New APA autism guidelines 'reduce diagnosis by more than 30%'

Last year, the American Psychiatric Association issued new guidelines for the diagnosis of autism spectrum disorder. But new research from Columbia University School of Nursing in New York, NY, suggests that these guidelines could leave thousands of children who have developmental delays without autism diagnosis, meaning they will miss out on social services, educational support and medical benefits.

The study findings were recently published in the Journal of Autism and Developmental Disorders.

According to the Centers for Disease Control and Prevention (CDC), approximately 1 in 88 children in the US have been diagnosed with autism spectrum disorder (ASD).

For the diagnosis of psychiatric conditions, the American Psychiatric Association (APA) provide a tool called the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Until last year, health care professionals had been using the fourth edition of a manual called the DSM-IV-TR to diagnose ASD.

This manual included three specific subgroups that were under the definition of ASD. These were autistic disorder (AD), Asperger's disorder and pervasive development disorder-not otherwise specified (PDD-NOS).

However, the APA introduced a revised fifth manual for ASD diagnosis in May 2013 called DSM-5. This manual has limited the range of criteria for ASD diagnosis and completely eliminated the three subgroups included in the old manual.

A new category has also been added to the the DSM-5 manual - social communication disorder (SCD). This category aims to diagnose individuals with impairments in verbal and nonverbal communication who do not have any other characteristics linked to autism.

The APA state that some individuals who would have been diagnosed with PDD-NOS under the old manual would fall under the SCD category using the new manual.

Decrease in ASD diagnosis under new guidelines

To determine how the new guidelines impact ASD diagnosis compared with the old guidelines, Kristine M. Kulage, director of the Office of Scholarship and Research Development at Columbia Nursing, and colleagues reviewed 418 studies looking at autism diagnosis, of which 14 met inclusion criteria.