New DSM Criteria Decrease Autism Spectrum Disorder Diagnoses

The implementation of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria will result in a decrease of autism spectrum disorder (ASD) diagnoses, according to a meta-analysis published in the February issue of the Journal of Autism and Developmental Disorders.

Kristine M. Kulage, MA, MPH, and researchers at Columbia University Medical Center conducted systematic literature review and meta-analysis of 14 studies that explored the change inASD diagnoses under DSM-IV-TR versus DSM-5.

There are some significant changes under DSM-5, which was released in May 2013 and is the first update of its kind in nearly 20 years. Under DSM-IV-TR, 3 subgroups are used to define an ASD: autistic disorder (AD), Asperger’s disorder, and pervasive development disorder—not otherwise specified (PDD-NOS).

However, under DSM-5 these subgroups are eliminated and are transformed into criteria that will include individuals diagnosed under previous DSM-IV-TR standards. A new category, social communication disorder (SCD), was implemented under DSM-5. While it is not defined as autism, it will likely include individuals with PDD-NOS.

“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],” the authors write.

Kulage believes the shift in diagnosis could be problematic. She and her colleagues recommended additional research to understand how this shift will affect individual’s still needing assistance that may not be diagnosed with an ASD.

“This study raises a concern that a medical provider diagnosing a child under the new guidelines won’t find the child to be on the autism spectrum, when the same child under the old criteria might have been diagnosed with ASD,” Kulage said in a statement.