How well are DSM‑5 diagnostic criteria for ASD represented in standardized diagnostic instruments?

Kris Evers*, Jarymke P.W. Maljaars, Sarah Carrington, Alice Carter, Francesca Happé, Jean Steyaert, Susan R. Leekam, Ilse Noens

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Five years after the publication of DSM-5 in 2013, three widely-used diagnostic instruments have published algorithms designed to represent its (sub)criteria for Autism Spectrum Disorder (ASD) in children and adolescents. This study aimed to: (1) establish the content validity of these three DSM-5-adapted algorithms, and (2) identify problems with the operationalization of DSM-5 diagnostic criteria in measurable and observable behaviors. Algorithm items of the Autism Diagnostic Observation Schedule - Second Edition (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3di) and Diagnostic Interview for Social and Communication Disorders - 11th edition (DISCO-11) were mapped onto DSM-5 sub-criteria. The development and decision-making rules integrated in their algorithms were then compared with DSM-5. Results demonstrated significant variability in the number and nature of sub-criteria covered by the ADOS-2, 3di and DISCO-11. In addition to differences in the development of algorithms and cut-off scores, instruments also differed in the extent to which they follow DSM-5 decision-making rules for diagnostic classification. We conclude that such differences in interpretation of DSM-5 criteria provide a challenge for symptom operationalization which will be most effectively overcome by consensus, testing and reformulation.
Original languageEnglish
Pages (from-to)75–87
Number of pages13
JournalEuropean Child and Adolescent Psychiatry
Early online date19 Feb 2020
Publication statusPublished - Jan 2021

Bibliographical note

© Springer Nature B.V. 2020. The final publication is available at Springer via


  • Autism spectrum disorder
  • Classification
  • Content validity
  • Diagnostic outcome


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