Journal of Autism and Developmental Disorders

, Volume 44, Issue 8, pp 1918–1932

How Will DSM-5 Affect Autism Diagnosis? A Systematic Literature Review and Meta-analysis


    • Department of Health Policy and ManagementColumbia University Mailman School of Public Health
    • Office of Scholarship and Research DevelopmentColumbia University School of Nursing
  • Arlene M. Smaldone
    • Columbia University School of Nursing
  • Elizabeth G. Cohn
    • Columbia University School of Nursing
Original Paper

DOI: 10.1007/s10803-014-2065-2

Cite this article as:
Kulage, K.M., Smaldone, A.M. & Cohn, E.G. J Autism Dev Disord (2014) 44: 1918. doi:10.1007/s10803-014-2065-2


We conducted a systematic review and meta-analysis to determine the effect of changes to the Diagnostic and Statistical Manual (DSM)-5 on autism spectrum disorder (ASD) and explore policy implications. We identified 418 studies; 14 met inclusion criteria. Studies consistently reported decreases in ASD diagnosis (range 7.3–68.4 %) using DSM-5 criteria. There were statistically significant pooled decreases in ASD [31 % (20–44), p = 0.006] and DSM-IV-TR subgroups of Autistic disorder [22 % (16–29), p < 0.001] and pervasive developmental disorder-not otherwise specified (PDD-NOS) [70 % (55–82), p = 0.01]; however, Asperger’s disorder pooled decrease was not significant [70 % (26–94), p = 0.38]. DSM-5 will likely decrease the number of individuals diagnosed with ASD, particularly the PDD-NOS subgroup. Research is needed on policies regarding services for individuals lacking diagnosis but requiring assistance.


DSM-5Autism spectrum disorderPDD-NOSDiagnosisPublic health policy

Supplementary material

10803_2014_2065_MOESM1_ESM.doc (54 kb)
Supplementary material 1 (DOC 54 kb)

Copyright information

© Springer Science+Business Media New York 2014