Comparison of DSM-IV-TR and DSM-5 Criteria in Diagnosing Autism Spectrum Disorders in Singapore.
DSM-5 drops more kids than the old rules, so re-screen and keep services if they still need help.
01Research in Context
What this study did
Doctors in Singapore compared two autism checklists. One was the older DSM-IV-TR. The other was the newer DSM-5.
They looked at kids who already had an autism label. They asked: who keeps the label under each checklist?
What they found
The older checklist caught more kids. The newer DSM-5 dropped about 4 out of 10 kids who had PDD-NOS.
Kids who lost the label still needed help. They just no longer met the stricter rules.
How this fits with other research
Wilson et al. (2013) saw the same drop in the UK. Their adult patients also lost the autism label under DSM-5.
Foley-Nicpon et al. (2017) showed a fix: give both ADOS and ADI-R. Using both tools kept every bright child in the autism group.
Bao et al. (2017) looked at a whole state. After DSM-5 arrived, new autism cases flat-lined. Fewer kids signed up for funding. All three studies echo the Singapore warning: tighter rules shrink the autism pool.
Why it matters
If a child loses the autism label, you can still write goals. Note social and rigid patterns in your report. Ask for both ADOS and ADI-R if you need data. Keep services running while the team re-checks.
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02At a glance
03Original abstract
Our study examines the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) and Diagnostic and Statistical Manual-Fourth Edition, Text Revision (DSM-IV-TR) when applied concurrently against the best estimate clinical diagnoses for 110 children (5.1-19.6 years old) referred for diagnostic assessments of Autism Spectrum Disorder (ASD) in a Singaporean outpatient speciality clinic. DSM-IV-TR performed slightly better, yielding sensitivity of 0.946 and specificity of 0.889, compared to DSM-5 (sensitivity = 0.837; specificity = 0.833). When considering the ASD sub-categories, sensitivity ranged from 0.667 to 0.933, and specificity ranged from 0.900 to 0.975. More participants with a PDD-NOS best estimate clinical diagnosis (40%) were misclassified on DSM-5. Merits and weaknesses to both classification systems, and implications for access to services and policy changes are discussed.
Journal of autism and developmental disorders, 2018 · doi:10.1007/s10803-018-3594-x