Mahoney W J, Szatmari P, MacLean J E, Bryson S E, Bartolucci G, Walter S D, Jones M B, Zwaigenbaum L
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
J Am Acad Child Adolesc Psychiatry. 1998 Mar;37(3):278-85. doi: 10.1097/00004583-199803000-00012.
To evaluate the ability of the DSM-IV criteria for the pervasive developmental disorders (PDD) to reliably and accurately differentiate PDD subtypes.
The sample consisted of 143 children with various types of developmental disabilities. A diagnosis of PDD and PDD subtype was made by one clinician using information obtained from the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule. The raw data from the Autism Diagnostic Interview-Revised, clinical notes (excluding diagnostic opinion), Autism Diagnostic Observation Schedule, IQ, and other available data were independently assessed by three experienced raters, each of whom then made a separate, blind diagnosis. If there was any disagreement, a consensus best-estimate (CBE) diagnosis was made after discussion. To assess reliability, the agreement between the three raters was calculated using k. Accuracy was assessed by calculating the agreement between the clinician's diagnosis and the CBE and by calculating the error rates associated with the three raters using latent class analysis.
The current DSM-IV criteria show good to excellent reliability for the diagnosis of PDD, Asperger's disorder (AsD), and autism, but they show poor reliability for the diagnosis of atypical autism. The clinician (compared to the CBE) had little difficulty differentiating PDD from non-PDD children and autism from AsD but had more difficulty identifying children with atypical autism. The latent class analysis also showed that the average error rates of the three raters for a differentiation of atypical autism from autism were unacceptably high.
Although the psychometric properties of the current DSM-IV criteria for autism and AsD appear quite acceptable, there is likely to be a high rate of misclassification of children given a diagnosis of atypical autism.
评估《精神疾病诊断与统计手册》第四版（DSM-IV）中广泛性发育障碍（PDD）的诊断标准可靠且准确地区分PDD亚型的能力。
样本包括143名患有各种发育障碍的儿童。一名临床医生根据修订版自闭症诊断访谈（Autism Diagnostic Interview-Revised）和自闭症诊断观察量表（Autism Diagnostic Observation Schedule）所获信息，对PDD及PDD亚型进行诊断。来自修订版自闭症诊断访谈的原始数据、临床记录（不包括诊断意见）、自闭症诊断观察量表、智商及其他可用数据由三名经验丰富的评估者独立评估，每位评估者随后进行单独的盲法诊断。如有任何分歧，则在讨论后做出共识最佳估计（CBE）诊断。为评估信度，使用k值计算三名评估者之间的一致性。通过计算临床医生的诊断与CBE之间的一致性以及使用潜在类别分析计算与三名评估者相关的错误率来评估准确性。
当前的DSM-IV标准在诊断PDD、阿斯伯格障碍（AsD）和自闭症方面显示出良好到优秀的信度，但在诊断非典型自闭症方面显示出较差的信度。临床医生（与CBE相比）在区分PDD儿童与非PDD儿童以及自闭症与AsD方面几乎没有困难，但在识别非典型自闭症儿童方面存在更多困难。潜在类别分析还表明，三名评估者将非典型自闭症与自闭症区分开来的平均错误率高得令人无法接受。
尽管当前DSM-IV自闭症和AsD诊断标准的心理测量特性似乎相当可接受，但被诊断为非典型自闭症的儿童可能存在较高的误诊率。
