Original Paper

Journal of Autism and Developmental Disorders

, Volume 44, Issue 8, pp 1918-1932

First online:

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

  • Kristine M. KulageAffiliated withDepartment of Health Policy and Management, Columbia University Mailman School of Public HealthOffice of Scholarship and Research Development, Columbia University School of Nursing Email author 
  • , Arlene M. SmaldoneAffiliated withColumbia University School of Nursing
  • , Elizabeth G. CohnAffiliated withColumbia University School of Nursing

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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-5 Autism spectrum disorder PDD-NOS Diagnosis Public health policy