DSM-5 Autism Criteria Applied to Toddlers with DSM-IV-TR Autism

The DSM-5 diagnostic criteria for autism spectrum disorders (ASD) include substantial revisions, including the combination of the subcategories (Autistic Disorder, Asperger’s Disorder, and PDD-NOS) into one dimensional category of ASD, combining the social and communication domains into one, and requiring two rather than one repetitive and restrictive behaviors (RRBs). Concerns have been raised about the DSM-5’s sensitivity for very young children, especially since RRBs may not manifest in this age group. In order to address concerns about the sensitivity of the DSM-5 ASD criteria in toddlers, the current study examined if toddlers who received an ASD diagnosis under the DSM-IV-TR criteria would maintain their diagnosis with the DSM-5 criteria. Children (n = 232) between the ages of 16 and 39 months (M = 25.95, SD = 4.49) who were part of a multi-site study examining the sensitivity and specificity of the Modified Checklist for Autism in Toddlers and who received an ASD or Non-ASD diagnosis were included in the study. Results suggested that 29% of toddlers who previously met an ASD diagnosis no longer did so with the new criteria. Relaxing criterion B by requiring one instead of two RRBs increased sensitivity while maintaining specificity. Because of the significant implications of early detection and intervention of ASD on outcome, it is important that the DSM-5 criteria reflect the presentation of ASD in toddlers. Requiring two RRBs may negatively impact the early detection of ASD because these behaviors may not have emerged in toddlers

Parental Perceptions of a Comprehensive Diagnostic Evaluation for Toddlers at Risk for Autism Spectrum Disorder

Comprehensive developmental and diagnostic evaluations for toddlers play an important role in identifying toddlers in need of early intervention. They may also provide parents with the support and resources needed to connect with early intervention service systems and providers. Therefore, it is important to develop a better understanding of how parents experience a comprehensive diagnostic evaluation, including how different aspects of the evaluation may impact parents’ overall satisfaction as well as their intention to follow recommendations. The current study included 262 toddlers (192 males; 70 females) between the ages of 16 and 39 months (M=24.95, SD=4.64) who were given a comprehensive diagnostic and developmental evaluation after screening positive for autism risk. The parents of 190 of these toddlers responded to the Post-Evaluation Satisfaction Questionnaire (Questionnaire Group). An Exploratory Factor Analysis based on a polychoric correlation matrix was conducted to examine the presence and correlates of factors in the Satisfaction Questionnaire. Five factors (i.e., Collaboration/Checking in, Feedback Quality, Report Quality, Availability, and Cultural Understanding) were derived from the Post-Evaluation Satisfaction Questionnaire. All but the Cultural Understanding factor was positively correlated with overall satisfaction. Although most child characteristics were not correlated with parent satisfaction, a few cognitive and adaptive functioning skills were negatively correlated with Feedback Quality, Report Quality, and overall satisfaction. Analysis of qualitative responses to open ended questions in the Satisfaction Questionnaire provided themes that overlapped across various questions, including the importance of direct, clear, and honest feedback, and dissatisfaction with the wait time for diagnostic reports. These findings suggested ways in which clinicians can better support parents during diagnostic evaluations