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Diagnostic rules for children with PDD-NOS and multiple complex developmental disorder
J K Buitelaar1, R J van der Gaag
1Department of Child Psychiatry and the Rudolph Magnus Institute for Neurosciences, Utrecht, The Netherlands. J.K.Buitelaar@psych.azu.nl
Insights
This study evaluated diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD). A PDD-NOS rule using seven DSM-IV criteria and an McDD rule focusing on anxieties and thought disturbance showed optimal classification performance.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Clinical Psychology
Background:
- Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) and Multiple Complex Developmental Disorder (McDD) are complex developmental disorders.
- Accurate diagnosis is crucial for effective intervention and treatment planning.
- Existing diagnostic criteria require refinement for optimal classification performance.
Purpose of the Study:
- To evaluate the diagnostic accuracy of specific rules for PDD-NOS and McDD.
- To compare the performance of these rules against clinical diagnosis as the gold standard.
- To identify the most effective and efficient diagnostic criteria for these disorders.
Main Methods:
- Retrospective chart review of 103 children with PDD-NOS/McDD, 32 with autistic disorder, and 96 controls.
- Application of DSM-IV criteria for autistic disorder and specific McDD criteria.
- Development and testing of scoring rules for PDD-NOS and McDD classification.
Main Results:
- A PDD-NOS rule with seven DSM-IV criteria (3-item cutoff, 1 mandatory social item) demonstrated the best sensitivity-specificity balance.
- An effective and simple McDD rule identified using six items related to anxieties and thought disturbance (3-item cutoff) was also established.
- Both rules showed promising classification performance for their respective disorders.
Conclusions:
- The developed diagnostic rules offer improved classification accuracy for PDD-NOS and McDD.
- These rules can aid clinicians in more precise differential diagnosis of developmental disorders.
- Further validation in diverse clinical populations is recommended to confirm generalizability.
Abstract:
This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSM-IV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.