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DSM-5 criteria may lower ASD prevalence estimates in children

Researchers expect fewer children will be classified as having autism spectrum disorder using new DSM-5 diagnostic criteria compared with DSM-IV-TR criteria, according to data published in JAMA Psychiatry. However, researchers say this expectation could be contradicted in the future by other factors affecting ASD prevalence.

Matthew J. Maenner, PhD, of the National Center on Birth Defects and Developmental Disabilities at the CDC, and colleagues used data from a population-based surveillance system — the Autism and Developmental Disabilities Monitoring Network (ADDMN) — to determine the effects of the new DSM-5 criteria on ASD prevalence. Over half a million 8-year-old children living in 11 US surveillance sites in 2006 and 14 sites in 2008 (n=644,883) were monitored by the ADDMN.

Using DSM-IV-TR criteria, 6,577 children were classified by ADDMN as having ASD; of these, 81.2% met DSM-5 criteria for ASD. More children with an intellectual disability met DSM-5 criteria for ASD vs. those without a disability (86.6% vs. 72.5%; P<.001), but the percentage remained similar for boys and girls. Conversely, 304 children met DSM-5 criteria but not ADDMN case status.

Based on DSM-IV-TR criteria, the reported prevalence of ASD in 2008 was 11.3 per 1,000 people (95% CI, 11.0-11.7); according to Maenner and colleagues, prevalence would have been 10 per 1,000 people using DSM-5 criteria (95% CI, 9.6-10.3), based on their findings.

The researchers note, however, that "Future changes in evaluation and reporting practices, as well as refinements to standardized diagnostic instruments, will also affect future trends in ASD prevalence estimation and may run counter to the potential effects of the DSM-5 criteria suggested by this study."

Disclosure: The study was supported by a grant from the Autism Science Foundation and by the CDC Cooperative Agreements UR3/CCU523235, UR3/DD000078 and UR3/DD000677. Additional support was provided by the National Institute of Child Health and Human Development grant T32 HD007489-04 and the Waisman Center (grant P30 HD03352).