How Will DSM-5 Affect Autism Diagnosis? A Systematic Literature Review and Meta-analysis
- 4.6k Downloads
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.
KeywordsDSM-5 Autism spectrum disorder PDD-NOS Diagnosis Public health policy
- APA. (2012a). DSM-5 Autism Spectrum Disorder Fact Sheet. http://dsmfacts.org/wp-content/uploads/2012/11/Autism-spectrum-disorder-fact-sheet.pdf.
- APA. (2012b). Recent updates to proposed revisions for DSM-5. http://www.dsm5.org/Pages/RecentUpdates.aspx.
- APA. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
- APA. (2013b). Social (pragmatic) communication disorder. http://www.dsm5.org/Documents/Social%20Communication%20Disorder%20Fact%20Sheet.pdf.
- Autism Speaks. (May 31, 2013). CT legislature passes DSM-V bill. http://www.autismspeaks.org/advocacy/advocacy-news/ct-legislature-passes-dsm-v-bill.
- Beighley, J. S., Matson, J. L., Rieske, R. D., Jang, J., Cervantes, P. E., & Goldin, R. L. (2013). Comparing challenging behavior in children diagnosed with autism spectrum disorders according to the DSM-IV-TR and the proposed DSM-5. Developmental Neurorehabilitation. doi:10.3109/17518423.2012.760119.Google Scholar
- Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report, 61(3), 1–19.Google Scholar
- Gibbs, V., Aldridge, F., Chandler, F., Witzlsperger, E., & Smith, K. (2012). Brief report: an exploratory study comparing diagnostic outcomes for autism spectrum disorders under DSM-IV-TR with the proposed DSM-5 revision. Journal of Autism and Developmental Disorders, 42(8), 1750–1756. doi:10.1007/s10803-012-1560-6.PubMedCrossRefGoogle Scholar
- Greaves-Lord, K., Eussen, M. L., Verhulst, F. C., Minderaa, R. B., Mandy, W., Hudziak, J. J., et al. (2013). Empirically based phenotypic profiles of children with pervasive developmental disorders: Interpretation in the light of the DSM-5. Journal of Autism and Developmental Disorders, 43(8), 1784–1797.PubMedCrossRefGoogle Scholar
- Huerta, M., Bishop, S. L., Duncan, A., Hus, V., & Lord, C. (2012). Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. American Journal of Psychiatry, 169(10), 1056–1064. doi:10.1176/appi.ajp.2012.12020276.PubMedCrossRefGoogle Scholar
- Lane, C. (May 4, 2013). The NIMH Withdraws Support for DSM-5. Psychology today. http://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5.
- Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule (WPS ed.). Los Angeles: Western Psychological Services.Google Scholar
- Matson, J. L., Belva, B. C., Horovitz, M., Kozlowski, A. M., & Bamberg, J. W. (2012b). Comparing symptoms of autism spectrum disorders in a developmentally disabled adult population using the current DSM-IV-TR diagnostic criteria and the proposed DSM-5 diagnostic criteria. Journal of Developmental and Physical Disabilities, 24(4), 403–414.CrossRefGoogle Scholar
- Mattila, M. L., Kielinen, M., Linna, S. L., Jussila, K., Ebeling, H., Bloigu, R., et al. (2011). Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 583–592. doi:10.1016/j.jaac.2011.04.001. e511.PubMedCrossRefGoogle Scholar
- McPartland, J. C., Reichow, B., & Volkmar, F. R. (2012). Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 368–383. doi:10.1016/j.jaac.2012.01.007.PubMedCentralPubMedCrossRefGoogle Scholar
- National Conference of State Legislatures. (August 2012). Insurance coverage for autism. http://www.ncsl.org/issues-research/health/autism-and-insurance-coverage-state-laws.aspx.
- Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., et al. (2013). DSM-5 field trials in the United States and Canada, Part II: Test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170(1), 59–70. doi:10.1176/appi.ajp.2012.12070999.PubMedCrossRefGoogle Scholar
- Robison, J.E. (January 17, 2013). Social Communication Disorder—is it “Autism Lite?”. Psychology Today. April 25, 2013, http://www.psychologytoday.com/blog/my-life-aspergers/201301/social-communication-disorder-is-it-autism-lite.
- Rutter, M., Le Couteur, A., & Lord, C. (2002). Autism diagnostic interview-revised (ADI-R). Los Angeles: Western Psychological Services.Google Scholar
- State of Connecticut. (June 5, 2013). Senate Bill No. 1029, Public Act No. 13–84, “An act concerning health insurance coverage for autism spectrum disorders”. http://www.cga.ct.gov/2013/ACT/PA/2013PA-00084-R00SB-01029-PA.htm.
- You, Y., Wu, B.-L., & Shen, Y. (2011). A pilot study on the diagnostic performance of DSM-IV and DSM-V for autism spectrum disorder. North American Journal of Medicine and Science, 4(3), 116–123.Google Scholar