Autism spectrum disorders Reassesment of pervasive developmental disorder-not otherwise specified outcome according to DSM-5 diagnostical criteria

摘要

OBJECTIVE: Autism Spectrum Disorders (ASD) are developmental disorders characterized by deficits in social relating, communication impairments, and the presence of restricted interests and stereotyped behaviors1. While they are classified as “Pervasive Developmental Disorders (PDD)” in DSM-4-TR, DSM-5 defined a single category “Autism Spectrum Disorder”. With this change, the concern that some cases will remain outside of the diagnosis has been an important research topic. Certain studies indicate that that only 60-63% of individuals who were diagnosed as PDD with DSM-4-TR are diagnosed as ASD when reevaluated with DSM-52,3. In this study, we investigate cases under 6 years of age diagnosed as PDD-NOS with DSM-4-TR to establish if they receive a diagnosis of ASD with DSM-5. If a patient is not diagnosed with ASD, we investigate whether the patient is diagnosed with Social Communication Disorder (SCD), which is a new diagnosis introduced with DSM-5. METHOD: Patients between the ages of 0 and 6 diagnosed with PDD-NOS by Ege University Disabled Health Committee in 2010-2011 have been enrolled. Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) was administered for each participant in the study. All participants were diagnostically reevaluated by a questionnaire form which examines ASD and Social Communication Disorder diagnosis criteria based on DSM-5. Children Autism Rating Scale (CARS) was administered for every participant in the study and Aberrant Behavior Checklist (ABC) was completed by their parents. RESULTS: Parents of 28 of the 150 patients diagnosed by the committee accepted to participate in the study voluntarily. Patients in this study were 23 boys and 5 girls. The mean age of the children at the time of first diagnosis was 3.79 years (SD=1.22) and their current mean age was 8.18 years (SD=1.80). As a result of reevaluation, while 18 patients (64.3%) were diagnosed as ASD according to DSM5, 10 of them (35.7%) were not. According to DSM-5, the mean CARS scores of diagnosed and undiagnosed children were found as 30.47 (SD=6.64) and 20.20 (SD=3.21), respectively. CARS score was significantly correlated with diagnosis of ASD according to DSM5 (p<0.001). Likewise, according to DSM-5, the mean ABC scores of diagnosed group and undiagnosed group were found as 40 (SD=24.42) and 11.50 (SD=9.22), respectively, and ABC score was significantly correlated with the diagnosis (p=0.002). CARS score was significantly correlated with the severity of ASD diagnosis according to DSM-5 (p=0.027). However, ABC score was not correlated with the severity of ASD diagnosis according to DSM-5 (p=0.370). Comorbid psychiatric disorders according to K-SADS in the ASD-diagnosed group were found as ADHD in 6 children, depression in 1 child, conduct disorder in 1 child, enuresis in 2 children, encopresis in 1 child, and tic disorder in 1 child. Only in 1 child, ADHD was found as a comorbidity in the undiagnosed group. CONCLUSION: In spite of the limited sample size of our study, it was observed that 64.3% of patients met criteria for ASD based on DSM-5 at re-evaluation after 4 years from the first diagnosis. None of the cases which were not diagnosed as ASD met the criteria of Social Communication Disorder, which is a new diagnosis in DSM-5; however, this result might be related to the limited size of our sample. Psychiatric disorders were found more common in the ASD-diagnosed group. In this study, we observed that there was a statistically significant correlation between ASD diagnosis based on DSM-5 and CARS and ABC scores. The results of our study and the present literature were found to be consistent. We consider that it would be convenient to support these findings with other studies in Turkey with an increasing sample size.