Fewer Autism Diagnoses Since DSM Update

Almost one-third fewer people are getting a diagnosis of autism, according to a new study reviewing the impact of the May 2013 revision of the diagnostic criteria for autism in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

The impact: Thousands of developmentally delayed children each year may go without an autism spectrum disorder (ASD) diagnosis and thus fail to qualify for social services, medical benefits, and the education support they need.

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Kristine M. Kulage, MA, MPH, and colleagues at the Columbia University School of Nursing completed a systematic literature review and meta-analysis to calculate the effect of the updates in last year's DSM-5. In its previous version, DSM-IV-TR, there were 3 subgroups for ASD: autistic disorder (AD), Asperger disorder, and pervasive development disorder not otherwise specified (PDD-NOS). In the new DSM-5, these subgroups are eliminated and replaced with one diagnosis of ASD, which is graded based on severity. Also new: A diagnosis of social communication disorder (SCD) for people with verbal and nonverbal communication impairments.

The meta-analysis found that 31% fewer ASD diagnoses were made using DSM-5 compared with the DSM-IV-TR.

"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.

Furthermore, under DSM-5, researchers noted 22% fewer AD diagnoses and a 70% decrease in PDD-NOS. Asperger disorder diagnoses were also on a decline, but the numbers were not statistically significant.

In addition, some individuals who no longer meet the criteria for ASD under the new manual's criteria will also fail to meet the criteria for SCD.

The complete analysis is published in the February issue of the Journal of Autism and Developmental Disorders.

—Pooja Shah


1. Kulage KM, Smaldone AM, Cohn EG. How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis [published online ahead of print February 26, 2014]. J Autism Dev Disord. doi:10.1007/s10803-014-2065-2.

2. Columbia University School of Nursing. New autism definition may increase diagnosis by one third, study from Columbia University School of Nursing finds [press release]. February 26, 2014.