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Potential Impact of DSM-5 Criteria on Autism Spectrum Disorder Prevalence Estimates
Open accessAbstract
IMPORTANCE: The DSM-5 contains revised diagnostic criteria for autism spectrum disorder (ASD) from the DSM-IV-TR. Potential impacts of the new criteria on ASD prevalence are unclear. OBJECTIVE: To assess potential effects of the DSM-5 ASD criteria on ASD prevalence estimation by retrospectively applying the new criteria to population-based surveillance data collected for previous ASD prevalence estimation. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, population-based ASD surveillance based on clinician review of coded behaviors documented in children's medical and educational evaluations from 14 geographically defined areas in the United States participating in the Autism and Developmental Disabilities Monitoring (ADDM) Network in 2006 and 2008. This study included 8-year-old children living in ADDM Network study areas in 2006 or 2008, including 644 883 children under surveillance, of whom 6577 met surveillance ASD case status based on the DSM-IV-TR. MAIN OUTCOMES AND MEASURES: Proportion of children meeting ADDM Network ASD criteria based on the DSM-IV-TR who also met DSM-5 criteria; overall prevalence of ASD using DSM-5 criteria. RESULTS: Among the 6577 children classified by the ADDM Network as having ASD based on the DSM-IV-TR, 5339 (81.2%) met DSM-5 ASD criteria. This percentage was similar for boys and girls but higher for those with than without intellectual disability (86.6% and 72.5%, respectively; P < .001). A total of 304 children met DSM-5 ASD criteria but not current ADDM Network ASD case status. Based on these findings, ASD prevalence per 1000 for 2008 would have been 10.0 (95% CI, 9.6-10.3) using DSM-5 criteria compared with the reported prevalence based on DSM-IV-TR criteria of 11.3 (95% CI, 11.0-11.7). CONCLUSIONS AND RELEVANCE: Autism spectrum disorder prevalence estimates will likely be lower under DSM-5 than under DSM-IV-TR diagnostic criteria, although this effect could be tempered by future adaptation of diagnostic practices and documentation of behaviors to fit the new criteria.
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“Studies that used more limited datasets, such as the DSM-IV checklist or the ADDM reviews of existing reports (Maenner et al. 2014, McPartland et al. 2012), found less evidence of repetitive behaviors in children with PDD-NOS, which suggests that it is very important that clinicians collect adequate information about these behaviors.”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Maenner et al. 2014
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“Evidence as to whether the switch from the DSM-IV to the DSM-5 algorithm of ASD has impacted on its prevalence is conflicting (56, 57).”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [56]
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“Previous analyses have suggested that fewer children will meet the behavioral criteria of DSM-5 compared with DSM-IV-TR (43).”
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Citations
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Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Robinson, C., Rosenberg, et al. (2018) · MMWR. Surveillance Summaries · doi:10.15585/mmwr.ss6706a1 · Cited by 6,078
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Self-citationIdentification, Evaluation, and Management of Children With Autism Spectrum Disorder
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Autism spectrum disorder: Definition, epidemiology, causes, and clinical evaluation
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Metadata
- Authors
- Maenner, M. J., Rice, C. E., Arneson, C. L., Cunniff, C., Schieve, L. A., Carpenter, L. A., Van Naarden Braun, K., Kirby, R. S., Bakian, A. V., & Durkin, M. S.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of Wisconsin–Madison (US)
- University of Arizona College of Medicine- Phoenix (US)
- Medical University of South Carolina (US)
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
- University of South Florida (US)
- University of Utah (US)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2014-03-01
- Volume
- 71
- Issue
- 3
- Pages
- 292
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4041577
- OpenAlex
- W2004918965
- Cited by
- 292
- References
- 41
- Citations by year
- 2026: 76 · 2025: 12 · 2024: 11 · 2023: 10 · 2022: 12 · 2021: 20 · 2020: 15 · 2019: 20 · 2018: 29 · 2017: 18 · 2016: 35 · 2015: 21 · 2014: 12
- FWCI
- 15.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Waisman Center (P30 HD03352, HD03352)
- Autism Science Foundation
- Centers for Disease Control and Prevention (UR3/CCU523235, UR3DD000677, UR3DD000078)
- U.S. Public Health Service (UR3/CCU523235)
- National Institute of Child Health and Human Development (P30HD03352, HD03352)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD03352., P30HD003352, T32HD007489)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Keywords
- autism spectrum disorder, DSM-5 diagnostic criteria, DSM-IV-TR, prevalence estimation, diagnostic criteria revision, intellectual disability, children
- MeSH terms
- Child, Child Development Disorders, Pervasive, Cross-Sectional Studies, Female, Humans, Male, Intellectual Disability, Population Surveillance, Retrospective Studies, United States, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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