Potential impact of DSM-5 criteria on autism spectrum disorder prevalence estimates.
OBJECTIVE
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.


METHODS
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.


METHODS
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
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.
University of Wisconsin-Madison2National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Matthew J
MJ
Maenner
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Catherine E
CE
Rice
University of Wisconsin-Madison.
Carrie L
CL
Arneson
University of Arizona, College of Medicine, Phoenix.
Christopher
C
Cunniff
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Laura A
LA
Schieve
Medical University of South Carolina, Charleston.
Laura A
LA
Carpenter
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
Kim
K
Van Naarden Braun
University of South Florida, Tampa.
Russell S
RS
Kirby
University of Utah, Salt Lake City.
Amanda V
AV
Bakian
University of Wisconsin-Madison.
Maureen S
MS
Durkin
D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology