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Autism Spectrum Disorders According to DSM-IV-TR and Comparison With DSM-5 Draft Criteria: An Epidemiological Study

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Objective

The latest definitions of autism spectrum disorders (ASDs) were specified in DSM-IV-TR in 2000. DSM-5 criteria are planned for 2013. Here, we estimated the prevalence of ASDs and autism according to DSM-IV-TR, clarified confusion concerning diagnostic criteria, and evaluated DSM-5 draft criteria for ASD posted by the American Psychiatry Association (APA) in February 2010.

Method

This was an epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (81%) of them rated via the Autism Spectrum Screening Questionnaire by parents and/or teachers, and 110 examined by using a structured interview, semi-structured observation, IQ measurement, school-day observation, and patient records. Diagnoses were assigned according to DSM-IV-TR criteria and DSM-5 draft criteria in children with a full-scale IQ (FSIQ) ≥50. Patient records were evaluated in children with an FSIQ <50 to discover diagnoses of ASDs.

Results

The prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 in 1,000 according to DSM-IV-TR. Of the subjects with ASDs and autism, 65% and 61% were high-functioning (FSIQ ≥70), respectively. The prevalence of pervasive developmental disorder not otherwise specified was not estimated because of inconsistency in DSM-IV-TR criteria. DSM-5 draft criteria were shown to be less sensitive in regard to identification of subjects with ASDs, particularly those with Asperger's syndrome and some high-functioning subjects with autism.

Conclusions

DSM-IV-TR helps with the definition of ASDs only up to a point. We suggest modifications to five details of DSM-5 draft criteria posted by the APA in February 2010. Completing revision of DSM criteria for ASDs is a challenging task.

Section snippets

Participants

The Finnish population is mainly of Finnish extraction and Finno-Ugric origin. In Finland, everyone has equal rights to healthcare and basic education. All children undergo developmental examinations several times before school age. If any developmental deviances are found, more detailed investigations are performed. Parents thus get to know the diagnosis and cognitive level of their child. In the Oulu University Hospital area, children diagnosed with mental retardation are referred to

Prevalence of ASDs and Autism According to DSM-IV-TR

The prevalence of ASDs was 8.4 (95% CI = 6.1–11.5) in 1,000 according to DSM-IV-TR; 65% of the subjects were high-functioning with an FSIQ ≥70. The prevalence of ASDs with mild mental retardation (FSIQ 50–69) was 0.9 (95% CI = 0.4–2.3) in 1,000, with moderate mental retardation (FSIQ 35–49), 1.6 (95% CI = 0.8–3.3) in 1,000, and with severe mental retardation (FSIQ 20–34), 0.45 (95% CI = 0.1–1.6) in 1,000. No subjects with profound mental retardation (FSIQ <20) were diagnosed as having ASDs.

The

Discussion

In this study, we do the following: 1) provide estimates of the prevalence of ASDs and autism in an 8-year-old epidemiological cohort, according to DSM-IV-TR; 2) clarify confusion concerning the diagnostic criteria; 3) evaluate DSM-5 draft criteria for ASD posted by the APA in February 2010; and 4) suggest modifications to five details of DSM-5 draft criteria. The results show that the prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 was in 1,000 according to DSM-IV-TR. Of the

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  • Cited by (0)

    This study was supported by research grants from Finland's Slot Machine Association, the Eija and Veikko Lesonen Foundation, Oulu, Finland, the Alma and K.A. Snellman Foundation, Oulu, Finland, the Rinnekoti Research Foundation, Espoo, Finland, the Child Psychiatric Research Foundation, Finland, the Child Psychiatric Research Foundation, Oulu Area, Finland, the Oulu Medical Research Foundation, Oulu, Finland, the Emil Aaltonen Foundation, Finland, the Thule Institute, University of Oulu, Finland, and the Jusélius Foundation, Finland. The sponsors had no role in the design of the study or the manner in which it was conducted.

    The study statistical experts were Ms. Leena Joskitt, M.Sc. and Mr. Risto Bloigu, M.Sc.

    Drs. Mattila, Linna, Ebeling, Moilanen, Kielinen, and Joseph, and Ms. Jussila and Mr. Bloigu, report no biomedical financial interests or potential conflicts of interest.

    This article is discussed in an editorial by Dr. Francesca Happé on page 540.

    Supplemental material cited in this article is available online.

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