DSM-5 如何影响自闭症诊断？一项为期 5 年的系统文献回顾和荟萃分析。

How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis.

机构信息

Columbia University School of Nursing, 630 West 168th Street, Box 6, New York, NY, 10032, USA.

Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

出版信息

J Autism Dev Disord. 2020 Jun;50(6):2102-2127. doi: 10.1007/s10803-019-03967-5.

DOI:10.1007/s10803-019-03967-5

PMID:30852784

Abstract

We conducted a 5-year follow-up systematic review and meta-analysis to determine change in frequency of autism spectrum disorder (ASD) diagnosis since diagnostic and statistical manual 5 (DSM-5) publication and explore the impact of Social Communication Disorder (SCD). For 33 included studies, use of DSM-5 criteria suggests decreases in diagnosis for ASD [20.8% (16.0-26.7), p < 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2-16.0), p < 0.001], and Asperger's [23.3% (12.9-38.5), p = 0.001]; pervasive developmental disorder-not otherwise specified decrease was not significant [46.1% (34.6-58.0), p = 0.52]. Less than one-third [28.8% (13.9-50.5), p = 0.06] of individuals diagnosed with DSM-IV-TR but not DSM-5 ASD would qualify for SCD. Findings suggest smaller decreases in ASD diagnoses compared to earlier reviews. Future research is needed as concerns remain for impaired individuals without a diagnosis.

摘要

我们进行了一项为期 5 年的随访系统评价和荟萃分析，以确定自《精神疾病诊断与统计手册》第 5 版（DSM-5）出版以来，自闭症谱系障碍（ASD）诊断的频率变化，并探讨社交沟通障碍（SCD）的影响。对于纳入的 33 项研究，使用 DSM-5 标准表明 ASD 的诊断率下降[20.8%（16.0-26.7），p<0.001]，DSM-IV-TR 自闭症障碍下降[10.1%（6.2-16.0），p<0.001]，和阿斯伯格症下降[23.3%（12.9-38.5），p=0.001]；未特定的广泛性发育障碍的下降没有显著差异[46.1%（34.6-58.0），p=0.52]。不到三分之一[28.8%（13.9-50.5），p=0.06]被诊断为 DSM-IV-TR 但不符合 DSM-5 ASD 的个体符合 SCD 的标准。与早期综述相比，这些发现表明 ASD 诊断的减少幅度较小。由于对没有诊断的受损个体仍然存在担忧，因此需要进行未来的研究。