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Adaptive Skills in Toddlers with DSM-IV but Not DSM-5 Autism
The DSM-5 diagnostic criteria for Autism Spectrum Disorders (ASD) has raised concerns about diagnostic sensitivity for very young children (Worley & Matson, 2012). One main concern is that children with marked social and communication difficulties who met ASD criteria on DSM-IV-TR may fail to meet the DSM-5 diagnostic criteria, especially on the restrictive and repetitive behaviors subdomain (RRB’s) (Gibbs et al., 2012; Barton et al., 2013). Though these individuals are impaired in social and communication functioning, it is unclear how they are different and/or similar to those who retain their diagnosis.
Objectives:
In a previous study, we examined whether toddlers who received an ASD diagnosis under the DSM-IV-TR criteria would maintain their diagnosis using DSM-5 criteria. The results (reported at IMFAR 2013) indicated that 29% of toddlers who previously met an ASD diagnosis no longer did so with the new criteria. The current study examined the parent-reported adaptive functioning of toddlers with an ASD diagnosis under DSM-IV-TR but not with DSM-5 (DSM-IV-only group) and compared these scores to those of toddlers who retained the ASD diagnosis under DSM-5 criteria (DSM-5 group) and a comparison group of toddlers who were diagnosed with a Developmental Language Disorder (DLD group; Mixed Expressive/Receptive Language Disorder under the DSM-IV-TR).
Methods:
Parents of 37 children with DSM-IV-only ASD, 37 children with DSM-5 ASD (all of whom met for DSM-IV-TR), and 12 DLD participants between the ages of 18 and 34 months (M=25.25, SD=4.61) completed the Vineland Adaptive Behavior Scales Interview (Sparrow, Balla, & Cicchetti, 1984), which assesses skills in the Communication (expressive and receptive language subdomains), Daily Living Skills (personal, domestic, community subdomains), Socialization (interpersonal, play and leisure, coping subdomains), and Motor domains (gross, fine subdomains). The adaptive level, which is a descriptive category for each subscale, was analyzed (i.e., 1=low, 2=moderately low, 3=adequate, 4=moderately high, 5=high).
Results:
Descriptive statistics, ANOVA, and t-tests were conducted to determine whether the subdomain scores differed by group.
Results indicated that the DSM-IV-only ASD group scored significantly higher than the DSM-5 ASD group in the expressive language (t(72)=2.51, p=.01), receptive language (t(72)=4.15, p =.00), personal (t(72)=2.78, p=.01), interpersonal (t(72)=2.63, p=.01), and play and leisure (t (72)=2.85, p=.01) subdomains. The DSM-IV-only group scored significantly lower than the DLD group in the play and leisure (t(47)=-3.43, p=.00), and fine motor (t(47)=-2.67, p=.01) and gross motor (t(47)=-2.65, p=.01 subdomains. The DSM-5 group scored significantly lower than the DLD group in all subdomains except domestic and coping skills.
Conclusions:
Although both ASD groups were lower functioning than the DLD children on most adaptive domains, the toddlers in the DSM-IV-only ASD group were less developmentally delayed in their adaptive skills than the children who continue to meet ASD criteria in DSM-5. It is of concern that the DSM-IV-only group, which might have the most potential for good outcomes because of smaller developmental delays, might not be able to get effective autism-specific services without an ASD diagnosis.