Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder.
Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder.
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DOI：
10.1016/j.jaac.2012.01.007
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发表时间：
2012-04
影响因子：
13.3
通讯作者：
Volkmar FR
中科院分区：
文献类型：
--
作者：
McPartland JC;Reichow B;Volkmar FR
本研究评估了建议的DSM-5自闭症谱系障碍(ASD)诊断标准的潜在影响。这项研究的重点是在DSM-IV现场试验期间评估的977名参与者的样本；657人被诊断为ASD，276人被诊断为非自闭症障碍。使用现场试验症状检查表评估拟议的DSM-5诊断标准的敏感性和特异性如下：(A)单独的现场试验检查表项目(例如，非语言交流)，(B)由单一DSM-5症状(例如，非语言和语言交流)描述的分组的检查表项目，(C)单独的DSM-5标准(例如，社交沟通障碍)，以及(D)总体诊断标准。当应用推荐的ASD诊断标准DSM-5时，60.6%(95%可信区间：57-%)的ASD临床诊断病例符合修订的ASD诊断标准。总体特异度很高，94.9%(95%可信区间：92-97%)的个体被准确排除在光谱之外。敏感度因诊断亚组(自闭症=0.76；阿斯伯格病=0.25；PDD-NOS=.28)和认知能力(IQ<；70=.70；IQ≥70=.46)而异。建议的DSM-5标准极大地改变了自闭症谱系的组成。修订的标准提高了特异性，但排除了很大一部分有认知能力的个人和那些患有自闭症以外的自闭症的人。更严格的诊断标准对服务资格以及历史和未来研究的兼容性具有重大的公共卫生影响。
This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). This study focused on a sample of 977 participants evaluated during the DSM-IV field trial; 657 carried a clinical diagnosis of an ASD, and 276 were diagnosed with a non-autistic disorder. Sensitivity and specificity for proposed DSM-5 diagnostic criteria were evaluated using field trial symptom checklists as follows: (a) individual field trial checklist items (e.g., nonverbal communication), (b) checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication), (c) individual DSM-5 criterion (e.g., social-communicative impairment), and (d) overall diagnostic criteria. When applying proposed DSM-5 diagnostic criteria for ASD, 60.6% (95% confidence interval: 57–64%) of cases with a clinical diagnosis of an ASD met revised DSM-5 diagnostic criteria for ASD. Overall specificity was high, with 94.9% (95% confidence interval: 92–97%) of individuals accurately excluded from the spectrum. Sensitivity varied by diagnostic subgroup (Autistic Disorder =.76; Asperger’s Disorder = .25; PDD-NOS = .28) and cognitive ability (IQ < 70 = .70; IQ ≥ 70 = .46). Proposed DSM-5 criteria substantially alter the composition of the autism spectrum. Revised criteria improve specificity, but exclude a substantial portion of cognitively able individuals and those with ASDs other than Autistic Disorder. A more stringent diagnostic rubric holds significant public health ramifications regarding service eligibility and compatibility of historical and future research.
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