Literature Review and Meta-Analysis Analyzes How DSM-5 Diagnostic Criteria For Autism May Affect Diagnosis Rate

A five-year follow-up systematic review and meta-analysis of 33 studies—conducted to determine changes in the frequency of Autism Spectrum Disorder (ASD) diagnosis since the publication of the Diagnostic and Statistical Manual 5 (DSM-5)—was published in the Journal of Autism and Developmental Disorders. The DSM-5 is the standard taxonomic and diagnostic tool used by health care providers to assess and designate mental and behavioral health disorders. Researchers included those from Columbia University School of Nursing and Columbia University Irving Medical Center.  

Findings and Analysis

The findings of the review and analysis, led by Columbia Nursing’s Kristine M. Kulage, MA, MPH, director of research and scholarly development, and Arlene Smaldone, PhD, professor, and assistant dean of scholarship and research, suggest that the publication of the DSM-5 has caused a decrease in the diagnosis of ASD, as the diagnostic criteria have become less numerous, more restrictive, and under-inclusive.  However, the decrease in diagnosis of ASD is less than that estimated in earlier systematic reviews of this topic.

“Our findings provide further insight regarding how the DSM-5 is being used nationally and internationally to diagnose, or failing to diagnose, those with ASD,” remarked Kulage. “Future research is needed, as concerns remain for impaired individuals, who, because of the change in diagnostic criteria for ASD, may no longer qualify for treatment but still demonstrate a need for services.” 

Social Communication Disorder

In addition, the study also explored the utility of a new DSM-5 diagnosis—Social Communication Disorder (SCD)—on capturing those who would have met earlier Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR) criteria but who no longer meet criteria under DSM-5. Symptoms of SCD partially overlap with ASD’s social deficits but lacks ASD’s attendant repetitive behaviors. As a result, SCD may be a legitimate independent diagnosis, requiring tailored treatment; however, the authors note that debate remains in the literature regarding whether SCD can be regarded as a distinct and valid diagnostic entity.

“Overall, these changes have caused concern that a higher threshold of symptoms is required for DSM-5 ASD diagnosis, which may fail to capture some individuals who would have previously been diagnosed with ASD under the DSM-IV-TR and who may benefit from access to treatment and services,” Kulage explained. “Fortunately, our findings suggest that the proportion of individuals who would not meet criteria under DSM-5 has decreased over the past 5 years. We noted that there was least discrepancy when applying DSM-5 criteria for ASD when the diagnosis was made by an interdisciplinary team of physicians and psychologists.”

Although numerous studies have quantified potential changes in ASD rates in the last five years, until now, no new systematic literature reviews with meta-analyses have been conducted to synthesize data from studies that compared DSM-IV-TR and DSM-5 ASD rates.

In addition to Kulage and Smaldone, the study’s authors include: Johanna Goldberg, MSLIS; John Usseglio, MPH; Danielle Romero, MS; and Jennifer M. Bain, MD, PhD.

A full version of the study can be found on the Springer Nature website: How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis.