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New study reports incorrect diagnosis of autism

Robin Wulffson MD's picture
autism, autism spectrum disorder, ASD, wrong diagnosis

According to the Centers for Disease Control and Prevention, about 1 in 88 children are diagnosed with an autism spectrum disorder (ASD). However, a new study reports that about 10% of these children are wrongly diagnosed as having the condition.

The evaluation of the revised classification of autism spectrum disorder were published October 1 in the Journal of American Psychiatry.

The researchers found that a new definition of autism, designated for inclusion in the next official Diagnostic and Statistical Manual of Psychiatry from the American Psychiatric Association (APA) will exclude about 10% of patients who have been diagnosed with autism in the past. A diagnosis of autism can be beneficial for obtaining medical treatment for the condition. However, a wrong diagnosis can result in harm.

The researchers noted that substantial revisions to the DSM-IV criteria for ASDs have been proposed in efforts to increase diagnostic sensitivity and specificity. Therefore, they designed a study to evaluate the proposed DSM-5 criteria for the single diagnostic category of autism spectrum disorder in children with DSM-IV diagnoses of pervasive developmental disorders (PDDs) and non-PDD diagnoses.

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The researchers evaluated three sets of data from a total of 4,453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnoses (i.e., a language disorder). Items from a parent report measure of ASD symptoms and clinical observation instrument were matched to DSM-5 criteria and used to evaluate the sensitivity and specificity of the proposed DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses.

The investigators found that, based on just parent data, the proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses. They noted that the sensitivity (ability to correctly identify the condition) of the criteria remained high in specific subgroups, including girls and children under 4.

The authors concluded that most children with DSM-IV PDD diagnoses would remain eligible for an ASD diagnosis under the proposed DSM-5 criteria. They added that, compared with the DSM-IV criteria for Asperger’s disorder and PDD-NOS, the DSM-5 ASD criteria have greater specificity (ability to correctly make the specific type of ASD), particularly when abnormalities are evident from both parents and clinical observation.

Take home message:
A fallout from the study is that millions of Americans who receive needed healthcare services because they are suffering with what had been described as autism by the APA could lose those services because a committee has decided to rewrite the definition of the condition. Another problem is that a shift in the criteria for the diagnosis of autism could potentially mean that millions of American children were told they had the condition when they did not. These children most likely suffer from a psychiatric disorder; however, the treatment they received may have been appropriate for whatever problem they actually had.

Reference: Journal of American Psychiatry

See also: An older father increases risk of autism and schizophrenia