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A Comparison of DSM-IV Pervasive Developmental Disorder and DSM-5 Autism Spectrum Disorder Prevalence in an Epidemiologic Sample

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Objective

Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria.

Method

The target population was all children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview–Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria.

Results

DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77–3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder.

Conclusion

Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services.

Section snippets

Study Subjects

The target population (N =55,266) included all children born from 1993 to 1999 (7–12 years of age at screening) in a suburb of Seoul, South Korea. Total population screening was conducted with both the Parents' and Teachers' Autism Spectrum Screening Questionnaire (ASSQ), using the mandatory elementary education system and Disability Registry (DR). This total population approach allowed us to include and examine children with ASD who have used service systems, including health care and

Results

Of 55,266 children 7 to 12 years of age, 36,886 children attended 33 participating elementary schools (from total 43 schools) and/or were enrolled in a DR. Parents of 23,337 children returned ASSQs (63% response). Of the 1,214 sampled screen-positive students, 869 (72%) parents consented to participate in the diagnostic stage (70% male), and 292 (34%) completed diagnostic assessment.

Discussion

Findings from this study show that the new DSM-5 ASD criteria yield changes in estimated prevalence previously established using the DSM-IV PDD criteria. These changes include an approximate 17% decrease in the ASD prevalence from the prior DSM-IV PDD prevalence estimate of 2.64% to a DSM-5 ASD prevalence of 2.20%. These findings are not surprising. When one examines the new DSM-5 criteria, it can be expected that some individuals without relatively high levels of the designated “core” ASD

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This research was funded by an Autism Speaks Pilot Research Grant and a Supplement Grant (7996), a Brain Research Foundation Research Grant, a Simons Foundation Autism Research Initiative Pilot Grant (137032 M134793), the National Institute for Mental Health (NIMH) Career Awards (5K01MH079317-02 [Y.S.K.] and K23MH082883 [S.J.K.]), the National Institute of Environmental Health Sciences (NIEHS) R01 Award (R01 ES021462-01), and the Korean Health Technology Research and Development Project, Ministry of Health and Welfare (HI12C0021; HI12C0245-A120029). Additional funding was provided by the Jean Young and Walden W. Shaw Foundation, the Daniel X. and Mary Freedman Foundation, and the Dukyoung Foundation.

We are grateful to all of the schools and families that participated in the study. We thank Eugene Laska, PhD, with the Nathan S. Kline Institute for Psychiatric Research, for his statistical assistance.

Disclosures: Dr. Leventhal has a consulting relationship with Janssen Pharmaceuticals that is specific to a single project that has no involvement in medication development or marketing. Drs. Y.S. Kim, Fombonne, Koh, S.-J. Kim, and Cheon report no biomedical financial interests or potential conflicts of interest.

This article is discussed in an editorial by Dr. Bryan H. King on page 494.

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