Diagnostic labelling of autism spectrum disorders in NSW.
OBJECTIVE
To describe the use of diagnostic labels by clinicians for children with autism spectrum disorders (ASD) and calculate the label-specific and overall agreement between diagnostic labels and Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) diagnoses provided by the same clinician.


METHODS
State-wide active surveillance was used to ascertain children newly recognised with one or more DSM-IV criteria for autistic disorder aged 0-15 years (incident cases) in New South Wales (NSW) between July 1999 and December 2000. Clinicians were asked to supply a diagnostic label and then complete DSM-IV criteria for each child reported.


RESULTS
Questionnaires with diagnostic label and DSM-IV criteria were returned for 348 children. The agreement between labels used and diagnosis based on DSM-IV classification system was the highest for autism (97%) and lower for labels of Asperger disorder, pervasive developmental disorder - not otherwise specified or atypical autism (27%). Kappa overall agreement was 0.31. Level of agreement between label and DSM-IV diagnosis was similar for questionnaires completed by multidisciplinary teams, psychiatrists, paediatricians and psychologists working as part of a team.


CONCLUSIONS
A lack of agreement between the diagnostic labelling used by clinicians and diagnosis based on DSM-IV criteria indicates a lack of consistency in diagnostic communication that is necessary to provide best clinical care, appropriate services and relevant information to parents and carers.
Williams
Katrina
K
Clinical Epidemiology Unit, The Children's Hosptial at Westmead, Westmead, New South Wales, Australia. katrina.williams@sesiahs.health.nsw.gov.au
Tuck
Marshall
M
Helmer
Megan
M
Bartak
Lawrence
L
Mellis
Craig
C
Peat
Jennifer K
JK
D000293:Adolescent; D020817:Asperger Syndrome / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D001321:Autistic Disorder / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires