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. 2022 Dec;52(12):5308-5320.
doi: 10.1007/s10803-021-05377-y. Epub 2022 Jan 4.

Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

C E Rice  1   2 , L A Carpenter  3 , M J Morrier  4 , C Lord  5 , M DiRienzo  6 , A Boan  3 , C Skowyra  7 , A Fusco  8 , J Baio  6 , A Esler  9 , W Zahorodny  8 , N Hobson  10 , A Mars  11 , A Thurm  12 , S Bishop  13 , L D Wiggins  6
Affiliations

Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

C E Rice et al. J Autism Dev Disord. 2022 Dec.

Erratum in

Abstract

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Keywords: Autism; Autism spectrum disorder; Classification; Clinician reliability; DSM-5; Diagnosis.

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Conflict of interest statement

Conflict of interest C. Lord acknowledges royalties from diagnostic instruments from Western Psychological Services. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of CDC, NIH, or Autism Speaks.

Figures

Fig. 1
Fig. 1
ASD clinician review percent agreement (y-axis) on each DSM-5 criterion (x-axis) for autism spectrum disorder by (a) sex, (b) race/ethnicity, and (c) cognitive level; ADDM Network, Surveillance Year 2014
See this image and copyright information in PMC

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