 DSM-IV, the new DSM-5 defines the two dimensions (social relation/communication and restricted interests/repetitive behaviours), with 7 criteria for the “Autism spectrum disorder” (ASD). Conceptualization of the core autistic symptoms has evolved from the single criteria of DSM III 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. Autism is a heterogeneous disorder with considerable clinical diversity, aetiological heterogeneity, and multiple accompanying disorders.
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