AUTISM SCIENCE IN THE NEWS Autism Numbers May Decline Under New DSM

A new study looking at data from the U.S. Centers for Disease Control and Prevention suggests that autism rates could drop off using the new DSM-5 criteria for Autism Spectrum Disorder (ASD) released by the American Psychiatric Association in 2013.

The DSM-5 changed the diagnostic label from Pervasive Developmental Disorder in DSM-IV and DSM-IV-TR to Autism Spectrum Disorder, doing away with Asperger´s syndrome, childhood disintegrative disorder and pervasive developmental disorder, not otherwise specified. The former definition by categories was changed in DSM-5 to a dimensional measure indicating level of severity.

In an effort to assess how this change could impact autism prevalence going forward, researchers looked at medical and educational records for 6,577 8 year old kids diagnosed with autism under using criteria in DSM-IV-TR, who were part of the CDC´s surveillance efforts. They found that only 81 % of the children, originally diagnosed with ASD using DSM-IV-TR, would qualify for an autism diagnosis under the DSM-5 definition.

Many of the kids who no longer appeared to qualify were missing just one criteria for the diagnosis.

According to Matthew J. Maenner of the CDC´s National Center on Birth Defects and Developmental Disabilities who led the study, “it is important to point out that we cannot predict what will happen in the future with how individuals with ASD are diagnosed, or how (or when) professionals will adapt to the new diagnostic criteria."

Reference: Maenner JJ, Rice CE, Arneson CL et al, Potential impact of DSM-5 criteria on Autism Spectrum Disorder Prevalence Estimates. JAMA Psychiatry, Published online, January 22, 2014.

Comment:

Lirio S Covey, Ph.D., AAAP President.

Previous research had shown decreased sensitivity but improved specificity of the DSM-5 criteria. In other words, DSM-5 criteria would result in fewer persons diagnosed to have ASD, but the error rate (a false diagnosis) would be lower.

If these criteria are strictly followed, future prevalence estimates of Autism Spectrum Disorders may be lower than past estimates. Access to treatment services for persons with ASD may be affected. In countries where financial assistance is provided to persons with autism, for example, through insurance payments for medical bills, fewer persons with ASD symptoms may qualify. This may reduce the number of persons, children or adults, who seek evaluation and treatment.

These labeling changes and consequences bring added importance to expert training of professionals and diagnostic teams placed in positions of determining the presence or not of ASD among persons presenting with ASD symptoms.