Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


New autism definition may decrease diagnosis by one-third, Columbia University finds


New diagnosis guidelines for autism spectrum disorder (ASD) issued by the American Psychiatric Association (APA) may reduce by almost one third the total number of people being diagnosed, according to new research from Columbia University School of Nursing published in the Journal of Autism and Developmental Disorders.

The guidelines, released in May 2013 and the first major update to psychiatric diagnosis criteria in almost two decades, may leave thousands of developmentally delayed children each year without the ASD diagnosis they need to qualify for social services, medical benefits and educational support.

A team led by Kristine M. Kulage, MA, MPH, director of the Office of Scholarship and Research Development at Columbia Nursing, conducted a systematic literature review and meta-analysis to determine the effect of changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the APA's classification tool for psychiatric conditions, on diagnosis of individuals with ASD. The study found a statistically significant decrease in ASD diagnosis of 31 percent using the new manual, DSM-5, compared with the number of cases of ASD that would have been identified under the previous version of the manual, DSM-IV-TR.

"This study raises a concern that a medical provider diagnosing a child under the new guidelines won't find the child to be on the autism spectrum, when the same child under the old criteria might have been diagnosed with ASD," says Kulage.

The old manual, DSM-IV-TR, included three distinct subgroups under the broad definition of ASD: autistic disorder (AD), Asperger's disorder, and pervasive development disorder-not otherwise specified (PDD-NOS). The revised manual, DSM-5, eliminates these subgroups, instead establishing a more limited range of criteria for a diagnosis of ASD that is designed to encompass individuals who previously would have fallen into one of the subgroups. The DSM-5 also added a new category called social communication disorder (SCD) to diagnose individuals who have verbal and nonverbal communication impairments but lack other attributes associated with autism. Some individuals diagnosed with PDD-NOS under the old manual would be identified as individuals with SCD under DSM-5, according to the APA.

Under DSM-5, there was a statistically significant decrease in AD diagnosis of 22 percent, compared with the fourth edition of the manual, the meta-analysis found. There was also a statistically significant decrease of 70 percent in diagnosis of PDD-NOS. While diagnosis of Asperger's also declined under DSM-5, the reduction was not statistically significant. In addition, the study found that some individuals who no longer met the criteria for an ASD diagnosis under DSM-5 would also fail to meet the criteria for SCD.

"We are potentially going to lose diagnosis and treatment for some of the most vulnerable kids who have developmental delays," says Kulage. "In many instances, children require a diagnosis of ASD to receive medical benefits, educational support and social services."

Approximately 1 in 88 children in the U.S. have ASD, according to the Centers for Disease Control and Prevention. People with ASD tend to have difficulties with communication, misread nonverbal interactions, and have difficulty making friends. They may also be heavily reliant on routines, extremely sensitive to changes in their environment, and intensely focused on interests not appropriate to the social context they are in. Symptoms fall on a continuum, with variation in severity, and early diagnosis and access to treatment have been proven to result in better outcomes.

The paper is titled: "How Will DSM-5 Affect Autism Diagnosis? A Systematic Literature Review and Meta-analysis" and it appeared in the February 2014 issue of the Journal of Autism and Developmental Disorders. Other contributors are: from Columbia Nursing, Arlene Smaldone, PhD, CPNP, associate professor and assistant dean, scholarship and research, and Elizabeth Cohn, PhD, RN, assistant professor and Robert Wood Johnson Foundation Nurse Faculty Scholar. Kulage completed the research while enrolled in a master's degree program at Joseph P. Mailman School of Public Health.

The authors declare no financial or other conflicts of interest.

Columbia University School of Nursing is part of the Columbia University Medical Center, which also includes the College of Physicians & Surgeons, the Mailman School of Public Health, and the College of Dental Medicine. With close to 100 full-time faculty and 600 students, the School of Nursing is dedicated to educating the next generation of nurse leaders in education, research, and clinical care. The School has pioneered advanced practice nursing curricula and continues to define the role of nursing and nursing research through its PhD program which prepares nurse scientists, and its Doctor of Nursing Practice (DNP), the first clinical practice doctorate in the nation. Among the clinical practice areas shaped by the School's research are the reduction of infectious disease and the use of health care informatics to improve health and health care. For more information, please visit:

Lisa Rapaport | EurekAlert!

Further reports about: ASD Autism Foundation Nursing determine diagnosis disorder guidelines reduction

More articles from Health and Medicine:

nachricht ARTORG and Inselspital develop artificial pancreas
26.11.2015 | Universitätsspital Bern

nachricht Laboratory study: Scientists from Cologne explore a new approach to prevent newborn epilepsies
24.11.2015 | Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Climate study finds evidence of global shift in the 1980s

Planet Earth experienced a global climate shift in the late 1980s on an unprecedented scale, fuelled by anthropogenic warming and a volcanic eruption, according to new research published this week.

Scientists say that a major step change, or ‘regime shift’, in the Earth’s biophysical systems, from the upper atmosphere to the depths of the ocean and from...

Im Focus: Innovative Photovoltaics – from the Lab to the Façade

Fraunhofer ISE Demonstrates New Cell and Module Technologies on its Outer Building Façade

The Fraunhofer Institute for Solar Energy Systems ISE has installed 70 photovoltaic modules on the outer façade of one of its lab buildings. The modules were...

Im Focus: Lactate for Brain Energy

Nerve cells cover their high energy demand with glucose and lactate. Scientists of the University of Zurich now provide new support for this. They show for the first time in the intact mouse brain evidence for an exchange of lactate between different brain cells. With this study they were able to confirm a 20-year old hypothesis.

In comparison to other organs, the human brain has the highest energy requirements. The supply of energy for nerve cells and the particular role of lactic acid...

Im Focus: Laser process simulation available as app for first time

In laser material processing, the simulation of processes has made great strides over the past few years. Today, the software can predict relatively well what will happen on the workpiece. Unfortunately, it is also highly complex and requires a lot of computing time. Thanks to clever simplification, experts from Fraunhofer ILT are now able to offer the first-ever simulation software that calculates processes in real time and also runs on tablet computers and smartphones. The fast software enables users to do without expensive experiments and to find optimum process parameters even more effectively.

Before now, the reliable simulation of laser processes was a job for experts. Armed with sophisticated software packages and after many hours on computer...

Im Focus: Quantum Simulation: A Better Understanding of Magnetism

Heidelberg physicists use ultracold atoms to imitate the behaviour of electrons in a solid

Researchers at Heidelberg University have devised a new way to study the phenomenon of magnetism. Using ultracold atoms at near absolute zero, they prepared a...

All Focus news of the innovation-report >>>



Event News

Fraunhofer’s Urban Futures Conference: 2 days in the city of the future

25.11.2015 | Event News

Gluten oder nicht Gluten? Überempfindlichkeit auf Weizen kann unterschiedliche Ursachen haben

17.11.2015 | Event News

Art Collection Deutsche Börse zeigt Ausstellung „Traces of Disorder“

21.10.2015 | Event News

Latest News

Siemens to supply 126 megawatts to onshore wind power plants in Scotland

27.11.2015 | Press release

Two decades of training students and experts in tracking infectious disease

27.11.2015 | Life Sciences

Coming to a monitor near you: A defect-free, molecule-thick film

27.11.2015 | Materials Sciences

More VideoLinks >>>