title: Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder.
abstract: OBJECTIVE
  This study evaluated the potential impact of proposed DSM-5 diagnostic criteria for autism spectrum disorder (ASD).
  
  
  METHODS
  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.
authors.affiliation: Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520-7900, USA. james.mcpartland@yale.edu
authors.forename: James C
authors.initials: JC
authors.lastname: McPartland
authors.forename: Brian
authors.initials: B
authors.lastname: Reichow
authors.forename: Fred R
authors.initials: FR
authors.lastname: Volkmar
mesh_terms: D000293:Adolescent; D020817:Asperger Syndrome / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D057189:Checklist; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D006801:Humans; D015994:Incidence; D008605:Mental Health Services / Q000331:legislation & jurisprudence; D012680:Sensitivity and Specificity; D014481:United States