Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children?
For older kids, social-communication DSM items spot ASD; repetitive items alone will mislead you.
01Research in Context
What this study did
The team looked at school-age kids with high-functioning ASD, ADHD, or anxiety.
They asked which DSM checklist items best tell the groups apart.
No new tests were given; they mined data that were already collected.
What they found
Social and communication items cleanly split ASD from ADHD or anxiety.
Restricted and repetitive behavior items did not help; kids in all three groups could show them.
In short, lean on social-communication cues when you suspect ASD.
How this fits with other research
Koyama et al. (2006) said the same thing three years earlier: social-communication gaps, not repetitive acts, mark ASD.
Mammarella et al. (2022) later added that pragmatic language alone can separate ASD, ADHD, and non-verbal learning disability.
Reus et al. (2013) warns that ADHD symptoms inflate parent ASD ratings, so use direct social items instead of broad severity scores.
Together the four studies form a clear line: watch how the child talks and relates, not how they line up toys.
Why it matters
When you do an intake, score social-communication DSM items first. If those are strong, pursue ASD tools. If they are weak, look harder at ADHD or anxiety. This small shift cuts misdiagnosis and saves hours of reassessment later.
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02At a glance
03Original abstract
Diagnosis of autism spectrum disorder (ASD) is often delayed in high-functioning children with milder and more varied forms of ASD. The substantial overlap between ASD and other psychiatric disorders is thought to contribute to this delay. This study examined the endorsement of DSM-IV-TR diagnostic criteria for ASD based on semi-structured parent interviews across three groups of older children referred to an ASD clinic: 55 children diagnosed with high-functioning ASD, 27 children diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 23 children diagnosed with anxiety disorder. Results indicate that the criteria within the domains of communication and social relatedness were largely able to discriminate the high-functioning ASD group from the ADHD and anxiety disorder groups, but criteria within the domain of restricted/repetitive/stereotyped patterns were not.
Autism : the international journal of research and practice, 2009 · doi:10.1177/1362361309335717