The DSM-5 ASD brief assessment
Notes for upgrading users
In 2022 we introduced a new DSM-5 brief assessment for autism, the fourth ASD assessment to be developed within the 3di's framework of fine-grained test items, computerised administration and scoring, and report generation. This page is a guide for users who trained prior to 2022 and are upgrading to the latest 3di version.
The ASD routes
Recall that Routes are how you choose which questions in the 3di you will answer during interview — and hence which assessment you are currently running. Below are the route names corresponding to the four ASD assessments, the first of which is used for the DSM-5 brief.
Note that the existing ASD routes were renamed when the DSM-5 ASD brief was released in 2022.
ASD_brief (DSM-5 Crit A+B)
use routinely for a brief DSM-5
ASD_brief (ICD-10)
under ICD-10/DSM-4 this was the original ASD_brief
ASD_extended (DSM-5 Crit A+B)
use routinely for an extended DSM-5 when ample time is available
ASD_extended (ICD-10)
under ICD-10/DSM-4 this was the original ASD_extended
Notes on the assessment
The new DSM-5 ASD brief assessment uses the 2-domain approach to ASD – so uniting Social Reciprocity and Communication domains, and extending considerably several aspects of the Restricted, Repetitive Behaviours and Interests group of symptoms.
The newer pair of brief and extended assessments can be considered both DSM-5 and ICD-11. By design the two sets of criteria are so similar that ASD outcomes (and many others) can be reported as DSM-5 or as ICD-11. The 3di always references DSM-5 because the APA got there about 7 years before the WHO; you can substitute one term for the other in your reports or perhaps reference neither.
In the Case Manager the buttons Generate full report and Generate brief report now generate DSM-5 output and use corresponding new interview routes.
The ICD-10/DSM-4 ASD routes are still included in the Route Explorer, but only included in the brief and extended reports as an optional extra. To enable inclusion of these report elements, click Edit report preferences in the Case Manager and select the last option ICD-10 ASD.
The ASD routes are renamed in the Choose route dropdowns so that you can choose the DSM-5 routes or the original ICD-10 routes. See the list of all the ASD routes above.
The two-domain DSM-5 ASD reports are different from the 3-domain reports of DSM-4/ICD-10: the 3-domain outcomes were reported as a single number for each domain despite the huge differences in symptomatic presentation across ASD children. Under DSM-5 there are independent scores for each aspect of symptomatology; merging measures of these aspects into a single number loses information about a child’s difficulties and strengths.
Both the brief and the extended assessments for DSM-5 ASD compute a measure of the child’s strengths and difficulties for each element of the diagnostic criteria. The DSM-5 extended assessment states percentage scores for each of 16 behaviours across Criteria A.1 to A.3, and 11 behaviours across Criteria B.1 to B.4. Meanwhile, the brief assessment gives 7 percentage scores aggregated to the level of diagnostic sub-criterion.
DSM-5 outlines how the clinician should use these as a basis for making a clinical judgement about the outcome. The formal requirement is for a minimum of 1 number over threshold in each of Criteria A.1 to A.3 and for a minimum of 1 number over threshold in at least two of Criterion B.1 to B.4. Whether these values constitute a diagnosis when supplemented by numbers derived from the child is in the end a clinical judgement – though often the values will be clear.
The Reference subfolder of your 3di installation folder gives details of the new scoring system.
The full report covers everything you might have completed in the entire 3di – and you select just what you need. Probably you would use only one or two of the report tables in a given case.
Whereas the ASD_extended route is too long for most CAMHS and similar settings, the percentage scoring system means that you can probe a particular aspect of symptomatology by completing ASD_brief and then selecting ASD_extended and answering just questions around that aspect. Your additional material will be reported in the extended report to add to your clinical picture (and, of course, can be played back to you in the route report for ASD_extended).
The DSM-5 brief assessment does not give a diagnosis. The emphasis is instead on clinician interpretation. In each scoring table row, a higher score indicates a higher level of symptomatology, but there isn’t a strict cut off or benchmark for what would be considered ‘clinically significant’. This matter is covered in depth during the training course.
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