Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

C. E. Rice, L. A. Carpenter, M. J. Morrier, C. Lord, M. DiRienzo, A. Boan, C. Skowyra, A. Fusco, J. Baio, A. Esler, W. Zahorodny, N. Hobson, A. Mars, A. Thurm, S. Bishop, L. D. Wiggins

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good.60–.79 to excellent ≥.80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Original languageEnglish (US)
Pages (from-to)5308-5320
Number of pages13
JournalJournal of Autism and Developmental Disorders
Issue number12
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Funding for the SC SUCCESS project was provided by Autism Speaks (Grant No. 7793 and 8408), Foundation for the National Institutes of Health (Grant No. UL1TR001450), and the Centers for Disease Control and Prevention (Grant No. DD10-1002). Funding for co-author (Thurm), Intramural Research Program of the NIMH (1ZICMH002961). The ADDM Network is supported by the Department of Health and Human Services, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.

Publisher Copyright:
© 2021, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.


  • Autism
  • Autism spectrum disorder
  • Classification
  • Clinician reliability
  • DSM-5
  • Diagnosis

PubMed: MeSH publication types

  • Journal Article


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