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The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review

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Abstract

A growing body of research has raised concerns about the number of individuals diagnosed with autism spectrum disorder (ASD) according to DSM-IV-TR who may no longer qualify for diagnoses under the new DSM-5 criteria, published in May 2013. The current study systematically reviews 25 articles evaluating samples according to both DSM-IV-TR and DSM-5 ASD criteria. Consistent with previous reviews, the majority of included studies indicated between 50 and 75 % of individuals will maintain diagnoses. We conducted visual analyses of subgroups using harvest plots and found the greatest decreases among high-functioning populations with IQs over 70 and/or previous diagnoses of PDD-NOS or Asperger’s disorder. We discuss the potential research and clinical implications of reduced numbers of individuals diagnosed with ASD.

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References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: APA Press.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., text rev.). Washington, DC: APA Press.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA Press.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: APA Press.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: APA Press.

    Google Scholar 

  • Asperger, H. (1944). Die “autistichen Psychopathen” im Kindersalter. Archive fur psychiatrie und Nervenkrankheiten, 117, 76–136.

    Article  Google Scholar 

  • Barton, M. L., Robins, D. L., Jashar, D., Brennan, L., & Fein, D. (2013). Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. Journal of Autism and Developmental Disorders, 43(5), 1184–1195. doi:10.1007/s10803-013-1817-8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Beighley, J. S., & Matson, J. L. (2014). Comparing social skills in children diagnosed with autism spectrum disorder according to the DSM-IV-TR and the DSM-5. Journal of Developmental and Physical Disabilities, 26, 689–701. doi:10.1007/s10882-014-9382-4.

    Article  Google Scholar 

  • Beighley, J. S., Matson, J. L., Rieske, R. D., Cervantes, P. E., Goldin, R., & Jang, J. (2014). Differences in stereotypic behavior in adults diagnosed with autism spectrum disorders using the DSM-IV-TR and the DSM-5. Journal of Developmental and Physical Disabilities, 26(2), 193–202. doi:10.1007/s10882-013-9356-y.

    Article  Google Scholar 

  • 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, 16(6), 375–381. doi:10.3109/17518423.2012.760119.

    Article  PubMed  Google Scholar 

  • Factor, D. C., Freeman, N. L., & Kardash, A. (1989). Brief report: A comparison of DSM-III and DSM-III-R criteria for autism. Journal of Autism and Developmental Disorders, 19(4), 637–640.

    Article  PubMed  Google Scholar 

  • Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J., & Eng, C. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 28.e23–40.e23. doi:10.1016/j.jaac.2011.09.021.

    Article  Google Scholar 

  • Gibbs, V., Aldridge, F., Chandler, F., Witzlsperger, E., & Smith, K. (2012). 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.

    Article  PubMed  Google Scholar 

  • Greenhaigh, T., & Peacock, R. (2005). Effectiveness and efficiency of search methods in systematic review of complex evidence: Audit of primary sources. British Medical Journal, 331, 1064–1065.

    Article  Google Scholar 

  • Grzadzinski, R., Huerta, M., & Lord, C. (2013). DSM-5 and autism spectrum disorders (ASDs): An opportunity for identifying ASD subtypes. Molecular Autism, 4(1), 12.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hertzig, M. E., Snow, M. E., New, E., & Shapiro, T. (1990). DSM-III and DSM-III-R diagnosis of autism and pervasive developmental disorder in nursery school children. Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 123–126.

    Article  PubMed  Google Scholar 

  • Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex differences in autism spectrum disorder based on dsm-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 42, 1381–1393. doi:10.1007/s10802-014-9881-x.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • Ibanez, L. V., Stone, W. L., & Coonrod, E. E. (2014). Screening for autism in young children. In F. R. Volkmar, R. Paul, S. J. Rogers, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders, Vol. 2 (4th ed., pp. 585–608). Hoboken: Wiley.

    Google Scholar 

  • Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.

    Google Scholar 

  • Kim, Y. S., Fombonne, E., Koh, Y. J., Kim, S. J., Cheon, K. A., & Leventhal, B. L. (2014). A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. Journal of the American Academy of Child and Adolescent Psychiatry, 53(5), 500–508. doi:10.1016/j.jaac.2013.12.021.

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Lord, C., Corsello, C., & Grzadzinski, R. (2014). Diagnositc instruments in autistic spectrum disorders. In F. R. Volkmar, R. Paul, S. J. Rogers, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders, Vol. 2 (4th ed., pp. 610–650). Hoboken: Wiley.

    Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H, Jr, Leventhal, B. L., DiLavore, P. C., & Rutter, M. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

    Article  PubMed  Google Scholar 

  • Maenner, M. J., Rice, C. E., Arneson, C. L., Cunniff, C., Schieve, L. A., Carpenter, L. A., & Durkin, M. S. (2014). Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates. JAMA Psychiatry, 71(3), 292–300. doi:10.1001/jamapsychiatry.2013.3893.

    Article  PubMed Central  PubMed  Google Scholar 

  • Mahjouri, S., & Lord, C. E. (2012). What the DSM-5 portends for research, diagnosis, and treatment of autism spectrum disorders. Current Psychiatry Reports, 14(6), 739–747. doi:10.1007/s11920-012-0327-2.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Belva, B. C., Horovitz, M., Kozlowski, A. M., & Bamburg, J. W. (2012a). 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. doi:10.1007/s10882-012-9278-0.

    Article  Google Scholar 

  • Matson, J. L., Kozlowski, A. M., Hattier, M. A., Horovitz, M., & Sipes, M. (2012b). DSM-IV vs DSM-5 diagnostic criteria for toddlers with autism. Developmental Neurorehabilitation, 15(3), 185–190. doi:10.3109/17518423.2012.672341.

    Article  PubMed  Google Scholar 

  • Mattila, M. L., Kielinen, M., Linna, S. L., Jussila, K., Ebeling, H., Bloigu, R., & Moilanen, I. (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.e511–592.e511. doi:10.1016/j.jaac.2011.04.001.

    Article  Google Scholar 

  • Mayes, S. D. (2012). Checklist for autism spectrum disorder. Wood Dale, IL: Stoelting.

    Book  Google Scholar 

  • Mayes, S. D., Black, A., & Tierney, C. D. (2013). DSM-5 under-identifies PDDNOS: Diagnostic agreement between the DSM-5, DSM-IV, and checklist for autism spectrum disorder. Research in Autism Spectrum Disorders, 7(2), 298–306. doi:10.1016/j.rasd.2012.08.011.

    Article  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Pearl, A., Black, A., & Tierney, C. D. (2014). Final DSM-5 under-identifies mild autism spectrum disorder: Agreement between the DSM-5, CARS, CASD, and clinical diagnoses. Research in Autism Spectrum Disorders, 8(2), 68–73. doi:10.1016/j.rasd.2013.11.002.

    Article  Google Scholar 

  • Mazefsky, C., McPartland, J., Gastgeb, H., & Minshew, N. (2013). Brief report: Comparability of DSM-IV and DSM-5 ASD research samples. Journal of Autism and Developmental Disorders, 43(5), 1236–1242. doi:10.1007/s10803-012-1665-y.

    Article  PubMed Central  PubMed  Google 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. doi:10.1371/journal.pmed.1000097.

    Article  PubMed Central  PubMed  Google Scholar 

  • Neal, D., Matson, J. L., & Hattier, M. A. (2012). A comparison of diagnostic criteria on the autism spectrum disorder observation for children (ASD-OC). Developmental Neurorehabilitation, 15(5), 329–335. doi:10.3109/17518423.2012.697492.

    Article  PubMed  Google Scholar 

  • Newborg, J. (2005). Battelle Developmental Inventory, Vol. q (2nd ed.). Itasca, IL: Riverside.

    Google Scholar 

  • Orinstein, A. J., Helt, M., Troyb, E., Tyson, K. E., Barton, M. L., Eigsti, I. M., et al. (2014). Intervention for optimal outcome in children and adolescents with a history of autism. Journal of Developmental and Behavioral Pediatrics, 35(4), 247–256.

    Article  PubMed Central  PubMed  Google Scholar 

  • Pelphrey, K. A., & McPartland, J. C. (2012). Brain development: neural signature predicts autism’s emergence. Current Biology, 22(4), R127–R128. doi:10.1016/j.cub.2012.01.025.

    Article  PubMed  Google Scholar 

  • Rieske, R. D., Matson, J. L., Beighley, J. S., Cervantes, P. E., Goldin, R. L., & Jang, J. (2013). Comorbid psychopathology rates in children diagnosed with autism spectrum disorders according to the DSM-IV-TR and the proposed DSM-5. Developmental Neurorehabilitation,. doi:10.3109/17518423.2013.790519.

    Google Scholar 

  • Ritvo, E. R., & Freeman, B. J. (1977). National Society for Autistic Children definition of the syndrome of autism. Journal of Pediatric Psychology, 2(4), 142–145.

    Article  Google Scholar 

  • Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144. doi:10.1023/A:1010738829569.

    Article  PubMed  Google Scholar 

  • Rutter, M. (1978). Diagnosis and definitions of childhood autism. Journal of Autism and Developmental Disorders, 8(2), 139–161.

    Article  Google Scholar 

  • Rutter, M., & Thupar, A. (2014). Genetics of autism spectrum disorder. In F. R. Volkmar, R. Paul, K. Pelphrey, & S. Roger (Eds.), Handbook of autism (4th ed.). Hoboken, NJ: John Wiley.

    Google Scholar 

  • Schopler, E., Reichler, R. J., DeVellis, R., & Daly, K. (1980). Towards objective classificaiton of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10(1), 91–103.

    Article  PubMed  Google Scholar 

  • Schopler, E., Reichler, R., & Renner, B. (1986). The Childhood Autism Rating Scale. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Siegel, B., Anders, T. F., Ciaranello, R. D., Bienenstock, B., & Kraemer, H. C. (1986). Empirically derived subclassification of the autistic syndrome. Journal of Autism and Developmental Disorders, 16(3), 275–293.

    Article  PubMed  Google Scholar 

  • Sturmey, P., & Dalfern, S. (2014). The effects of DSM5 autism diagnostic criteria on number of individuals diagnosed with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders, 1, 249–252. doi:10.1007/s40489-014-0016-7.

    Article  Google Scholar 

  • Szatmari, P. (1992). The validity of autistic spectrum disorders: A literature review. Journal of Autism and Developmental Disorders, 22(4), 583–600.

    Article  PubMed  Google Scholar 

  • Taheri, A., & Perry, A. (2012). Exploring the proposed DSM-5 criteria in a clinical sample. Journal of Autism and Developmental Disorders, 42(9), 1810–1817. doi:10.1007/s10803-012-1599-4.

    Article  PubMed  Google Scholar 

  • Taheri, A., Perry, A., & Factor, D. C. (2014). Brief report: A further examination of the DSM-5 autism spectrum disorder criteria in practice. Journal on Developmental Disabilities, 21(1), 116–121.

    Google Scholar 

  • Turygin, N. C., Matson, J. L., Adams, H., & Belva, B. (2013a). The effect of DSM-5 criteria on externalizing, internalizing, behavioral and adaptive symptoms in children diagnosed with autism. Developmental Neurorehabilitation, 16(4), 277–282. doi:10.3109/17518423.2013.769281.

    Article  PubMed  Google Scholar 

  • Turygin, N., Matson, J. L., Beighley, J., & Adams, H. (2013b). The effect of DSM-5 criteria on the developmental quotient in toddlers diagnosed with autism spectrum disorder. Developmental Neurorehabilitation, 16(1), 38–43. doi:10.3109/17518423.2012.712065.

    Article  PubMed  Google Scholar 

  • Volkmar, F. R., & Klin, A. (2005). Issues in the classification of autism and related conditions. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., pp. 5–41). Hoboken, NJ: Wiley.

    Google Scholar 

  • Volkmar, F. R., Klin, A., Siegel, B., Szatmari, P., Lord, C., Campbell, M., et al. (1994). Field trial for autistic disorder in DSM-IV. American Journal of Psychiatry, 151(9), 1361–1367.

    Article  PubMed  Google Scholar 

  • Volkmar, F. R., & Reichow, B. (2013). Autism in DSM-5: Progress and challenges. Molecular Autism, 4(13), 1–6.

    Google Scholar 

  • Volkmar, F. R., Reichow, B., & McPartland, J. (2012). Classification of autism and related conditions: Progress, challenges, and opportunities. Dialogues in Clinical Neuroscience, 14(3), 229–237.

    PubMed Central  PubMed  Google Scholar 

  • Volkmar, F. R., Reichow, B., Westphal, A., & Mandell, D. S. (2014a). Autism and the autism spectrum: Diagnostic concepts. In F. R. Volkmar, R. Paul, S. J. Rogers, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders, Vol. 1 (4th ed., pp. 5–41). Hoboken, NJ: Wiley.

    Chapter  Google Scholar 

  • Volkmar, F. R., Reichow, B., Westphal, A., & Mandell, D. S. (2014b). Autism and the autism spectrum: Diagnostic concepts. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders, Vol. 1 (4th ed., pp. 3–23). Hoboken, NJ: Wiley.

    Chapter  Google Scholar 

  • Waterhouse, L., Wing, L., Spitzer, R. L., & Siegel, B. (1993). Diagnosis by DSM-III-R versus ICD-10 criteria. Journal of Autism and Developmental Disorders, 23(3), 572–573.

    PubMed  Google Scholar 

  • World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.

  • Worley, J. A., & Matson, J. L. (2012). Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria. Research in Autism Spectrum Disorders, 6(2), 965–970. doi:10.1016/j.rasd.2011.12.012.

    Article  Google Scholar 

  • Young, R. L. (2007). Autism Detection in Early Childhood (ADEC) manual. Camberwell: ACER Press.

    Google Scholar 

  • Young, R. L., & Rodi, M. L. (2014). Redefining autism spectrum disorder using DSM-5: The implications of the proposed DSM-5 criteria for autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(4), 758–765. doi:10.1007/s10803-013-1927-3.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Callie Gilchrest and Lia Thibodaux for their contributions to the paper in the form of coding data from included studies and reconciling this data with the first author.

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  1. Yale Child Study Center, 230 South Frontage Rd., New Haven, CT, 06520, USA

    Isaac C. Smith & Fred R. Volkmar

  2. University of Florida College of Education, University of Florida, Gainesville, FL, USA

    Brian Reichow

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Smith, I.C., Reichow, B. & Volkmar, F.R. The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review. J Autism Dev Disord 45, 2541–2552 (2015). https://doi.org/10.1007/s10803-015-2423-8

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