Comment on “Potential Impact of DSM-5 Criteria on Autism Spectrum Disorder Prevalence Estimates”

25 Jan

One of the big topics of discussion in the past few years was the roll out of the DSM-5. The new criteria for what defines autism. One could find those saying “this is designed to undiagnose autistics with intellectual disability” as well as “this is designed to undiagnose autistics without intellectual disability” together with the multiple comments that “this is designed to obfuscate the “epidemic” of autism”.

A recent paper discusses this: Potential Impact of DSM-5 Criteria on Autism Spectrum Disorder Prevalence Estimates. The study looks at the CDC’s ADDM network–the same basis for the CDC autism prevalence estimates that come out every two years.

I haven’t read the full paper yet, but here’s the abstract:

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.

Based on this, about 20% of those who would receive an ASD diagnosis under DSM-IV will not get one under DSM-5. The decrease was seen in both autistics with and without intellectual disability–with a larger decrease for those without ID. At the same time, some kids who were not previously identified as autistic would be under DSM-5.

By Matt Carey

13 Responses to “Comment on “Potential Impact of DSM-5 Criteria on Autism Spectrum Disorder Prevalence Estimates””

  1. Dave January 25, 2014 at 12:02 #

    These are some confusion waters to navigate. Is this report saying that certain children without an ASD diagnosis are going to receive one, or is it saying that in the course of the study they realized that certain children had been under-diagnosed to start with?

    The problem I have with the DSM-5, though, is different. I believe that they are taking two (or more) mostly separate conditions, and forcing them into the same diagnosis. To me, this seems to be the wrong direction.

    Just in our local circle of friends there are children with vastly different conditions now being grouped into the same diagnosis.

    Every one of us has seen this: One child who is nearly non-verbal receives similar treatment to a child who mostly just has compulsive repetitive behaviors. Another child with emotional, gross-motor and sensory deficits is in the same group therapy, receiving the same treatments.

    The DSM-5 is not to blame for the “one-size-fits-all” treatments, but they certainly aren’t helping things. Without separate diagnosis codes, insurance companies have a hard time customizing treatments and therapies. The DSM-5 can only make this worse.

  2. farmwifetwo January 25, 2014 at 13:30 #

    Yes, they will no longer double dx, no longer take in the ID kids that are just non-verbal, the Aspies will now become “social communication disorder”… read the books on the V.. they all tell you the “epidemic” was caused by those dx’ing under the IV.

    • Sullivan (Matt Carey) January 25, 2014 at 18:01 #

      What do you mean by “yes”? That’s not what the paper says at all. Don’t project. Being non-verbal and having ID is not an automatic diagnosis of autism.

      Further, I don’t know what “books” you are talking about. Some less than credible websites make the claim that the rise in autism diagnoses was caused by the changes of the DSM-IV. There’s also the addition of autism to the qualifying categories of IDEA. There’s also a general broadening of the understanding of what constitutes autism. Plus a number of other social factors.

      Please take your disdain for those diagnosed with Asperger Syndrome elsewhere. I know you are fully aware of places where you can display that to your heart’s content. There’s nothing that says all those diagnosed with Asperger Syndrome will be now diagnosed with SCD. That claim demonstrates a significant level of ignorance on your part.

    • IMKenny January 26, 2014 at 07:33 #

      Any Aspie with restricted or repetitive behaviour and interests – including the new sensory sensitivity criterion – will meet DSM5 criteria for ASD. I have “mild” Asperger’s, and I certainly have significant sensory sensitivity, repetitive behaviours and intense/unusual interests.

  3. CcOoBb January 27, 2014 at 23:38 #

    Please read the long response with the videos at this link:

    Not sure what to think of it all

    • CcOoBb January 27, 2014 at 23:39 #

      Sorry try this link:

    • CcOoBb January 28, 2014 at 10:32 #

      I wanted to ask the question to the person that runs the blog – which I’ve read many times for answers/info on Wakefield/MMR and didn’t know a better way to ask.

      Sorry if I’m breaking protocol.

      • Lawrence January 28, 2014 at 11:03 #

        There is an excellent article just below this one that breaks down the Fraud that Wakefield has participated in….

    • CcOoBb January 28, 2014 at 11:12 #

      I am aware of that article 🙂

      The issue is that many of the claims against Wakefield are disputed in the link I posted. I am confused as I don’t know enough about the legal proceeding to really understand if the statements made in the linked comment are accurate or are simply more guff promoted by the anti-vax crowd.

      For instance the linked comment claims that Wakefield never actually received the 55k. And that he never falsified information, though that seems contradicted by other accounts.

      I was just hoping someone with a better grasp of the legal proceedings could have a look and comment on the actual points.


      • Chris January 28, 2014 at 16:07 #

        Just go to the previous article, please read the linked paper by Dr. Harrison and then ask your question there. We will not comment on that particular forum link here.

        I will say that my son was diagnosed has not being autistic under DSM III in about 1991. He probably would have for with the DSM IV criteria.

  4. Michelle @ PregnancyPillow February 4, 2014 at 09:56 #

    I will have to take out time to read this piece. I only scanned through and will bookmark for later read. Dr. Harrison’s research is a great read as well

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