JAACAP：研究者用新标准来检测孤独症谱系障碍

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2013年，当修订的孤独症诊断手册生效时，诊断孤独症将会变得困难。近日，来自耶鲁儿童研究中心的研究者刊登在国际杂志Journal of the American Academy of Child&Adolescent Psychiatry的文章中指出，孤独症诊断手册的改变将会影响孤独症谱系障碍的诊断。

诊断提议的改变将出版在美国精神病协会第五版上，标题为“精神障碍诊断和统计手册” （DSM-5）。研究者Fred Volkmar表示，我们的研究发现将会DSM-5的诊断提供一些重要的信息和建议。

Volkmar和他的同事运用DSM-4（第四版诊断手册）评估分析了933个个体的症状，发现，25%的患者诊断为典型的孤独症，而75%的患者为阿斯伯格综合症或者正常的发育障碍，这种诊断结果和新版的诊断手册不完全相符。研究者的这项研究表明，高智商的个体相比智商残缺的个体更不适合用新标准进行诊断。

研究者Volkmar表示，检测新标准对于临床和研究的影响闲的尤为重要，在美国使用新的诊断手册对于公众来也很有必要，但是诊断方法的主要改变对于比较研究结果来说又会出现新的问题。（生物谷：T.Shen编译）

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doi:10.1016/j.jaac.2012.01.007
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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.