Changing criteria of autistic disorders: a comparison of the ICD-10 research criteria and DSM-IV with DSM-III-R, CARS, and ABC.
ICD-10 and DSM-IV only agree on five PDD types, and later DSM-5 drops even more kids who once qualified.
01Research in Context
What this study did
The authors lined up five ways to label autism. They used ICD-10 research rules, DSM-IV, the older DSM-III-R, plus two rating scales: CARS and ABC.
They looked at the same group of kids with each tool. The goal was to see which labels matched and which did not.
What they found
Only five of the ten PDD sub-types showed up under both ICD-10 and DSM-IV. The extra ICD-10 groups almost never appeared in real clinics.
Big differences stayed between most diagnostic groups. A child could meet one rule book but miss the other.
How this fits with other research
Wilson et al. (2013) later added DSM-5 to the same race. They found DSM-5 drops even more able adults than ICD-10. The story keeps going: each new manual tightens the gate.
Sung et al. (2018) saw the same shrinkage in kids. DSM-5 mis-labeled four in ten PDD-NOS cases that DSM-IV had caught. The 1996 warning about lost kids keeps repeating.
Bao et al. (2017) looked at whole-state data. Once DSM-5 arrived, new autism cases flat-lined and funding dropped. The 1996 lab finding now shows up in real-world numbers.
Why it matters
You may get referrals who met the old rules but miss the new ones. Keep a copy of the 1996 table in your file. If a child loses the label yet still needs help, document why and fight for hours. The criteria change; the need does not.
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02At a glance
03Original abstract
Revised versions of diagnostic manuals, the International Classification of Diseases (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) all operate with several subgroups in the autistic spectrum. Five of the subgroups are identical in the two manuals, but ICD-10 contains five in addition. 132 children were diagnosed using ICD-10, DSM-IV, DSM-III-R, the Childhood Autism Rating Scale (CARS), and the Autistic Behavior Checklist (ABC). Five out of ten alternative subgroups of Pervasive Developmental Disorders (PDD) were identified in a population of developmentally impaired children. These subgroups were the same in the two manuals; the additional ones in ICD-10 were not identified. With the exception of the groups Disintegrative Disorder and Rett syndrome, significant differences were found between all the subgroups within the PDD spectrum and between the PDD group and the non-PDD group. Some problems connected with the guidelines in the ICD-10 manual are discussed.
Journal of autism and developmental disorders, 1996 · doi:10.1007/BF02172273