How Does Relaxing the Algorithm for Autism Affect DSM-V Prevalence Rates?

Abstract

Although it is still unclear what causes autism spectrum disorders (ASDs), over time researchers and clinicians have become more precise with detecting and diagnosing ASD. Many diagnoses, however, are based on the criteria established within the Diagnostic and Statistical Manual of Mental Disorders (DSM); thus, any change in these diagnostic criteria can have a great effect upon children with ASD and their families. It is predicted that the prevalence of ASD diagnoses will dramatically decrease with the adoption of the proposed DSM-5 criteria in 2013. The aim of this current study was to inspect the changes in prevalence first using a diagnostic criteria set which was modified slightly from the DSM-5 criteria (Modified-1 criteria) and again using a set of criteria which was relaxed even a bit more (Modified-2 criteria). Modified-1 resulted in 33.77 % fewer toddlers being diagnosed with ASD compared to the DSM-IV, while Modified-2 resulted in only a 17.98 % decrease in ASD diagnoses. Children diagnosed with the DSM-5 criteria exhibited the greatest levels of autism symptomatology, but the Mod-1, Mod-2, and DSM-IV groups still demonstrated significant impairments. Implications of these findings are discussed.

Comparing Diagnostic Outcomes of Autism Spectrum Disorder Using DSM-IV-TR and DSM-5 Criteria

“…Given the emphasis on early diagnosis and intervention for ASDs (Maglione et al 2012), the possibility that younger children may be less likely to meet DSM-5 diagnostic criteria is concerning. Prior studies have also found that young children may be less likely to meet DSM-5 ASD criteria, leading to speculation that relaxing the diagnostic criteria for young children may be necessary (Barton et al 2013;Matson et al 2012a;Matson et al 2012b). Furthermore, it will be important to evaluate the developmental trajectory of these young children who manifest some degree of impairment in the social and communication domains.…”

Brief Report: Investigating the Implications of Applying the New DSM-5 Criteria for Diagnosing Autism Spectrum Disorder in a Preschool Population in Singapore

“…There were also two children who showed adequate nonverbal communicative behaviours on report, yet with significant RRBs not attributable to other conditions. These cases would all achieve an ASD diagnosis on the DSM-5 should modified or relaxed criteria be used as suggested by Matson et al (2012) and Frazier et al (2012). There were children in the sample who met only one RRB criterion at the time of assessment, but were found to have further RRB emerging later on follow-up.…”

WhatDSM-5Could Mean to Children With Autism and Their Families

“…In fact, recent studies that have compared historical clinical diagnosis from the DSM-IV field trials suggest that the specificity of the new DSM-5 criteria is quite high (approximately 95%), yet the same studies also showed that the sensitivity is reduced dramatically. [33][34][35][36] Those who endorse the new criteria also point out that DSM-IV-TR did not serve women and toddlers well and did not account for adolescents who might not have demonstrated problems in social interactions until the social demands of teen life overwhelmed their ability to function. Supporters of the new DSM-5 criteria also note that many of those who will lose the ASD diagnosis will meet social communication disorder criteria.…”

“…37 Several studies published in the peer-reviewed literature in 2012 suggest that at least 12% and potentially as many as 40% of children currently classified in one of the PDD subcategories will be reclassified or lose their diagnosis. [33][34][35][36][38][39][40][41][42] Some of these studies indicate that the specificity is likely to improve using DSM-5 criteria but that the sensitivity will potentially suffer, particularly for children with PDD not otherwise specified 43 ; however, these recent studies have various limitations, including using older data sets, applying older versions of DSM-5 criteria, and using different types of diagnostic determinations (eg, clinician, parent report). Huerta et al 44 published a largescale retrospective analysis of 4453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnosis (eg, language disorder) and found that the proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses and that the specificity of the DSM-5 criteria was 0.63 as compared with 0.24 to 0.53 for DSM-IV.…”