Key Findings: Potential impact of DSM-5 criteria on autism spectrum disorder (ASD) prevalence estimates

JAMA Psychiatry has published a new study: “Potential impact of DSM-5 criteria on autism spectrum disorder (ASD) prevalence estimates.” Researchers found that estimates of the number of children with ASD might be lower using the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria than using the previous Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria.

You can read the article’s abstract here. Read more below for a summary of the findings from this study.

Main findings:

• Over 80% of children who met the Autism and Developmental Disabilities Monitoring (ADDM) Network classification for ASD, which is based on DSM-IV-TR criteria, also had documented symptoms that met the DSM-5 criteria (which were published in May 2013).
  • The remaining 20% met the ADDM Network classification for ASD, but did not meet the DSM-5 criteria. However, many of those children were very close to meeting DSM-5 criteria and were missing only one of the necessary symptoms.
  • Children who met the ADDM Network classification for ASD were more likely to meet DSM-5 criteria if:
    • They had a history of developmental regression
    • They had intellectual disability or
    • They had been diagnosed with ASD by a community provider or were receiving special education services under an autism exceptionality, or both
  • There were no differences between boys and girls or between White and Black children in their likelihood of meeting both the DSM-5 criteria and the ADDM Network classification for ASD.
• The findings suggested that estimates of the number of children with ASD might be lower using the current DSM-5 criteria than using the previous DSM-IV-TR criteria.
• As doctors and other clinicians start using the DSM-5 criteria, they might diagnose ASD using new or revised tools or they might document symptoms differently. These changes in everyday community practice could offset the DSM-5’s effect on estimates of the number of children with ASD.

Because of the way that CDC’s ADDM Network collects data, in the future CDC will be able to use both the previous DSM-IV-TR and the current DSM-5 criteria to estimate the number of children with ASD. CDC also will continue to evaluate the effect of using the DSM-5 on trends in how doctors and other health professionals diagnose ASD and how service providers evaluate and document symptoms as they transition to using the DSM-5 criteria.

About This Study

This study looked at information collected by CDC’s ADDM Network. This is the first population-based study (meaning the study used information on thousands of children in multiple communities) in the United States to look at what effect the updated ASD criteria in the DSM-5 might have on estimates of the number of children with ASD.

Autism Spectrum Disorder: CDC Activities

CDC is committed to continuing to provide essential data on ASD, search for risk factors and causes of ASD, and develop resources for parents and professionals that help identify children with ASD and other developmental disabilities as early as possible. Please visit CDC’s website to learn more about ASD and to find resources for parents and professionals.

Reference for Key Findings Feature:

Maenner MJ, Rice CE, Arneson CL, Cunniff C, Schieve LA, Carpenter LA, Van Naarden Braun K, Kirby RS, Bakian AV, Durkin MS. Potential impact of DSM-5 criteria on autism spectrum disorder (ASD) prevalence estimates. JAMA Psychiatry. 2013.