Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnostic clinic.
DSM-5 can cut your adult autism caseload in half unless you use both ADOS and ADI-R and score generously.
01Research in Context
What this study did
The team compared three rule books for autism: ICD-10R, DSM-IV-TR, and the new DSM-5.
They looked at 150 smart adults who already had an autism diagnosis.
Each person was checked again with all three sets of rules to see who still qualified.
What they found
DSM-5 said only half of the adults had autism.
ICD-10R and DSM-IV-TR kept almost everyone.
When the clinic lowered the cutoff or counted unsure items as “yes,” DSM-5 caught more cases.
How this fits with other research
Foley-Nicpon et al. (2017) seemed to disagree at first. They kept every bright child when they used both ADOS and ADI-R.
The gap is method: the kids got two full tests, while the adults only got one pass through the new rules.
Bao et al. (2017) widened the lens. Across a whole region, child autism labels and funding flat-lined right after DSM-5 arrived.
Together the three papers show the same shrinkage effect, just at different ages and with different tools.
Why it matters
If you assess bright teens or adults, expect DSM-5 to drop half who met older rules. Run both ADOS and ADI-R, note unclear items, and write the service plan before the label fight starts.
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02At a glance
03Original abstract
An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56 % met DSM-5 ASD criteria. A further 19 % met DSM-5 (draft) criteria for Social Communication Disorder. Of those diagnosed with Autistic Disorder/Asperger Syndrome on DSM-IV-TR, 78 % met DSM-5 ASD criteria. Sensitivity of DSM-5 was significantly increased by reducing the number of criteria required for a DSM-5 diagnosis, or by rating 'uncertain' criteria as 'present', without sacrificing specificity. Reduced rates of ASD diagnosis may mean some ASD individuals will be unable to access clinical services.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-013-1799-6