Comparison of the diagnostic criteria for Autism spectrum disorder (ASD) using Diagnostic and Statistical Manual (DSM) and International Classification of Diseases (ICD): A study from India

Background: The significant changes in the DSM 5 diagnostic criteria for ASD need to be assessed in an Indian population by comparing it with ICD-10 DCR and DSM-IV TR. There are very few studies that look at the concordance between the criteria and practically none from India. An understanding on the diagnostic concordance will help in reliable diagnoses, service delivery and not miss out on any previously diagnosed child with ASD. Aim: To compare the diagnostic criteria for ASD using DSM 5, DSM-IV-TR and ICD-10 (DCR-10) Methods: Hundred children in age of 2.5-16 years without any co-morbid severe/profound mental retardation and any one symptom suggestive of ASD, presenting consecutively to the outpatient department were assessed using DSM 5, ICD-10 (DCR-10) and DSM-IV-TR manuals It was a cross sectional study in which agreement analysis between the diagnostic criteria was done using Cohen’s Kappa coefficient (κ') using IBM SPSS Statistics 20.  Results: Agreement analysis revealed DSM-5 ASD showed κ' = 0.846 and 0.874 with DSM-IV-TR, ICD 10 (DCR-10) respectively for childhood autism/autistic disorder. This agreement dropped for the analysis between DSM 5 ASD criteria and the DSM-IV-TR ASD (κ' =0.699 ); and ICD 10 (DCR-10) ASD(κ' = 0.703). DSM-5 ASD criteria overall had specificity values as 1 and 0.961 when compared with DSM-IV-TR ASD and ICD 10 (DCR-10) ASD. Conclusions: The diagnosis of autism will not be missed. Some children will no longer meet criteria for ASD under DSM-5 and will most likely be those diagnosed with Atypical Autism/PDD NOS, but possibly would meet criteria for DSM-5 SCD.