The DSM-5 ASD brief assessment
In 2023 the 3di introduced a new DSM-5 ASD brief assessment. This is a guide for users who trained prior to 2023 and are upgrading to the latest 3di version.
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 Behaviours group of symptoms.
The 3di is now 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 Report (with ASD_extended) and Report ASD_brief 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 the ASD_brief route is reported, and only as an optional extra in the brief and extended reports. 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 all the Choose route dropdowns so that you can choose the DSM-5 routes or the original ICD-10 routes. There’s a list of all the ASD routes below.
The two-domain DSM-5 ASD reports are very 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 of the many aspects of symptomatology; merging measures of these aspects into a single number loses a great deal of 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. There are 16 elements across Criteria A.1 to A.3 and 11 elements across Criteria B.1 to B.4. The brief assessment gives a tally for each of the 27 elements and computes whether the child meets criteria for the diagnosis on the basis of the parental report. The extended assessment instead gives percentage scores for each element of the criteria – and 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 scope of the DSM-5 ASD symptomatic criteria is wider than it had been under DSM-4 and ICD-10 (especially in relation to sensory interest, hyper/hypo sensory sensitivity, and speech analogues of repetitive/stereotyped behaviour), so we had to replace some items in order to achieve a manageably short assessment. Items were chosen that were already reasonably represented by other items. However, if you miss certain questions you can add these to a variant of the provided Route – they won’t change the computed scores, but they will add to your clinical understanding of the child.
Tab_6_3 in the training manual gives details of the tallied and the percentage scoring systems.
Tab_6_2 in the training manual corresponds to the Report (with ASD_extended) when the option to include ICD-10 outcomes is selected in Edit report preferences. If you wanted only ICD-10 ASD outcomes and no other elements of the report you could make the preference selection and use the Report ASD_brief button. Any preference changes you make persist until you change them.
The extended report prior to DSM-5 attempted to cover everything you might have completed in the entire 3di – and you would select just what you needed. Under DSM-5 the extended report does the same thing and so includes all the possible variants of the DSM-5 ASD tables. Probably you would use only one or two of those in a given case. Note that the column headings of the many ASD tables make it clear whether you are looking at a tallied or a percentage set of results.
However, 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 as with the prior ICD-10 assessments. 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.
The ASD routes
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
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