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

Abstract

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.

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Acknowledgements

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.

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Correspondence to Kristine M. Kulage.

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Kulage, K.M., Smaldone, A.M. & Cohn, E.G. How Will DSM-5 Affect Autism Diagnosis? A Systematic Literature Review and Meta-analysis. J Autism Dev Disord 44, 1918–1932 (2014). https://doi.org/10.1007/s10803-014-2065-2

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  • DOI: https://doi.org/10.1007/s10803-014-2065-2

Keywords

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