Exploring the boundaries of pervasive developmental disorder not otherwise specified: analyses of data from the DSM-IV Autistic Disorder Field Trial.
A 7-item DSM-IV shortcut spots PDD-NOS faster and just as accurately as the full 12-item set.
01Research in Context
What this study did
Buitelaar et al. (1999) mined the DSM-IV Autistic Disorder Field Trial data.
They asked: can a shorter list catch PDD-NOS as well as the full 12-item rule?
The team built a 7-item screener and tested it against the long form.
What they found
The lean 7-item rule won.
It needed only 3 positive items plus 1 social item to flag PDD-NOS.
Sensitivity and specificity beat the full DSM-IV set, so fewer kids were missed or over-labeled.
How this fits with other research
Lecavalier et al. (2009) later showed the whole DSM-IV syndromes hold up in autistic kids.
That study extends K et al. by saying the rest of the manual works fine; just swap the PDD-NOS slice for the 7-item shortcut.
Murphy et al. (2014) moved the goalposts again, validating a two-factor DSM-5 model with the SRS-2.
Their CFA work supersedes the 1999 rule by folding PDD-NOS into the broader ASD spectrum, yet the same math spirit lives on: fewer items, clearer cutoff.
Sturmey (1995) previewed this dance by warning that DSM-III-R misfits people with ID; K et al. answered with data instead of critique.
Why it matters
You still meet kids who don’t meet full ASD criteria yet need services.
Keep the 7-item rule in your back pocket for lean screenings while you wait for a full DSM-5 evaluation.
It’s a quick gate, not a label for life.
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02At a glance
03Original abstract
This study aimed to explore the boundaries between PDD and related disorders and to develop classificatory algorithms for what is currently called Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS). Data collected by means of a standard coding system for the DSM-IV field trial for autistic disorder were used. Information on diagnostic criteria for autistic disorder as listed in ICD-10 and DSM-IV was compared between subjects functioning at least in the mildly retarded range and clinically classified as autistic disorder (n = 205), PDDNOS (n = 80) and other non-PDD disorders (n = 174). Only a limited number of items from the ICD-10 and DSM-IV systems for autistic disorder significantly discriminated the PDDNOS group from other disorders. A scoring rule based on a short set of 7 ICD-10/DSM-IV criteria with a cutoff of 3 items and 1 social interaction item set as mandatory had the best balance between high sensitivity and high specificity in discriminating PDDNOS from non-PDD disorders. These rules yielded a somewhat better prediction than most effective rules based on the full set of 12 criteria for autistic disorder with a cutoff of 4 items and 1 social item as mandatory. Generally accepted and well-validated criteria to identify individuals with PDDNOS should facilitate both research and clinical services.
Journal of autism and developmental disorders, 1999 · doi:10.1023/a:1025966532041