Kim Young Shin, Fombonne Eric, Koh Yun-Joo, Kim Soo-Jeong, Cheon Keun-Ah, Leventhal Bennett L
Child Study Center, Yale University, New Haven, CT, the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, and Yonsei University, Seoul, South Korea.
Oregon Health and Science University, Portland, OR.
J Am Acad Child Adolesc Psychiatry. 2014 May;53(5):500-8. doi: 10.1016/j.jaac.2013.12.021. Epub 2014 Jan 21.
Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria.
The target population was all children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria.
DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77-3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder.
Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services.
《精神疾病诊断与统计手册》第5版（DSM-5）中自闭症诊断标准的变化可能会影响自闭症谱系障碍（ASD）的患病率、研究结果、诊断流程以及临床和其他服务的资格认定。利用我们已发表的韩国总人口患病率数据，我们计算了DSM-5中ASD和社交沟通障碍（SCD）的患病率，并将其与DSM-IV广泛性发育障碍（PDD）的患病率估计值进行比较。我们还描述了那些先前被诊断为DSM-IV PDD但诊断因DSM-5标准而改变的个体。
目标人群为韩国一个社区中所有7至12岁的儿童（N = 55,266），包括普通和特殊教育学校的儿童以及一个残疾登记处的儿童。我们使用自闭症谱系筛查问卷进行系统的多信息源筛查。对筛查呈阳性的儿童的家长提供使用标准化诊断程序的全面评估，包括修订版自闭症诊断访谈和自闭症诊断观察量表。使用DSM-IV PDD以及DSM-5中ASD和SCD的标准进行最佳估计的临床诊断。
DSM-5中ASD的估计患病率为2.20%（95%置信区间 = 1.77 - 3.64）。DSM-5中ASD和SCD的合并患病率与DSM-IV PDD的患病率（2.64%）几乎相同。大多数自闭症障碍儿童（99%）、阿斯伯格障碍儿童（92%）和未特定的广泛性发育障碍儿童（63%）符合DSM-5中ASD的标准，而分别有1%、8%和32%符合SCD的标准。其余所有儿童（2%）患有其他精神病理学问题，主要是注意力缺陷/多动障碍和焦虑症。
我们的研究结果表明，大多数先前被诊断为DSM-IV PDD的个体符合DSM-5中ASD和SCD的诊断标准。PDD、ASD或SCD；现有的诊断标准确定了一大群临床上有意义的个体和家庭，他们需要基于证据的服务。
