How well are DSM‑5 diagnostic criteria for ASD represented in standardized diagnostic instruments?


Five years after the publication of DSM-5 in 2013, three widely-used diagnostic instruments have published algorithms designed to represent its (sub)criteria for Autism Spectrum Disorder (ASD) in children and adolescents. This study aimed to: (1) establish the content validity of these three DSM-5-adapted algorithms, and (2) identify problems with the operationalization of DSM-5 diagnostic criteria in measurable and observable behaviors. Algorithm items of the Autism Diagnostic Observation Schedule - Second Edition (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3di) and Diagnostic Interview for Social and Communication Disorders - 11th edition (DISCO-11) were mapped onto DSM-5 sub-criteria. The development and decision-making rules integrated in their algorithms were then compared with DSM-5. Results demonstrated significant variability in the number and nature of sub-criteria covered by the ADOS-2, 3di and DISCO-11. In addition to differences in the development of algorithms and cut-off scores, instruments also differed in the extent to which they follow DSM-5 decision-making rules for diagnostic classification. We conclude that such differences in interpretation of DSM-5 criteria provide a challenge for symptom operationalization which will be most effectively overcome by consensus, testing and reformulation.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
College of Health & Life Sciences
Additional Information: © Springer Nature B.V. 2020. The final publication is available at Springer via
Uncontrolled Keywords: Autism spectrum disorder,Classification,Content validity,Diagnostic outcome,Pediatrics, Perinatology, and Child Health,Developmental and Educational Psychology,Psychiatry and Mental health
Publication ISSN: 1435-165X
Last Modified: 21 May 2024 07:13
Date Deposited: 02 Apr 2020 08:55
Full Text Link:
Related URLs: https://link.sp ... 787-020-01481-z (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2021-01
Published Online Date: 2020-02-19
Accepted Date: 2020-01-23
Authors: Evers, Kris
Maljaars, Jarymke P.W.
Carrington, Sarah (ORCID Profile 0000-0001-5548-8793)
Carter, Alice
Happé, Francesca
Steyaert, Jean
Leekam, Susan R.
Noens, Ilse



Version: Accepted Version

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