Skip to main content

Advertisement

SpringerLink
Log in

DSM Criteria that Best Differentiate Intellectual Disability from Autism Spectrum Disorder

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Clinical characteristics of autism spectrum disorder (ASD) and intellectual disability (ID) overlap, creating potential for diagnostic confusion. Diagnostic and statistical manual of mental disorders (DSM) criteria that best differentiate children with ID and some ASD features from those with comorbid ID and ASD were identified. Records-based surveillance of ASD among 8-year-old children across 14 US populations ascertained 2816 children with ID, with or without ASD. Area under the curve (AUC) was conducted to determine discriminatory power of DSM criteria. AUC analyses indicated that restricted interests or repetitive behaviors best differentiated between the two groups. A subset of 6 criteria focused on social interactions and stereotyped behaviors was most effective at differentiating the two groups (AUC of 0.923), while communication-related criteria were least discriminatory. Matching children with appropriate treatments requires differentiation between ID and ASD. Shifting to DSM-5 may improve differentiation with decreased emphasis on language-related behaviors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) DSM 5 [Internet]. Am J Psychiatry

  2. (2009) Autism and Developmental Disabilities Monitoring Network 2006 Principal Investigators. Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, United States, 2006. Morb Mortal Wkly Rep Surveill Summ 58(SS-10):1–20

  3. (2007) Autism and Developmental Disabilities Monitoring Network 2000 Principal Investigators. Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, six sites, United States, 2000. Morb Mortal Wkly Rep Surveill Summ 56(SS-1):1–11

  4. (2007) Autism and Developmental Disabilities Monitoring Network Surveillance Year 2002 Principal Investigators. Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 sites, United States, 2002. Morb Mortal Wkly Rep Surveill Summ 55(SS-1):12–28

  5. (2014) Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Morb Mortal Wkly Rep Surveill Summ 63(SS-02):1–13

  6. Croen LA, Grether JK, Hoogstrate J, Selvin S (2002) The changing prevalence of autism in California. J Autism Dev Disord 32(3):207–215

    Article  PubMed  Google Scholar 

  7. Lazoff T, Zhong L, Piperni T, Fombonne E (2010) Prevalence of pervasive developmental disorders among children at the English Montreal school board. Can J Psychiatry 55(11):715–720

    Article  PubMed  Google Scholar 

  8. Rice C, Nicholas J, Baio J, Pettygrove S, Lee LC, Van Naarden Braun K et al (2010) Changes in autism spectrum disorder prevalence in 4 areas of the United States. Disabil Health J 3(3):186–201

    Article  PubMed  Google Scholar 

  9. Hertz-Picciotto I, Delwiche L (2009) The rise in autism and the role of age at diagnosis. Epidemiology 20(1):84–90

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fombonne E (1992) Diagnostic assessment in a sample of autistic and developmentally impaired adolescents. J Autism Dev Disord 22(4):563–581

    Article  PubMed  Google Scholar 

  11. Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S (2011) Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil 32:419–436

    Article  PubMed  Google Scholar 

  12. Boyle CA, Boulet S, Schieve LA, Cohen RA, Blumberg SJ, Yeargin-Allsopp M et al (2011) Trends in the prevalence of developmental disabilities in US children, 1997–2008. Pediatrics 127(6):1034–1042

    Article  PubMed  Google Scholar 

  13. Van Naarden Braun K, Christensen D, Doernberg N, Schieve L, Rice C, Wiggins L et al (2015) Trends in the prevalence of autism spectrum disorder, cerebral palsy, hearing loss, intellectual disability, and vision impairment, metropolitan Atlanta, 1991–2010. PLoS One0(4):e0124120. http://dx.plos.org/10.1371/journal.pone.0124120

  14. Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcín C et al (2012) Global prevalence of autism and other pervasive developmental disorders. Autism Res 5(3):160–179

    Article  PubMed  PubMed Central  Google Scholar 

  15. Edelson MG (2006) Are the majority of children with autism mentally retarded? A systematic evaluation of the data. Focus Autism Other Dev Disabl. 21(2):66–83

    Article  Google Scholar 

  16. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn., text rev. American Psychiatric Association, Washington, DC

  17. Croen LA, Grether JK, Selvin S (2002) Descriptive epidemiology of autism in a California population: who is at risk? J Autism Dev Disord 32(3):217–224

    Article  PubMed  Google Scholar 

  18. Jick H, Kaye JA (2003) Epidemiology and possible causes of autism. Pharmacotherapy 23(12):1524–1530

    Article  PubMed  Google Scholar 

  19. King M, Bearman P (2009) Diagnostic change and the increased prevalence of autism. Int J Epidemiol 38(5):1224–1234

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gillott A, Standen PJ (2007) Levels of anxiety and sources of stress in adults with autism. J Intellect Disabil 11(4):359–370

    Article  PubMed  Google Scholar 

  21. Estes AM, Dawson G, Sterling L, Munson J (2007) Level of intellectual functioning predicts patterns of associated symptoms in school-age children with autism spectrum disorder. Am J Ment Retard 112(6):439–449

    Article  PubMed  Google Scholar 

  22. Hove O, Havik OE (2010) Developmental level and other factors associated with symptoms of mental disorders and problem behaviour in adults with intellectual disabilities living in the community. Soc Psychiatry Psychiatr Epidemiol 45(1):105–113

    Article  PubMed  Google Scholar 

  23. Bakken TL, Helverschou SB, Eilertsen DE, Heggelund T, Myrbakk E, Martinsen H (2010) Psychiatric disorders in adolescents and adults with autism and intellectual disability: a representative study in one county in Norway. Res Dev Disabil 31(6):1669–1677

    Article  PubMed  Google Scholar 

  24. Hepburn SL, MacLean WE (2009) Maladaptive and repetitive behaviors in children with Down syndrome and autism spectrum disorders: implications for screening. J Ment Health Res Intellect Disabil 2:67–88

    Article  Google Scholar 

  25. Rojahn J, Wilkins J, Matson JL, Boisjoli J (2010) A comparison of adults with intellectual disabilities with and without ASD on parallel measures of challenging behaviour: the Behavior Problems Inventory-01 (BPI-01) and Autism Spectrum Disorders-Behavior Problems for Intellectually Disabled Adults (ASD-B). J Appl Res Intellect Disabil 23(2):179–185

    Article  Google Scholar 

  26. Totsika V, Felce D, Kerr M, Hastings RP (2010) Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism. J Autism Dev Disord 40(10):1171–1178

    Article  PubMed  Google Scholar 

  27. Rice CE, Baio J, Van Naarden Braun K, Doernberg N, Meaney FJ, Kirby RS (2007) A public health collaboration for the surveillance of autism spectrum disorders. Paediatr Perinat Epidemiol 21(2):179–190

    Article  PubMed  Google Scholar 

  28. Office of Management and Budget (1997) Revisions to the standards for the classification of federal data on race and ethnicity. Fed Regist 62(210):58782–58790

    Google Scholar 

  29. Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R (2002) Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? The public health disparities geocoding project. Am J Epidemiol 156(5):471–482

    Article  PubMed  Google Scholar 

  30. Hartley SL, Sikora DM (2010) Detecting autism spectrum disorder in children with intellectual disability: which DSM-IV-TR criteria are most useful? Focus Autism Other Dev Disabil 25(2):85–97

    Article  Google Scholar 

  31. Matson JL, Wilkins J, Ancona M (2008) Autism in adults with severe intellectual disability: an empirical study of symptom presentation. J Intellect Dev Disabil 33(1):36–42

    Article  PubMed  Google Scholar 

  32. Stone WL, Hogan KL (1993) A structured parent interview for identifying young children with autism. J Autism Dev Disord 23(4):639–652

    Article  PubMed  Google Scholar 

  33. Van Bourgondien ME, Marcus LM, Schopler E (1992) Comparison of DSM-III-R and childhood autism rating scale diagnoses of autism. J Autism Dev Disord 22(4):493–506

    Article  PubMed  Google Scholar 

  34. Bodfish JW, Symons FJ, Parker DE, Lewis MH (2000) Varieties of repetitive behavior in autism: comparisons to mental retardation. J Autism Dev Disord 30(3):237–243

    Article  PubMed  Google Scholar 

  35. Lord C, Storoschuk S, Rutter M, Pickles A (1993) Using the ADI-R to diagnose autism in preschool children. Infant Ment Health J [Internet]. 14(3):234–252

    Article  Google Scholar 

  36. Vig S, Jedrysek E (1999) Autistic features in young children with significant cognitive impairment: autism or mental retardation? J Autism Dev Disord 29(3):235–248

    Article  PubMed  Google Scholar 

  37. Peters-Scheffer N, Didden R, Sigafoos J, Green VA, Korzilius H (2013) Behavioral flexibility in children with autism spectrum disorder and intellectual disability. Res Autism Spectr Disord 7(6):669–709

    Article  Google Scholar 

  38. Osterling JA, Dawson G, Munson JA (2002) Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation. Dev Psychopathol 14(2):239–251

    Article  PubMed  Google Scholar 

  39. Freeman BJ, Ritvo ER, Schroth PC, Tonick I, Guthrie D, Wake L (1981) Behavioral characteristics of high- and low-IQ autistic children. Am J Psychiatry 138(1):25–29

    Article  PubMed  Google Scholar 

  40. Sigman M, Ungerer JA (1984) Cognitive and language skills in autistic, mentally retarded, and normal children. Dev Psychol 20:293–302

    Article  Google Scholar 

  41. Lord C (1995) Follow-up of two-year-olds referred for possible autism. J Child Psychol Psychiatry 36(8):1365–1382

    Article  PubMed  Google Scholar 

  42. Baron-Cohen S, Baldwin DA, Crowson M (1997) Do children with autism use the speaker’s direction of gaze strategy to crack the code of language? Child Dev 65(1):48–57

    Article  Google Scholar 

  43. Wilkins J, Matson JL (2009) A comparison of social skills profiles in intellectually disabled adults with and without ASD. Behav Modif 33(2):143–155

    Article  PubMed  Google Scholar 

  44. Ahmad S, Mahmood Z (2011) Differential diagnosis of autism and mental retardation: issues and possible solutions. FWU J Soc Sci 5(1):16–33

    Google Scholar 

  45. Matson JL, Dempsey T, LoVullo SV, Wilkins J (2008) The effects of intellectual functioning on the range of core symptoms of autism spectrum disorders. Res Dev Disabil 29(4):341–350

    Article  PubMed  Google Scholar 

  46. Maenner MJ, Schieve LA, Rice CE, Cunniff C, Giarelli E, Kirby RS et al (2013) Frequency and Pattern of documented diagnostic features and the age of autism identification. J Am Acad Child Adolesc Psychiatry 52(4):401–413

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

Data collection for this study was supported by cooperative agreements with the Center for Disease Control and Prevention (UR3 DD000090).

Author information

Authors and Affiliations

  1. Department of Psychology and Child Development, California State University, Stanislaus, One University Circle, Turlock, CA, 95382, USA

    Anita L. Pedersen

  2. Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA

    Sydney Pettygrove

  3. Statistical Consulting Laboratory, Bio5 Institute, The University of Arizona, Tucson, AZ, USA

    Zhenqiang Lu

  4. Department of Pediatrics, College of Medicine, The University of Arizona, Tucson, AZ, USA

    Jennifer Andrews & F. John Meaney

  5. Department of Genetics and Developmental Pediatrics, College of Medicine, The University of Arizona, Tucson, AZ, USA

    Margaret Kurzius-Spencer

  6. Department of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Li-Ching Lee

  7. Department of Population Health Sciences and Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Maureen S. Durkin

  8. Waisman Center, University of Wisconsin-Madison, Madison, WI, USA

    Maureen S. Durkin

  9. Division of Medical Genetics, Weill Cornell Medical College, New York, NY, USA

    Christopher Cunniff

Authors
  1. Anita L. Pedersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sydney Pettygrove
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhenqiang Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Andrews
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. John Meaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Margaret Kurzius-Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li-Ching Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maureen S. Durkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christopher Cunniff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anita L. Pedersen.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pedersen, A.L., Pettygrove, S., Lu, Z. et al. DSM Criteria that Best Differentiate Intellectual Disability from Autism Spectrum Disorder. Child Psychiatry Hum Dev 48, 537–545 (2017). https://doi.org/10.1007/s10578-016-0681-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-016-0681-0

Keywords

Search

Navigation