Journal of Autism and Developmental Disorders

, Volume 44, Issue 8, pp 1918–1932 | Cite as

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

  • Kristine M. KulageEmail author
  • Arlene M. Smaldone
  • Elizabeth G. Cohn
Original Paper


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 



Elizabeth G. Cohn’s work on this project was supported by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program.

Conflict of interest

The authors declare they have no conflict of interest.

Ethical standards

This systematic literature review and meta-analysis did not involve any human subjects research.

Supplementary material

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


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kristine M. Kulage
    • 1
    • 2
    Email author
  • Arlene M. Smaldone
    • 3
  • Elizabeth G. Cohn
    • 3
  1. 1.Department of Health Policy and ManagementColumbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Office of Scholarship and Research DevelopmentColumbia University School of NursingNew YorkUSA
  3. 3.Columbia University School of NursingNew YorkUSA

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