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How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis

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Abstract

We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0–26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2–16.0), p < 0.001], and Asperger’s [23.3% (12.9–38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6–58.0), p = 0.52]. Less than one-third [28.8% (13.9–50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.

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Acknowledgments

This study is a follow-up systematic literature review and meta-analysis to Kulage, K. M., Smaldone, A. M., & Cohn, E. G. (2014). How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. The Journal of Autism and Developmental Disorders, 44(8), 1918–1932, https://doi.org/10.1007/s10803-014-2065-2.

Funding

This study was not supported by any type of external or grant funding.

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Authors and Affiliations

  1. Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA

    Kristine M. Kulage MA, MPH & Arlene M. Smaldone

  2. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Johanna Goldberg

  3. Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center, 701 West 168th Street, New York, NY, 10032, USA

    John Usseglio

  4. Lucile Packard Children’s Hospital at Stanford, 770 Welch Road, Palo Alto, CA, 94304, USA

    Danielle Romero

  5. Department of Neurology, Division of Child Neurology, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, 5th Floor, New York, NY, 10032, USA

    Jennifer M. Bain

Authors
  1. Kristine M. Kulage MA, MPH
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  2. Johanna Goldberg
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  3. John Usseglio
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  4. Danielle Romero
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  5. Jennifer M. Bain
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  6. Arlene M. Smaldone
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Contributions

KMK conceived of the study, participated in the design and coordination of the study, and drafted and revised the manuscript. JG conducted the initial literature search and JU updated the literature search; both coordinated the study workflow in Covidence, drafted part of the methods section, and revised the manuscript. DR participated in the design and coordination of the study, drafted the introduction, and revised the manuscript. JMB provided clinical context in interpretation of study findings, drafted part of the results and discussion sections, and revised the manuscript. AMS conceived of the study, participated in the design and coordination of the study, performed analyses, and drafted and revised the manuscript. KMK, JG, JU, DR, and AMS participated in the literature screening, quality appraisal, and data extraction. All authors read and approved the final manuscript.

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Correspondence to Kristine M. Kulage MA, MPH.

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Kulage, K.M., Goldberg, J., Usseglio, J. et al. How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis. J Autism Dev Disord 50, 2102–2127 (2020). https://doi.org/10.1007/s10803-019-03967-5

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