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2013年,，當修訂的孤獨癥診斷手冊生效時，診斷孤獨癥將會變得困難,。近日，來自耶魯兒童研究中心的研究者刊登在國際雜志Journal of the American Academy of Child&Adolescent Psychiatry的文章中指出,，孤獨癥診斷手冊的改變將會影響孤獨癥譜系障礙的診斷,。
診斷提議的改變將出版在美國精神病協(xié)會第五版上，標題為“精神障礙診斷和統(tǒng)計手冊” （DSM-5）,。研究者Fred Volkmar表示,，我們的研究發(fā)現(xiàn)將會DSM-5的診斷提供一些重要的信息和建議。
Volkmar和他的同事運用DSM-4（第四版診斷手冊）評估分析了933個個體的癥狀,，發(fā)現(xiàn),，25%的患者診斷為典型的孤獨癥，而75%的患者為阿斯伯格綜合癥或者正常的發(fā)育障礙,，這種診斷結果和新版的診斷手冊不完全相符,。研究者的這項研究表明，高智商的個體相比智商殘缺的個體更不適合用新標準進行診斷,。
研究者Volkmar表示,，檢測新標準對于臨床和研究的影響閑的尤為重要，在美國使用新的診斷手冊對于公眾來也很有必要,，但是診斷方法的主要改變對于比較研究結果來說又會出現(xiàn)新的問題,。（生物谷：T.Shen編譯）
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doi:10.1016/j.jaac.2012.01.007
PMC:
PMID:
Sensitivity and Specificity of Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorder
James C. McPartland, Ph.D., , Brian Reichow, Ph.D., Fred R. Volkmar, M.D.
Objective This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD).
Method The study focused on a sample of 933 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: individual field trial checklist items (e.g., nonverbal communication); checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication); individual DSM-5 criterion (e.g., social-communicative impairment); and overall diagnostic criteria.
Results 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 = 0.76; Asperger's disorder = 0.25; pervasive developmental disorder—not otherwise specified = 0.28) and cognitive ability (IQ < 70 = 0.70; IQ ≥ 70 = 0.46).
Conclusions Proposed DSM-5 criteria could 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.Objective This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD). Method The study focused on a sample of 933 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: individual field trial checklist items (e.g., nonverbal communication); checklist items grouped together as described by a single DSM-5 symptom (e.g., nonverbal and verbal communication); individual DSM-5 criterion (e.g., social-communicative impairment); and overall diagnostic criteria. Results 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 = 0.76; Asperger's disorder = 0.25; pervasive developmental disorder—not otherwise specified = 0.28) and cognitive ability (IQ < 70 = 0.70; IQ ≥ 70 = 0.46). Conclusions Proposed DSM-5 criteria could 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.
