DSM Criteria that Best Differentiate Intellectual Disability from Autism Spectrum Disorder

Anita L. Pedersen, Sydney Pettygrove, Zhenqiang Lu, Jennifer Andrews, F. John Meaney, Margaret Kurzius-Spencer, Li Ching Lee, Maureen S. Durkin, Christopher Cunniff

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Clinical characteristics of autism spectrum disorder (ASD) and intellectual disability (ID) overlap, creating potential for diagnostic confusion. Diagnostic and statistical manual of mental disorders (DSM) criteria that best differentiate children with ID and some ASD features from those with comorbid ID and ASD were identified. Records-based surveillance of ASD among 8-year-old children across 14 US populations ascertained 2816 children with ID, with or without ASD. Area under the curve (AUC) was conducted to determine discriminatory power of DSM criteria. AUC analyses indicated that restricted interests or repetitive behaviors best differentiated between the two groups. A subset of 6 criteria focused on social interactions and stereotyped behaviors was most effective at differentiating the two groups (AUC of 0.923), while communication-related criteria were least discriminatory. Matching children with appropriate treatments requires differentiation between ID and ASD. Shifting to DSM-5 may improve differentiation with decreased emphasis on language-related behaviors.

Original languageEnglish (US)
Pages (from-to)537-545
Number of pages9
JournalChild Psychiatry and Human Development
Issue number4
StatePublished - Aug 1 2017


  • Autism spectrum disorder
  • DSM
  • Differential diagnosis
  • Intellectual disability
  • Restricted interests/repetitive behaviors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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