How Has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-Analysis
Saved in:
| Title: | How Has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-Analysis |
|---|---|
| Language: | English |
| Authors: | Kulage, Kristine M., Goldberg, Johanna, Usseglio, John, Romero, Danielle, Bain, Jennifer M., Smaldone, Arlene M. |
| Source: | Journal of Autism and Developmental Disorders. Jun 2020 50(6):2102-2127. |
| Availability: | Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ |
| Peer Reviewed: | Y |
| Page Count: | 26 |
| Publication Date: | 2020 |
| Document Type: | Journal Articles Reports - Research Information Analyses |
| Descriptors: | Clinical Diagnosis, Guides, Autism, Pervasive Developmental Disorders, Followup Studies, Meta Analysis, Communication Disorders, Criteria, Asperger Syndrome |
| DOI: | 10.1007/s10803-019-03967-5 |
| ISSN: | 0162-3257 |
| 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. |
| Abstractor: | As Provided |
| Entry Date: | 2020 |
| Accession Number: | EJ1255361 |
| Database: | ERIC |
|
Full text is not displayed to guests.
Login for full access.
|
|
| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEglNd1H0gGpQ_oiQJJoYTVAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDGrlBqIZaXfqAYp76gIBEICBmhJ2TBabFgl2MZptcACk-WmRW-rmFYoNFnJaty8fz-R3SDt4tbqZKI6qUKJU7LsJhzyP5k6qQ62o94-RfxjROMjZIM9UzgjY4I2Tu7lK4IPuA_w0SXHK3odDq7IJBmiZwPFE9Y-2PMD-QbfcVDfTrlM_nCTnPE6oUxUpF6C0iahqpNpiGo4TWY_n6JuntT7U9tLBPUaMVsCcmIo= Text: Availability: 1 Value: <anid>AN0143506764;aut01jun.20;2020Jun02.05:48;v2.2.500</anid> <title id="AN0143506764-1">How has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-analysis </title> <p>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 &lt; 0.001], DSM-IV-TR Autistic Disorder [10.1% (6.2–16.0), p &lt; 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.</p> <p>Keywords: Autism Spectrum Disorder; DSM-5; Diagnosis; Asperger's Disorder; PDD-NOS; Social Communication Disorder</p> <p>Electronic supplementary material The online version of this article (10.1007/s10803-019-03967-5) contains supplementary material, which is available to authorized users.</p> <hd id="AN0143506764-2">Introduction</hd> <p>Autism Spectrum Disorder (ASD) was first established as a unique diagnosis from schizophrenia in 1980 in the Third Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the clinical diagnostic standard for mental disorders, including development disorders. Prior to 1980, the prevalence of autism estimated both in the United States (US) and globally ranged from 0.07 to 0.31 (Treffert [<reflink idref="bib78" id="ref1">78</reflink>]) to 0.49 (Wing and Gould [<reflink idref="bib87" id="ref2">87</reflink>]) per 1000 children. When the DSM, Fourth Edition, Text-Revision (DSM-IV-TR) was published in 2000 (American Psychiatric Association [<reflink idref="bib2" id="ref3">2</reflink>]), data from the first surveillance year (2000) of the Autism and Developmental Disabilities Monitoring (ADDM) Network estimated an ASD prevalence rate of 6.7 per 1000 or 1 in 150 children aged 8 years (Rice and Autism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators [<reflink idref="bib56" id="ref4">56</reflink>]), a finding similar to that reported by Mattila et al. in a study of Finnish children (Mattila et al. [<reflink idref="bib45" id="ref5">45</reflink>]). The most recent estimate from the ADDM Network (2014) illustrates a further increase in prevalence to 16.8 per 1000 or 1 in 59 American children (Baio et al. [<reflink idref="bib5" id="ref6">5</reflink>]) and is consistent with estimates of the increase in diagnosis rate obtained by parent self-report via national surveys (Kogan et al. [<reflink idref="bib33" id="ref7">33</reflink>]; Schieve et al. [<reflink idref="bib62" id="ref8">62</reflink>]). While estimates by country and the methods by which they are derived may vary, the increasing prevalence of autism as a global issue clear (Adak and Halder [<reflink idref="bib1" id="ref9">1</reflink>]; Elsabbagh et al. [<reflink idref="bib17" id="ref10">17</reflink>]; Fombonne et al. [<reflink idref="bib19" id="ref11">19</reflink>]; Levy et al. [<reflink idref="bib38" id="ref12">38</reflink>]). Collectively, this has prompted public health concerns, an expansion of research efforts, and a continued need for services (Baio et al. [<reflink idref="bib5" id="ref13">5</reflink>]).</p> <p>Changes in the criteria for autism diagnosis published in the Fifth Edition of the DSM (DSM-5) (American Psychiatric Association [<reflink idref="bib3" id="ref14">3</reflink>]) have stimulated much debate. First, the DSM-IV-TR contained ASD subtypes of Autistic Disorder (AD), Asperger's Disorder, and pervasive developmental disorder-not otherwise specified (PDD-NOS) that were omitted in the DSM-5; instead, subtypes were collapsed into a single diagnostic category—ASD. The DSM-5 also reduced the core domains of impairment from three to two: (<reflink idref="bib1" id="ref15">1</reflink>) social interaction and social communication (previously two distinct categories of "social interaction" and "communication") and (<reflink idref="bib2" id="ref16">2</reflink>) restricted, repetitive patterns of behavior, interests, or activities. In addition, while the DSM-IV-TR contained 12 distinct diagnostic criteria, the DSM-5 outlines only seven which are more general principles and behaviors. Finally, the DSM-5 allows for inclusion of historical behaviors in the ASD criteria, with the caveat that these behaviors must have been present in the early developmental period, while the previous edition was limited to current behaviors. Overall, these changes have caused concern that a higher threshold of symptoms is required for DSM-5 ASD diagnosis, thereby failing to capture some individuals who would have previously been diagnosed with ASD under the DSM-IV-TR and who may benefit from access to treatment and services (Maenner et al. [<reflink idref="bib42" id="ref17">42</reflink>]). Notably, while ADDM Network data on autism rates released just prior to publication of the DSM-5 identified a prevalence of 1 in 88 children aged 8 years old (Centers for Disease Control and Prevention [<reflink idref="bib12" id="ref18">12</reflink>]), the most recent ADDM Network prevalence estimate <emph>since</emph> DSM-5 publication was 1 in 59 children (Baio et al. [<reflink idref="bib5" id="ref19">5</reflink>]). However, data for this latest report are from 2014, and children included in this analysis would have primarily been evaluated under DSM-IV-TR ASD criteria (Baio et al. [<reflink idref="bib5" id="ref20">5</reflink>]). Therefore, the impact of DSM-5 criteria on ASD diagnosis rates remains unknown.</p> <p>To date, three systematic literature reviews (one with a meta-analysis) which examined the potential impact of DSM-5 on ASD diagnosis rates have been published; two were conducted just prior to DSM-5 publication (Kulage et al. [<reflink idref="bib35" id="ref21">35</reflink>]; Sturmey and Dalfern [<reflink idref="bib71" id="ref22">71</reflink>]), and one was conducted a year after (Smith et al. [<reflink idref="bib68" id="ref23">68</reflink>]). All three determined that ASD rates could decrease by at least one-third. While numerous studies have quantified potential changes in ASD rates in the last 5 years, no new systematic literature reviews with meta-analyses have been conducted to synthesize data from studies comparing DSM-IV-TR and DSM-5 ASD rates. In addition, the impact of a new DSM-5 diagnosis, Social Communication Disorder (SCD)—defined as a primary deficit in social communication and interaction (SCI) without restrictive, repetitive behaviors (RRB) (Ohashi et al. [<reflink idref="bib52" id="ref24">52</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref25">72</reflink>]; Swineford et al. [<reflink idref="bib74" id="ref26">74</reflink>])—on ASD rates has not been specifically examined in a systematic review since DSM-5 publication. This is an important gap in the literature because not only must an ASD diagnosis be "ruled out" before an SCD diagnosis can be given, but SCD was also initially described by the American Psychiatric Association as potentially capturing individuals with symptoms of PDD-NOS but who would no longer meet criteria for ASD under DSM-5 (American Psychiatric Association [<reflink idref="bib4" id="ref27">4</reflink>]).</p> <p>To address these gaps on the impact of DSM-5 on ASD diagnosis rates, the aims of this follow-up systematic literature review and meta-analysis were to: (<reflink idref="bib1" id="ref28">1</reflink>) determine the change in frequency of ASD diagnosis in the first five years after publication of the revised DSM-5 ASD criteria; (<reflink idref="bib2" id="ref29">2</reflink>) identify the DSM-IV-TR autism subtypes most affected by the new criteria; and (<reflink idref="bib3" id="ref30">3</reflink>) assess the potential of an alternative diagnosis of SCD for individuals who meet DSM-IV-TR but not DSM-5 ASD diagnostic criteria.</p> <hd id="AN0143506764-3">Methods</hd> <p></p> <hd id="AN0143506764-4">Search Strategy and Inclusion Criteria</hd> <p>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. [<reflink idref="bib47" id="ref31">47</reflink>]) in conducting this literature review and meta-analysis. An a priori protocol was registered (PROSPERO 2017 CRD42017077533) in November 2017 and updated in October 2018; the protocol can be accessed from <ulink href="http://www.crd.york.ac.uk/PROSPERO/display%5frecord.php?ID=CRD42017077533">http://www.crd.york.ac.uk/PROSPERO/display%5frecord.php?ID=CRD42017077533</ulink>. We used Covidence (<ulink href="http://covidence.org">http://covidence.org</ulink>), the web-based production platform for Cochrane Reviews, to manage our work flow. On October 26, 2017, we searched MEDLINE (PubMed), the Cumulative Index to Nursing and Allied Health Literature (EBSCO), Education Resources Information Center (ProQuest), and PsycInfo (Ovid) for original studies published from April 1, 2013, the end of coverage of the first literature review on this topic, through December 31, 2017. Subsequently, we re-ran the search on July 11, 2018 for studies published between January 1, 2018 and June 30, 2018. For search terms, two main domains were combined with the AND operator: one relating to DSM-5 and the other to autism diagnoses (e.g., Asperger's) or other related diagnoses (e.g., SCD). The full search strategy by database is available online in Appendix 1. Both subject headings and free text were used. No language requirement was placed on the text. To supplement the database search, we hand-searched issues of the <emph>Review Journal of Autism and Developmental Disorders</emph> and conference proceedings of the International Society for Autism Research from 2013 to 2017. We conducted a grey literature search for conference proceedings in both BIOSIS and Embase and examined.gov and.org sites for seven pages of search results on Google.com.</p> <p>All items found in the literature during the identification phase were screened by at least two authors who examined titles and abstracts for two inclusion criteria: studies needed to (<reflink idref="bib1" id="ref32">1</reflink>) present original data and (<reflink idref="bib2" id="ref33">2</reflink>) compare application of DSM-IV-TR and DSM-5 ASD diagnostic criteria to populations at risk for or previously diagnosed with ASD and/or one of three DSM-IV-TR ASD subtypes (AD, Asperger's disorder, or PDD-NOS). If it was unclear whether a study met these criteria based on abstract review, we conservatively included the study for full-text review. During full-text review, at least two authors assessed each study and came to a consensus for inclusion based on the following criteria: studies needed to (<reflink idref="bib1" id="ref34">1</reflink>) report results as raw data or percentages of individuals meeting diagnostic criteria using both DSM-IV-TR and DSM-5 criteria separately or (<reflink idref="bib2" id="ref35">2</reflink>) provide sufficient information so that percentages could be calculated (for example, present DSM-5 sensitivity and specificity with DSM-IV-TR as the reference standard). We excluded studies if they (<reflink idref="bib1" id="ref36">1</reflink>) did not compare DSM-IV-TR and DSM-5 diagnostic criteria applied to the same population; (<reflink idref="bib2" id="ref37">2</reflink>) did not provide sufficient information for extracting raw data on changes in rates of ASD diagnoses under DSM-IV-TR as compared to DSM-5; (<reflink idref="bib3" id="ref38">3</reflink>) had been included in the first literature review and meta-analysis on this topic (Kulage at al. [<reflink idref="bib35" id="ref39">35</reflink>]); (<reflink idref="bib4" id="ref40">4</reflink>) examined a duplicate study sample; or (<reflink idref="bib5" id="ref41">5</reflink>) used an inappropriate study design/article type for purposes of this review (i.e., editorials, letters to the editor, case reports, review articles, qualitative studies, or summaries or press releases of another article). We then hand-searched reference lists of included studies to locate other studies that may not have been identified in the electronic search.</p> <hd id="AN0143506764-5">Data Extraction</hd> <p>Two authors independently extracted data from each study and four authors compared results to arrive at a consensus. We extracted the following study characteristics: continent; study design; data sources; funding information; sample size; sample demographics including gender, race, and ethnicity; number diagnosed with ASD and/or its subtypes under DSM-IV-TR criteria; the version of DSM-5 ASD diagnostic criteria used in the study (i.e., draft or final); the discipline of the rater(s) responsible for making the autism diagnosis; and the instruments used by raters. The change in frequency of ASD diagnosis when DSM-5 criteria were applied to the same sample and/or subsamples was then calculated, including number and percent reduction in diagnosis. For studies which examined SCD, we extracted information on the number of individuals with ASD and its subtypes under DSM-IV-TR criteria who did not meet DSM-5 criteria but would qualify for an alternative diagnosis of SCD. Finally, we collected data from studies which reported specificity and sensitivity of DSM-5 diagnostic criteria.</p> <hd id="AN0143506764-6">Quality Appraisal</hd> <p>To rate the scientific rigor of individual studies, we used the quality appraisal of reliability studies (QAREL) (Lucas et al. [<reflink idref="bib40" id="ref42">40</reflink>]) which was developed for use in systematic reviews and meta-analyses to assess the quality of studies which explore diagnostic reliability. This 11-item checklist examines seven principles including the appropriateness of subjects, qualification of examiners, examiner blinding, ordering of examination, suitability of the time interval between repeated measurements, appropriate test application and interpretation, and statistical analysis of intra or inter-rater agreement. Each QAREL item can be answered with "yes," "no," or "unclear," with five items also including "not applicable" as an option. When raters agree upon the interpretation of criteria for each item, the QAREL has been demonstrated to be a reliable assessment tool for studies of diagnostic reliability (Lucas et al. [<reflink idref="bib41" id="ref43">41</reflink>]). In this study, two authors independently rated each study using QAREL, and then four authors collectively reviewed results and came to a consensus on each item.</p> <hd id="AN0143506764-7">Data Analysis</hd> <p>We conducted three meta-analyses. In the first pooled analysis, all included studies were examined to determine the change in frequency of ASD diagnosis based on DSM-5 criteria. For the second pooled analysis, we included studies that explored differences in ASD diagnosis by DSM-IV-TR subtype. For each, data were extracted as the number of individuals meeting DSM-IV-TR ASD diagnostic criteria and the number no longer meeting ASD diagnostic criteria under DSM-5; we then computed the proportion of those who would not retain an ASD diagnosis. Pooled effects were estimated for the proportion of individuals who no longer met criteria for ASD diagnosis using a random effects meta-analysis model. For the third meta-analysis, we pooled data from studies that examined application of DSM-5 SCD criteria to ASD samples. Specifically, we extracted the number of individuals who met DSM-IV-TR ASD criteria but no longer met criteria for an ASD diagnosis under DSM-5 and, of those, the number who would alternatively meet criteria for SCD. Because of the small number of studies, and to obtain a more comprehensive assessment of the impact of the SCD diagnosis and its potential to capture these individuals, we also extracted the same data from the four studies that examined SCD that were included in the first review on this topic (Kulage et al. [<reflink idref="bib35" id="ref44">35</reflink>]). A pooled effect was estimated for the proportion of individuals who would meet criteria for SCD. Results are presented as forest plots using random effects meta-analysis models.</p> <p>For pooled effects indicative of a statistically significant reduction (<emph>p</emph> &lt; 0.05) in diagnoses when DSM-5 criteria were applied, we examined heterogeneity and publication bias. Heterogeneity was assessed using Cochran's Q and I<sups>2</sups> statistics and was considered to be present if the Cochran's Q <emph>p</emph>-value was &lt; 0.05 or I<sups>2</sups> was &gt; 50% (Higgins et al. [<reflink idref="bib27" id="ref45">27</reflink>]). To examine differences between studies that might explain heterogeneity, we conducted subgroup analyses by sample age; continent where the study was conducted; study design; instrument used to make an ASD diagnosis; discipline of the rater (MD, PhD, or both) responsible for making the diagnosis; version of DSM-5 ASD diagnosis criteria used (draft or final); study funding source; and three risk of bias domains: whether order of examination varied, measurement of intra and/or interrater agreement, and whether raters making the diagnosis were blinded to the results of the reference standard (i.e., DSM-IV-TR diagnosis). To examine the risk of publication bias, we constructed a funnel plot, examined it visually, and conducted a Classic fail-safe N test, which is used to determine the number of additional studies needed to change interpretation of publication bias (Persaud [<reflink idref="bib54" id="ref46">54</reflink>]). Data were analyzed using Comprehensive Meta-Analysis statistical software (Biostat, Inc., Englewood, NJ).</p> <hd id="AN0143506764-8">Results</hd> <p>Figure 1 presents details of the literature search. A total of 898 records were initially identified from the database and supplemental search phases; following removal of duplicates, 600 articles were deemed eligible for screening. After screening titles and abstracts, 509 items were excluded, leaving an initial group of 91 studies for full-text assessment. However, prior to full-text assessment, the reference lists of the 91 studies were hand-searched, and two additional publications were identified, creating a total of 93 for full-text review. Sixty studies were subsequently excluded after the full-text review, including seven which used the same sample as a study (Matson et al. [<reflink idref="bib44" id="ref47">44</reflink>]) that was included in the first review on this topic (See Appendix 2 online for list of excluded references and rationale for exclusion). Therefore, a total of 33 studies were included in the systematic review and meta-analysis; of these, 19 studies that examined ASD subtypes and nine studies that examined SCD (five studies identified in this review and four studies from the previous review) were eligible for the additional analyses.</p> <p>Graph: Fig. 1 PRISMA flow diagram for the systematic literature review</p> <hd id="AN0143506764-9">Study Quality</hd> <p>Figure 2 summarizes the results of the quality appraisal of the 33 studies. All but one study (Kim et al. [<reflink idref="bib32" id="ref48">32</reflink>]) used an appropriate sample of subjects. In the majority of studies, appropriately credentialed raters provided diagnoses, correctly applied and interpreted the instruments or criteria for diagnoses, and employed an appropriate time-interval between DSM-IV-TR and DSM-5 measurement. However, only eight studies (Baio et al. [<reflink idref="bib5" id="ref49">5</reflink>]; Helles et al. [<reflink idref="bib25" id="ref50">25</reflink>]; Hiller et al. [<reflink idref="bib28" id="ref51">28</reflink>]; Kim et al. [<reflink idref="bib32" id="ref52">32</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref53">46</reflink>]; Mugzach et al. [<reflink idref="bib48" id="ref54">48</reflink>]; Taheri et al. [<reflink idref="bib76" id="ref55">76</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref56">92</reflink>]) reported inter and/or intra-rater reliability, and variation in the order of examination could only be verified in three studies (Mazurek et al. [<reflink idref="bib46" id="ref57">46</reflink>]; Mugzach et al. [<reflink idref="bib48" id="ref58">48</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref59">92</reflink>]). The risk for bias in relation to study blinding across studies was largely unclear. Only one study specified that raters were blinded to the findings of other raters (Wong and Koh [<reflink idref="bib88" id="ref60">88</reflink>]), and no studies definitively indicated that raters were blinded to their own prior findings. In addition, in only four studies could we determine that the raters were blinded to both clinical information and additional cues not part of the diagnosing process (Mazurek et al. [<reflink idref="bib46" id="ref61">46</reflink>]; Taheri et al. [<reflink idref="bib76" id="ref62">76</reflink>]; Turygin et al. [<reflink idref="bib80" id="ref63">80</reflink>]; Wong and Koh [<reflink idref="bib88" id="ref64">88</reflink>]), and only three studies reported that raters were blinded to the results of DSM-IV-TR when applying DSM-5 criteria (Magana and Vanegas [<reflink idref="bib43" id="ref65">43</reflink>]; Sung et al. [<reflink idref="bib73" id="ref66">73</reflink>]; Wong and Koh [<reflink idref="bib88" id="ref67">88</reflink>]).</p> <p>Graph: Fig. 2 Study quality appraisal results using the QAREL checklist</p> <hd id="AN0143506764-10">Characteristics of the Included Studies</hd> <p></p> <hd id="AN0143506764-11">Study Year, Type, and Continent</hd> <p>Table 1 provides a descriptive summary of each study. Publication years for articles ranged from 2013 to 2018 with the majority (61%) published in the 2 years immediately following the release of the DSM-5. Fifty-five percent (n = 18) of studies were prospective (Barton et al. [<reflink idref="bib7" id="ref68">7</reflink>]; Beighley et al. [<reflink idref="bib8" id="ref69">8</reflink>]; Dawkins et al. [<reflink idref="bib14" id="ref70">14</reflink>]; Helles et al. [<reflink idref="bib25" id="ref71">25</reflink>]; Jashar et al. [<reflink idref="bib31" id="ref72">31</reflink>]; Konst et al. [<reflink idref="bib34" id="ref73">34</reflink>]; Magana and Vanegas [<reflink idref="bib43" id="ref74">43</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref75">46</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref76">51</reflink>]; Romero et al. [<reflink idref="bib60" id="ref77">60</reflink>]; Signorelli et al. [<reflink idref="bib65" id="ref78">65</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref79">72</reflink>]; Sung et al. [<reflink idref="bib73" id="ref80">73</reflink>]; Tartaglia et al. [<reflink idref="bib77" id="ref81">77</reflink>]; van Steensel et al. [<reflink idref="bib81" id="ref82">81</reflink>]; Wheeler et al. [<reflink idref="bib85" id="ref83">85</reflink>]; Yaylaci and Miral [<reflink idref="bib90" id="ref84">90</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref85">92</reflink>]), and the remaining were retrospective. While 16 studies were conducted in North America (15 in the US and one in Canada), the majority of studies were conducted globally, including seven in Asia (Kim et al. [<reflink idref="bib32" id="ref86">32</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref87">51</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref88">52</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref89">72</reflink>]; Sung et al. [<reflink idref="bib73" id="ref90">73</reflink>]; Wong and Koh [<reflink idref="bib88" id="ref91">88</reflink>]; Yaylaci and Miral [<reflink idref="bib90" id="ref92">90</reflink>]), six in Europe (Helles et al. [<reflink idref="bib25" id="ref93">25</reflink>]; Romero et al. [<reflink idref="bib60" id="ref94">60</reflink>]; Signorelli et al. [<reflink idref="bib65" id="ref95">65</reflink>]; Solerdelcoll Arimany et al. [<reflink idref="bib70" id="ref96">70</reflink>]; van Steensel et al. [<reflink idref="bib81" id="ref97">81</reflink>]; Zander and Bolte [<reflink idref="bib94" id="ref98">94</reflink>]); and three in Australia (Christiansz et al. [<reflink idref="bib13" id="ref99">13</reflink>]; Hiller et al. [<reflink idref="bib28" id="ref100">28</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref101">92</reflink>]); one was unreported (Mugzach et al. [<reflink idref="bib48" id="ref102">48</reflink>]).</p> <p>Characteristics of 33 included studies</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Author, location, study type, data sources, and funding sources&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Sample characteristics (i.e., number, age, gender, race, ethnicity)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Clinician type and diagnostic instruments&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;DSM-IV-TR diagnoses (including subtypes)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;DSM-5 diagnoses&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Reduction in diagnoses using DSM-5 criteria&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Baio et al. (&lt;xref ref-type="bibr" rid="bibr5"&gt;2018&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 4920&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4658 ASD&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4236 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.1% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Age 8 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD case determination criteria for DSM-IV-TR and DSM-5&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;State vital records for 11 ADDM network sites&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Barton et al. (&lt;xref ref-type="bibr" rid="bibr7"&gt;2013&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 422&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;284 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;239 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.8% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 16.79&amp;#8211;39.36 months&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective, cross sectional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.1% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Toddlers with siblings with ASD from pediatric offices in Atlanta, Connecticut, and bordering states; Connecticut early intervention program&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;69.9% white; 10.4% black&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M-CHAT-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8.3% Hispanic; 6.4% not reported; 3.1% Asian/Pacific Islander; 1.9% multi-racial&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Beighley et al. (&lt;xref ref-type="bibr" rid="bibr8"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 261&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;135 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;51 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;62.2% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 16&amp;#8211;87 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DSM-IV-TR/ICD-10 Checklist&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective, cross sectional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;53.6% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Louisiana state developmental center&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.6% white, 23% black, 0.4% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Christiansz et al. (&lt;xref ref-type="bibr" rid="bibr13"&gt;2016&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 185&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;126 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;106 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.9% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Australia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 20&amp;#8211;55 months and 1.7&amp;#8211;4.6 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;103 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;90 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.6%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;83.2% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;23 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30.4%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Early childhood services, pediatricians, and public regional autism assessment programme&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Dawkins et al. (&lt;xref ref-type="bibr" rid="bibr14"&gt;2016&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 183&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;142 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;134 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.6% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 1&amp;#8211;62 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective, cross sectional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;78.6% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CARS2-HF&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;TEACCH Autism Program Centers in North Carolina&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;61.2% white, 20.9% black, 7.7% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CARS2-ST&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Foley-Nicpon et al. (&lt;xref ref-type="bibr" rid="bibr18"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 45&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 5.5&amp;#8211;17.8 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75.6% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;University center psychology clinic for gifted and talented students&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;12 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Harstad et al. (&lt;xref ref-type="bibr" rid="bibr24"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 227&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;156 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;120 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;23.1% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 1.3&amp;#8211;18 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;114 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;103 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.6% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;83.7% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Bayley Scales, 3rd edition&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40.0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Multidisciplinary developmental behavioral pediatric clinic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;DAS-II&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;37 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;62.2% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Helles et al. (&lt;xref ref-type="bibr" rid="bibr25"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 50&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;39 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sweden&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 23&amp;#8211;43 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASDI&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DISCO-II&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.1% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Gothenburg Child Neuropsychiatric Clinic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;Gillberg's Criteria for Asperger's Syndrome&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Hiller et al. (&lt;xref ref-type="bibr" rid="bibr28"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 114&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;114 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;87 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;23.7% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Australia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Mean ages: Male = 8.76 &amp;#177; 3.91 years Female = 8.06 &amp;#177; 4.03 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55.3% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Private practice specializing in diagnostic assessments for PDDs&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADEC&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;CARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Jashar et al. (&lt;xref ref-type="bibr" rid="bibr31"&gt;2016&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 281&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD or PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;203 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;146 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28.1% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 16&amp;#8211;39 months&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;M-CHAT&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;134 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;116 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.4% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;77.9% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VABS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;69 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;56.5% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Pediatrician offices&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.5% white, 6.4% black, 10.3% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Kim et al. (&lt;xref ref-type="bibr" rid="bibr32"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 292&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;206 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;184 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10.7% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;South Korea&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 7&amp;#8211;12 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;114 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;112 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.8% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective file review&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;34 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8.8% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;All children born from 1993 to 1999 in a suburb of Seoul, South Korea&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;BASC II-PRS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;41 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29.3% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Konst et al. (&lt;xref ref-type="bibr" rid="bibr34"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 1722&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1104 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;605 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45.2% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 17&amp;#8211;37 months&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;BISCUIT &amp;#8211; Part I&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective, cross sectional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;71.5% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;BISCUIT &amp;#8211; Part II&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;State-funded early intervention program for children at-risk for developmental disability&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49.2% white, 38.2% black&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10.3% other, 2.3% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Maenner et al. (&lt;xref ref-type="bibr" rid="bibr42"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 7597&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6577 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5339 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.8% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Age 8 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;82.3% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;ADDM Network, 11 sites in 2006 and 14 sites in 2008&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;55.8% white, 22.5% black; 12.2% Hispanic, 2.9% Asian/Pacific Islander&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0.6% other&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Magana and Vanegas (&lt;xref ref-type="bibr" rid="bibr43"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 29&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;23 ASD&lt;sup&gt;c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 4&amp;#8211;16 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R (Spanish)&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Clinics and parent support groups across two Midwestern cities&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mazurek et al. (&lt;xref ref-type="bibr" rid="bibr46"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 439&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;278 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;249 ASD&lt;sup&gt;d&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10.4% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 2-17.7 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ABC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;229 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;222 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;79% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20.0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Six autism centers affiliated with the Autism Treatment Network&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;78% white&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CBCL&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mugzach et al. (&lt;xref ref-type="bibr" rid="bibr48"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 2642&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2642 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2485 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.9% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Country not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Data source not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ocakoglu et al. (&lt;xref ref-type="bibr" rid="bibr51"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 28&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;37.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Turkey&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages birth to 6 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ABC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;37.5% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;82.1% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Children diagnosed with PDD-NOS by Ege University Disabled Health Committee in 2010&amp;#8211;2011&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ohashi et al. (&lt;xref ref-type="bibr" rid="bibr52"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 68&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Japan&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 6.2&amp;#8211;14.9 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;63.2% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;16 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.8% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Department of Psychology and Development, Nagoya City University Hospital&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;21 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;47.6% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Rieske et al. (&lt;xref ref-type="bibr" rid="bibr57"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 424&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;300 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;192 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;36.0% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 2&amp;#8211;18 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DSM-IV-TR/ICD-10 Checklists&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective database review&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;72.9% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ASD-CC&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Outpatient clinics, schools, and community organizations&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;69.1% white, 17.4% unknown; 8.3% black&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.2% other&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Romero et al. (&lt;xref ref-type="bibr" rid="bibr60"&gt;2016&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 123&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;123 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;57 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;53.6% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Spain&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 5&amp;#8211;15 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;DSM-IV-TR/ICD-10 Checklists&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;34 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;50.0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;82% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;IDEA&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;48.1% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Schools in Magala, Spain&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% white&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;62 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;58.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Signorelli et al. (&lt;xref ref-type="bibr" rid="bibr65"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 15&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;80.0% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Italy&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Adults; Ages not provided&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;80.0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Clinic-based sample&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;VABS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Solerdelcoll Arimany et al. (&lt;xref ref-type="bibr" rid="bibr70"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 118&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;88 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;77 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Spain&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 3&amp;#8211;17 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11.1% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective chart review&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;86.5% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;47 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;44 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6.4% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital clinic, Barcelona, Spain&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;23 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sumi et al. (&lt;xref ref-type="bibr" rid="bibr72"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 180&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;64 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;62 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.1% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Japan&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 2&amp;#8211;5 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;27 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Nagoya West District Care Center for disabled children&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;96% Asian/Pacific Islander, 4% other&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;29 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6.9% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sung et al. (&lt;xref ref-type="bibr" rid="bibr73"&gt;2018&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 110&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;92 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;77 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16.3% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Singapore&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 5.1&amp;#8211;19.6 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;80.9% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;32 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.3% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;The Child Guidance Clinic under the Institute of Mental Health&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;81.8% Chinese, 6.4% Malay, 6.4% other, 5.4% Indian&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;30 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Taheri et al. (&lt;xref ref-type="bibr" rid="bibr76"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 22&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;45.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Canada&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 5&amp;#8211;19 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31.3% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective chart review&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;95.5% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;VABS-II&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;83.3% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;The TRE-ADD Program&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Tartaglia et al. (&lt;xref ref-type="bibr" rid="bibr77"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 98&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 3&amp;#8211;22 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Hospital-based outpatient clinics and national SCA support organizations&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;88.8% white&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Turygin et al. (&lt;xref ref-type="bibr" rid="bibr80"&gt;2013&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 142&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;66 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;44 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;33.3% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 2&amp;#8211;16 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;BASC-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective database review&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;62.7% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;University-affiliated clinic in Louisiana&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.1% white, 12% black&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7% Hispanic&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Van Steensel et al. (&lt;xref ref-type="bibr" rid="bibr81"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 90&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;88 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;63 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28.4% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Netherlands&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 7&amp;#8211;17 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76.7% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CSBQ&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Outpatient mental health centers&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wheeler et al. (&lt;xref ref-type="bibr" rid="bibr85"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 758&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;276 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;191 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;30.8% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 2&amp;#8211;67 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Survey questions; no standardized instrument&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective (survey)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;84.3% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Registry of fragile X syndrome&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;89.8% white, 3.8% Hispanic, 2.6% black&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wong and Koh (&lt;xref ref-type="bibr" rid="bibr88"&gt;2016&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 206&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD &lt;italic&gt;and&lt;/italic&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;202 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;184 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8.9% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Singapore&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Mean age = 3 years, 10 months&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;174 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;165 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.2% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;85.9% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;50.0% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Specialist multidisciplinary clinic for developmental concerns&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;67% Chinese, 18% Malay, 10% Indian, 5% other&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;4 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75.0% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;22 Non-specified&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17 Non-specified&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;22.7% Non-specified&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Yaylaci and Miral (&lt;xref ref-type="bibr" rid="bibr90"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 150&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;MD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;149 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;120 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.5% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Turkey&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 3&amp;#8211;15 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ABC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;139 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;120 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.6% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective, cross sectional&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;77.3% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;CARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Data source not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;6 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Young and Rodi (&lt;xref ref-type="bibr" rid="bibr92"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 233&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;210 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;120 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;42.9% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Australia&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 1&amp;#8211;54 years&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;76 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;56 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26.3% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Prospective&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;72.5% male&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;AQ&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;114 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;64 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43.9% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Private practice offering services by psychologists and pathologists&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;CARS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;20 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;100% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;CAST&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;SCQ&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Zander and Bolte (&lt;xref ref-type="bibr" rid="bibr94"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N = 171&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Not reported&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;127 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;115 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.4% ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sweden&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Ages 20&amp;#8211;47 months&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;ABC&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;68 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;66 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2.9% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Retrospective chart review&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;59 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;49 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16.9% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Subset from previous study sample from the Neuropsychiatric Resource Team Southeast, Division of Child and Adolescent Psychiatry, Stockholm County Council&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;ADOS-2&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Federal and non-federal funding&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;VABS-II&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <sups>a</sups>The abbreviation of "ASD" under DSM-IV-TR refers to group of three diagnoses under the autism spectrum: Autistic Disorder (AD), Asperger's Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and "ASD" under DSM-5 refers to a diagnosis of Autism Spectrum Disorder <sups>b</sups>Study used draft instead of final published DSM-5 criteria to diagnose ASD <sups>c</sups>Three individuals met DSM-5 but not DSM-IV-TR ASD criteria <sups>d</sups>One individual met DSM-5 but not DSM-IV-TR ASD criteria <emph>ADDM</emph> Autism and Developmental Disabilities Monitoring; <emph>ADI-R</emph> Autism Diagnostic Interview—revised; <emph>ADOS</emph> Autism Diagnosis Observation Schedule; <emph>M-CHAT-R</emph> Modified Checklist for Autism in Toddlers—revised; <emph>ICD-10</emph> international statistical classification of diseases and related health problems, 10th edition; <emph>ADOS-2</emph> Autism Diagnosis Observation Schedule, 2nd edition; <emph>CARS2-HF</emph> Childhood Autism Rating Scale, 2nd edition (high-functioning clinical tool); <emph>CARS2-ST</emph> Childhood Autism Rating Scale, 2nd edition (standard clinical tool); <emph>TEACCH</emph> Treatment and Education of Autistic and Communication related handicapped Children; <emph>DAS-II</emph> Differential Ability Scale, 2nd edition; <emph>ASDI</emph> Autism Spectrum Disorder Interview; <emph>DISCO-II</emph> Diagnostic Interview for Social and Communication Disorders, 2nd edition; <emph>ADEC</emph> Autism Detection in Early Childhood; <emph>CARS</emph> Childhood Autism Rating Scale; <emph>M-CHAT</emph> Modified Checklist for Autism in Toddlers; <emph>VABS</emph> Vineland Adaptive Behavior Scale; <emph>BASC II-PRS</emph> Behavior Assessment System for Children II—Parent Report Scale; <emph>BISCUIT-Part I</emph> Baby and Infant Screen for Children with aUtIsm Traits-Part I; <emph>BISCUIT-Part II</emph> Baby and Infant Screen for Children with aUtIsm Traits-Part II; <emph>ABC</emph> Autism Behavior Checklist; <emph>CBCL</emph> Child Behavior Checklist; <emph>PARS</emph> Pervasive Developmental Disorder-Autism Society Japan Rating Scale; <emph>ASD-CC</emph> Autism Spectrum Disorders-Comorbidity for Children; <emph>IDEA</emph> Autism Spectrum Disorder Inventory; <emph>TRE-ADD</emph> Treatment, Research, and Education for Autism and Developmental Disorders; <emph>VABS-II</emph> Vineland Adaptive Behavior Scale, 2nd edition; <emph>SCA</emph> sex chromosome aneuploidy; <emph>BASC-2</emph> Behavior Assessment System for Children, 2nd edition; <emph>CSBQ</emph> Children's Social Behavior Questionnaire; <emph>AQ</emph> Autism Spectrum Quotient; <emph>CAST</emph> Childhood Asperger Syndrome Test; <emph>SCQ</emph> Social Communication Questionnaire</p> <hd id="AN0143506764-12">Demographics</hd> <p>Samples were heterogeneous in terms of size, age, and data sources. Sample sizes ranged from 15 (Signorelli et al. [<reflink idref="bib65" id="ref103">65</reflink>]) to 7597 (Maenner et al. [<reflink idref="bib42" id="ref104">42</reflink>]) individuals. The majority of studies (n = 24) restricted their samples to pediatric populations (i.e., ages ≤ 19 years). There were six studies limited to young children under the age of five (Barton et al. [<reflink idref="bib7" id="ref105">7</reflink>]; Christiansz et al. [<reflink idref="bib13" id="ref106">13</reflink>]; Jashar et al. [<reflink idref="bib31" id="ref107">31</reflink>]; Konst et al. [<reflink idref="bib34" id="ref108">34</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref109">72</reflink>]; Zander and Bolte [<reflink idref="bib94" id="ref110">94</reflink>]); eight that included all children ages ≤ 19 years (Harstad et al. [<reflink idref="bib24" id="ref111">24</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref112">46</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref113">51</reflink>]; Rieske et al. [<reflink idref="bib57" id="ref114">57</reflink>]; Solerdelcoll Arimany et al. [<reflink idref="bib70" id="ref115">70</reflink>]; Turygin et al. [<reflink idref="bib80" id="ref116">80</reflink>]; Wong and Koh [<reflink idref="bib88" id="ref117">88</reflink>]; Yaylaci and Miral [<reflink idref="bib90" id="ref118">90</reflink>]); and 10 studies with older children ages 5–19 years (Baio et al. [<reflink idref="bib5" id="ref119">5</reflink>]; Foley-Nicpon et al. [<reflink idref="bib18" id="ref120">18</reflink>]; Hiller et al. [<reflink idref="bib28" id="ref121">28</reflink>]; Kim et al. [<reflink idref="bib32" id="ref122">32</reflink>]; Maenner et al. [<reflink idref="bib42" id="ref123">42</reflink>]; Magana and Vanegas [<reflink idref="bib43" id="ref124">43</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref125">52</reflink>]; Romero et al. [<reflink idref="bib60" id="ref126">60</reflink>]; Taheri et al. [<reflink idref="bib76" id="ref127">76</reflink>]; van Steensel et al. [<reflink idref="bib81" id="ref128">81</reflink>]). Two studies included samples of children and adults ages ≥ five years (Beighley et al. [<reflink idref="bib8" id="ref129">8</reflink>]; Sung et al. [<reflink idref="bib73" id="ref130">73</reflink>]); two restricted inclusion to adults ≥ 20 years (Helles et al. [<reflink idref="bib25" id="ref131">25</reflink>]; Signorelli et al. [<reflink idref="bib65" id="ref132">65</reflink>]); four included all ages (Dawkins et al. [<reflink idref="bib14" id="ref133">14</reflink>]; Tartaglia et al. [<reflink idref="bib77" id="ref134">77</reflink>]; Wheeler et al. [<reflink idref="bib85" id="ref135">85</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref136">92</reflink>]); and one did not report ages (Mugzach et al. [<reflink idref="bib48" id="ref137">48</reflink>]). Twenty-eight studies provided data on gender, race, and/or ethnicity of their samples. In the 27 studies which reported gender, 79.6% of the cumulative sample population was male (11,367 of 14,276). For the 16 studies which reported figures on race and/or ethnicity, 61% of the cumulative sample population was white (7926 of 12,975). Nine studies specifically indicated their populations included individuals of Hispanic ethnicity; out of a total sample population of 11,395 individuals, only 1113 (9.8%) were Hispanic.</p> <hd id="AN0143506764-13">Data Sources and Funding Sources</hd> <p>Studies used a wide variety of data sources; for example, prospective studies included sources such as early intervention programs and centers; pediatric offices; developmental clinics; support groups; and organizational registries. For retrospective studies, data sources included state records (e.g., ADDM Network site records); hospital, university, and clinic records; private practices; public schools; community organizations; census records; and previous study samples. Fifteen studies reported receiving financial support from a variety of funding sources including federal (e.g., National Institutes of Health, Centers for Disease Control and Prevention) and non-federal (e.g., Autism Speaks, Simons Foundation Autism Research Initiative) entities (Baio et al. [<reflink idref="bib5" id="ref138">5</reflink>]; Barton et al. [<reflink idref="bib7" id="ref139">7</reflink>]; Christiansz et al. [<reflink idref="bib13" id="ref140">13</reflink>]; Foley-Nicpon et al. [<reflink idref="bib18" id="ref141">18</reflink>]; Helles et al. [<reflink idref="bib25" id="ref142">25</reflink>]; Hiller et al. [<reflink idref="bib28" id="ref143">28</reflink>]; Jashar et al. [<reflink idref="bib31" id="ref144">31</reflink>]; Kim et al. [<reflink idref="bib32" id="ref145">32</reflink>]; Maenner et al. [<reflink idref="bib42" id="ref146">42</reflink>]; Magana and Vanegas [<reflink idref="bib43" id="ref147">43</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref148">46</reflink>]; Mugzach et al. [<reflink idref="bib48" id="ref149">48</reflink>]; Tartaglia et al. [<reflink idref="bib77" id="ref150">77</reflink>]; Wheeler et al. [<reflink idref="bib85" id="ref151">85</reflink>]; Zander and Bolte [<reflink idref="bib94" id="ref152">94</reflink>]).</p> <hd id="AN0143506764-14">Diagnostic Instruments, Raters, and DSM-5 Criteria Version</hd> <p>The most common screening instruments used in combination with clinical impressions to diagnose ASD were the Autism Diagnostic Interview—Revised (ADI-R) and the Autism Diagnosis Observation Schedule (ADOS) with more than half of studies (55%) using either one of these or both. Other objective tools coupled with clinical impressions included a wide variety of checklists, scales, and diagnostic instruments focused on identifying and measuring autism characteristics, developmental delays, and social behavior deficiencies. Clinicians who interpreted findings of the instruments to make the diagnosis of ASD included physicians (e.g., child psychiatrists, behavioral pediatricians), psychologists (e.g., PhD and/or PsyD), and teams of physicians and psychologists. The majority of studies (78.8%) used the final published version of the DSM-5 (American Psychiatric Association [<reflink idref="bib3" id="ref153">3</reflink>]) to diagnose ASD, and the 2011 draft version of the criteria (You et al. [<reflink idref="bib91" id="ref154">91</reflink>]) was used to diagnose ASD in the remaining studies (Barton et al. [<reflink idref="bib7" id="ref155">7</reflink>]; Harstad et al. [<reflink idref="bib24" id="ref156">24</reflink>]; Rieske et al. [<reflink idref="bib57" id="ref157">57</reflink>]; Solerdelcoll Arimany et al. [<reflink idref="bib70" id="ref158">70</reflink>]; Taheri et al. [<reflink idref="bib76" id="ref159">76</reflink>]; Turygin et al. [<reflink idref="bib80" id="ref160">80</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref161">92</reflink>]).</p> <hd id="AN0143506764-15">Changes in ASD Diagnosis Rates since DSM-5 Publication</hd> <p>The percent reduction in DSM-IV-TR ASD diagnoses using DSM-5 criteria ranged from 0% (Foley-Nicpon et al. [<reflink idref="bib18" id="ref162">18</reflink>]; Magana and Vanegas [<reflink idref="bib43" id="ref163">43</reflink>]; Tartaglia et al. [<reflink idref="bib77" id="ref164">77</reflink>]) to 80% (Signorelli et al. [<reflink idref="bib65" id="ref165">65</reflink>]). Overall, 91% of studies reported ASD diagnosis reduction rates between 0 and 50% when applying DSM-5 criteria, with the majority of studies (60.6%) reporting reduction rates of 0–25% and 30.3% demonstrating reduction rates of 26–50%. Only three studies (9.1%) reported ASD diagnosis rates &gt; 50% (Beighley et al. [<reflink idref="bib8" id="ref166">8</reflink>]; Romero et al. [<reflink idref="bib60" id="ref167">60</reflink>]; Signorelli et al. [<reflink idref="bib65" id="ref168">65</reflink>]); of note, the highest reduction rate of 80% was in a sample of 15 individuals, all of whom were adults (Signorelli et al. [<reflink idref="bib65" id="ref169">65</reflink>]).</p> <hd id="AN0143506764-16">DSM-IV-TR Subtypes most affected by DSM-5 ASD Criteria</hd> <p>Nineteen studies (57.5%) reported data on changes in ASD diagnosis under DSM-5 criteria according to one or more of the DSM-IV-TR ASD subtypes, and the reduction rates in ASD diagnosis varied widely by subtype. In the 17 studies that examined AD, reduction rates of ≤ 25% were demonstrated in the vast majority of studies (82.4%) with the remaining reporting reduction rates of 26–50%. For the 14 studies that looked at Asperger's, the reduction rates were more equally spread with 57.1% of studies reporting reduction rates of ≤ 25 and 42.9% of studies reporting reduction rates ≥ 26%. Of note, Signorelli et al. ([<reflink idref="bib65" id="ref170">65</reflink>]) reported a reduction rate in Asperger's of 80% and Yaylaci and Miral ([<reflink idref="bib90" id="ref171">90</reflink>]) reported a reduction rate of 100%. Highest overall reduction rates were seen for the PDD-NOS subtype. Only 16.7% of the eight studies which examined PDD-NOS saw ASD diagnosis reduction rates of ≤ 25%. The majority of studies (66.6%) reported PDD-NOS reduction rates in the 26–75% range with the remaining three studies (16.7%) finding reduction rates &gt; 75%, two of which reported a 100% reduction rate (Yaylaci and Miral [<reflink idref="bib90" id="ref172">90</reflink>]; Young and Rodi [<reflink idref="bib92" id="ref173">92</reflink>]).</p> <hd id="AN0143506764-17">Impact of DSM-5 Social Communication Disorder (SCD) Diagnosis</hd> <p>Table 2 provides details on the five studies from the current review (Kim et al. [<reflink idref="bib32" id="ref174">32</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref175">46</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref176">51</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref177">52</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref178">72</reflink>]) and four studies from the first review (Dickerson Mayes et al. [<reflink idref="bib16" id="ref179">16</reflink>]; Huerta et al. [<reflink idref="bib29" id="ref180">29</reflink>]; Taheri and Perry [<reflink idref="bib75" id="ref181">75</reflink>]; Wilson et al. [<reflink idref="bib86" id="ref182">86</reflink>]) that examined the proportion of individuals with DSM-IV-TR ASD who did not retain an ASD diagnosis under DSM-5 but alternatively met SCD criteria. Only three studies utilized US populations (Dickerson Mayes et al. [<reflink idref="bib16" id="ref183">16</reflink>]; Huerta et al. [<reflink idref="bib29" id="ref184">29</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref185">46</reflink>]). Five studies examined the impact of SCD on DSM-IV-TR ASD subtypes (Dickerson Mayes et al. [<reflink idref="bib16" id="ref186">16</reflink>]; Kim et al. [<reflink idref="bib32" id="ref187">32</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref188">51</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref189">52</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref190">72</reflink>]). Individuals qualifying for an alternative SCD diagnosis included 2/2 (100%) for the AD subtype; 4/6 (66.7%) for the Asperger's Disorder subtype; and 23/57 (40.4%) for the PDD-NOS subtype.</p> <p>Impact of Social Communication Disorder on Individuals who do not retain an ASD diagnosis under DSM-5</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Study and country&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;DSM-IV-TR diagnoses (including subtypes)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;DSM-5 diagnoses&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;SCD diagnoses N (% captured)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Dickerson Mayes (2013)&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 ASD&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7 ASD&lt;sup&gt;c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5/18 (28%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5/18 (28%) PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Huerta et al. (&lt;xref ref-type="bibr" rid="bibr29"&gt;2012&lt;/xref&gt;)&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;US and Canada&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4,453 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4,058 ASD&lt;sup&gt;c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;75/395 (19%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Kim et al. (&lt;xref ref-type="bibr" rid="bibr32"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;206 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;184 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17/22 (77%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;South Korea&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;114 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;112 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/2 (100%) AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;34 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/3 (67%) Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;58 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;41 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13/17 (76%) PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Mazurek et al. (&lt;xref ref-type="bibr" rid="bibr46"&gt;2017&lt;/xref&gt;)&lt;/p&gt;&lt;p&gt;US&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;278 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;249 ASD&lt;sup&gt;d&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/30 (7%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ocakoglu et al. (&lt;xref ref-type="bibr" rid="bibr51"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0/10 (0%) ASD;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Turkey&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;28 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;0/10 (0%) PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Ohashi et al. (&lt;xref ref-type="bibr" rid="bibr52"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;40 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5/13 (38%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Japan&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;AD = N/A&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;16 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/3 (67%) Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;21 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3/10 (30%) PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sumi et al. (&lt;xref ref-type="bibr" rid="bibr72"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;64 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;62 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/2 (100%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Japan&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8 AD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;AD = N/A&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;27 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 Asperger's&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Asperger's = N/A&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;29 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;27 PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/2 (100%) PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Taheri and Perry (&lt;xref ref-type="bibr" rid="bibr75"&gt;2012&lt;/xref&gt;)&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;129 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;82 ASD&lt;sup&gt;c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2/47 (4%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Canada&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Wilson et al. (&lt;xref ref-type="bibr" rid="bibr86"&gt;2013&lt;/xref&gt;)&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;80 ASD&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;61 ASD&lt;sup&gt;c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12/19 (63%) ASD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Europe&lt;/p&gt;&lt;/td&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>SCD</emph> social communication disorder; <emph>N/A</emph> not applicable <sups>a</sups>Study included in previous literature review <sups>b</sups>The abbreviation of "ASD" under DSM-IV-TR refers to group of three diagnoses under the autism spectrum: Autistic Disorder (AD), Asperger's Disorder, and Pervasive Developmental Disorder-not otherwise specified (PDD-NOS), and "ASD" under DSM-5 refers to a diagnosis of Autism Spectrum Disorder <sups>c</sups>Study used draft instead of final published DSM-5 criteria to diagnose ASD <sups>d</sups>One participant met DSM-5 but not DSM-IV-TR ASD criteria</p> <hd id="AN0143506764-18">DSM-5 Sensitivity and Specificity</hd> <p>Seven studies reported the sensitivity and specificity of DSM-5 diagnostic criteria with ADI-R and/or ADOS. Of three studies that used both the ADI-R and ADOS (Barton et al. [<reflink idref="bib7" id="ref191">7</reflink>]; Christiansz et al. [<reflink idref="bib13" id="ref192">13</reflink>]; Sung et al. [<reflink idref="bib73" id="ref193">73</reflink>]), sensitivity and specificity values ranged from 0.84 to 0.93 and 0.54 to 0.83, respectively. For two studies that used the ADI-R alone (Magana and Vanegas [<reflink idref="bib43" id="ref194">43</reflink>]; Solerdelcoll Arimany et al. [<reflink idref="bib70" id="ref195">70</reflink>]), the sensitivity range was reported between 0.88 and 0.90 while the specificity range was between 0.57 and 0.86. The remaining two studies used the ADOS alone (Dawkins et al. [<reflink idref="bib14" id="ref196">14</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref197">46</reflink>]); the sensitivity range was 0.89 to 1.00 and the specificity range was 0.71 to 0.99.</p> <hd id="AN0143506764-19">Quantitative Synthesis</hd> <p>Results of the meta-analyses are provided in Figs. 3, 4, and 5. Data from 33 studies which examined changes in DSM-IV-TR ASD diagnosis when DSM-5 criteria were applied were pooled and represent data from 18,648 individuals. Using a random effects model, the pooled proportion suggests a 20.8% [95% confidence interval (CI) 16.0–26.7, <emph>p</emph> &lt; 0.001] reduction in ASD diagnoses (Cochran's Q = 1454.9, <emph>p</emph> &lt; 0.001; I<sups>2</sups> = 97.8) when DSM-5 criteria were applied (Fig. 3).</p> <p>Graph: Fig. 3 Forest plots of the 33 studies included studies representing the proportion of individuals who met criteria for an Autism Spectrum Disorder (ASD) diagnosis under DSM-IV-TR but not for DSM-5 ASD. Squares represent effect sizes of individual studies with extended lines denoting 95% confidence intervals. Sizes of squares indicate the weight of each study based on sample size using random effects analysis. The diamond represents the estimated pooled effect size</p> <p>Graph: Fig. 4 Forest plots of Autistic Disorder (top), Asperger's Disorder (middle), and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) (bottom) representing the proportion of individuals who met criteria for diagnosis under DSM-IV-TR criteria but not for DSM-5 Autism Spectrum Disorder. Squares represent effect sizes of individual studies with extended lines denoting 95% confidence intervals. Sizes of squares indicate the weight of each study based on sample size using random effects analysis. The diamond represents the estimated pooled effect size</p> <p>Graph: Fig. 5 Forest plot of Social Communication Disorder (SCD) representing the proportion of individuals who met criteria for an Autism Spectrum Disorder (ASD) diagnosis under DSM-IV-TR criteria but not for DSM-5 and instead met the criteria for an alternative diagnosis of SCD. Squares represent effect sizes of individual studies with extended lines denoting 95% confidence intervals. Sizes of squares indicate the weight of each study based on sample size using random effects analysis. The diamond represents the pooled effect size</p> <p>Figure 4 presents the pooled analyses that examined DSM-IV-TR diagnoses of AD, Asperger's Disorder, and PDD-NOS when DSM-5 criteria were applied. Nineteen of 33 studies examined these subtypes: AD was examined in 17 studies with data representing 1285 individuals; Asperger's Disorder was examined in 14 studies with data representing 387 individuals; and PDD-NOS was examined in 18 studies with data representing 519 individuals. Pooled effects suggest statistically significant reductions in ASD diagnoses of 10.1% (95% CI 6.2–16.0, <emph>p</emph> &lt; 0.001) for those with AD (Cochran's Q = 90.9, <emph>p</emph> &lt; 0.001, I<sups>2</sups> = 82.4) and 23.3% (95% CI 12.9–38.5, <emph>p</emph> = 0.001) for those with Asperger's Disorder (Cochran's Q = 65.4, <emph>p</emph> &lt; 0.001, I<sups>2</sups> = 80.1) when DSM-5 criteria were applied. The reduction in diagnoses for PDD-NOS was not statistically significant [46.1% (95% CI 34.6–58.0), <emph>p</emph> = 0.52] (Cochran's Q = 80.3, <emph>p</emph> &lt; 0.001; I<sups>2</sups> = 78.8). For all models, heterogeneity was greater than expected by chance alone.</p> <p>Figure 5 provides the pooled analysis that examined the number of individuals who met DSM-IV-TR ASD diagnosis but would not meet DSM-5 criteria and instead would qualify for an alternative diagnosis of SCD; these include data from nine studies representing 556 individuals. While the finding did not achieve statistical significance, the pooled effect suggests that less than one-third [28.8% (95% CI 13.9–50.5), <emph>p</emph> = 0.06] of those who met DSM-IV-TR ASD diagnostic criteria but not DSM-5 would meet SCD diagnostic criteria. Heterogeneity was greater than expected by chance alone (Cochran's Q = 57.5, <emph>p</emph> &lt; 0.001, I<sups>2</sups> = 86.1). Although four of the studies that examined the impact of SCD used the draft version of DSM-5 ASD diagnostic criteria, there were no statistical differences between those and the five studies which used the final version of the criteria.</p> <hd id="AN0143506764-20">Subgroup Analyses</hd> <p>Table 3 presents results of subgroup analyses for ASD and the AD and Asperger's subtypes. Of 10 variables explored, six were found to contribute to heterogeneity: age group (all models); continent where study was conducted (ASD); instruments administered to make the diagnosis (AD); clinician who made the diagnosis (all models); study funding sources (ASD and AD); and one risk of bias criterion – measures of intra and inter-rater agreement (ASD).</p> <p>Subgroup analyses</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;&lt;p&gt;Variable&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;All studies&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Autistic Disorder&lt;/p&gt;&lt;/th&gt;&lt;th align="left" colspan="2"&gt;&lt;p&gt;Asperger's Disorder&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;# Studies&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Pooled result (%) (95% CI)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;# Studies&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Pooled result (%) (95% CI)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;# Studies&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Pooled result (%) (95% CI)&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Study sample age&lt;sup&gt;a,b,c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Young children &amp;#60; 5 years&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;17.2 (8.7, 31.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10.6 (6.3, 17.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.8 (0.1, 23.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Young (&amp;#60; 5 years) and older children (5&amp;#8211;18 years)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;20.3 (13.2, 30.0)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7.5 (4.1, 13.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29.2 (9.9, 61.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Children (5&amp;#8211;19 years)&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;21.7 (14.5, 31.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.2 (2.7, 45.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.4 (5.3, 37.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Children and adults&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;36.4 (6.6, 82.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1.6 (0.1, 21.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Adults only&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;49.2 (6.2, 93.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.0 (0.3, 47.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;39.2 (1.7, 96.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; All ages&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;18.7 (8.3, 36.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;26.3 (17.7, 37.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43.9 (35.1, 53.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Age not reported&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;5.9 (5.1, 6.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Continent&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; North America&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;16&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;21.6 (14.9, 30.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9.8 (4.5, 20.0)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.2 (6.2, 46.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Europe&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;29.2 (13.9, 51.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11.9 (1.9, 49.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;29.0 (6.7, 70.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Asia&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;15.9 (10.1, 24.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.7 (2.3, 13.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16.9 (6.1, 39.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Australia&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;26.4 (13.3, 45.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.7 (8.6, 35.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43.9 (35.1, 53.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Not reported&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;5.9 (5.1, 6.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Study design&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Prospective&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;18&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;25.5 (18.5, 33.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12.8 (6.0, 25.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31.2 (15.8, 52.2)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Retrospective&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;15&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;16.8 (12.2, 22.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8.1 (4.6, 13.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.6 (6.3, 27.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Instruments&lt;sup&gt;b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; ADI-R and ADOS&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;16.4 (10.8, 24.0)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3.9 (1.3, 11.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;17.4 (2.6, 62.8)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; ADI-R&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;14.9 (4.3, 40.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;21.1 (9.6, 40.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.8 (2.2, 72.8)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; ADOS&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;11.0 (6.0, 19.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5.5 (2.8, 10.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;25.8 (13.2, 44.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Other&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;14&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;29.8 (18.6, 44.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.6 (10.1, 34.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.1 (6.9, 57.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Not reported&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;18.8 (17.9, 19.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;--&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Clinician type&lt;sup&gt;a,b,c&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; MD&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;34.0 (15.2, 59.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.8 (6.4, 61.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;44.6 (15.9, 77.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;28.1 (17.6, 41.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;21.3 (11.8, 35.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;43.9 (35.1, 53.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; MD or PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;28.1 (22.3, 34.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13.4 (8.6, 20.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Both MD and PhD/PsyD&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;9&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;11.9 (8.7, 16.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.8 (2.8, 8.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;15.0 (7.2, 28.9)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Not reported&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;14&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;22.7 (15.1, 32.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4.6 (1.9, 10.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;16.0 (2.1, 62.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;DSM-5 criteria version&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Draft&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;28.0 (19.6, 38.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;18.1 (9.3, 32.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;24.9 (5.8, 63.8)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Final&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;26&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;18.9 (13.8, 25.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;13&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;7.8 (4.1, 14.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;11&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;22.6 (10.4, 42.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Funding source&lt;sup&gt;a,b&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Both federal and non-federal&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;11.3 (6.4, 19.0)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;2.7 (1.5, 4.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;14.2 (6.2, 29.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Federal only&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;14.3 (7.8, 24.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;12.8 (9.1, 17.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;2.8 (0.2, 32.2)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Non-federal only&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;22.9 (16.9, 30.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;5.0 (0.3, 47.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;9.1 (2.3, 30.0)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; No funding reported&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;18&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;28.8 (21.9, 36.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;15.1 (8.2, 26.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;31.4 (16.5, 51.5)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Risk of bias&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Blinded to reference standard&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Low risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;3&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;11.1 (5.9, 19.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;4.9 (2.6, 8.9)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;18.3 (2.7, 64.9)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Unclear risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;16&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;22.2 (13.8, 33.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;12.0 (7.1, 19.5)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;26.3 (10.4, 52.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; High risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;14&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;21.5 (15.2, 29.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;9.1 (3.0, 24.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;20.5 (6.5, 49.1)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Order of examination varied&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Low risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;22.9 (4.6, 64.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;9.7 (1.0, 53.8)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;2&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;32.7 (13.9, 59.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Unclear risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;20&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;20.9 (15.0, 28.3)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;10.6 (8.0, 14.1)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;22.7 (8.8, 47.3)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; High risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;11&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;19.5 (10.6, 33.0)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;8.6 (2.0, 29.7)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;6&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;17.7 (4.5, 49.4)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Statistical measures&lt;/italic&gt;&lt;italic&gt;of agreement&lt;/italic&gt;&lt;sup&gt;a&lt;/sup&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td char="(" align="char" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="(" align="left" /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Low risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;8&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;17.1 (10.1, 27.4)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;8.6 (2.2, 28.2)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;4&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;18.9 (6.7, 42.8)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; Unclear risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;1&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;36.0 (30.8, 41.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;&amp;#8211;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt; High risk&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;24&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="char"&gt;&lt;p&gt;22.1 (16.7, 28.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;12&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;10.8 (6.4, 17.6)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;10&lt;/p&gt;&lt;/td&gt;&lt;td char="(" align="left"&gt;&lt;p&gt;25.8 (10.5, 50.8)&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>MD</emph> physicians (e.g., child psychiatrists, behavioral pediatricians); <emph>PhD/PsyD</emph> psychologists; <emph>Both MD and PhD/PsyD</emph> teams of physicians and psychologists <sups>a</sups>Variable contributing to heterogeneity (p &lt; 0.05) in all studies <sups>b</sups>Variable contributing to heterogeneity (p &lt; 0.05) in Autistic disorder <sups>c</sups>Variable contributing to heterogeneity (p &lt; 0.05) in Asperger's disorder</p> <hd id="AN0143506764-21">Publication Bias</hd> <p>Figure 6 displays the funnel plot representing differences in the proportion of those diagnosed with ASD using DSM-IV-TR versus DSM-5 criteria for all studies. The open circles indicate each of the 33 individual studies. The upper portion of the funnel plot displays symmetry. The three circles on the lower left side represent studies with small sample sizes and do not represent a major concern. Findings of the Classic fail-safe N test suggests that an additional 7765 studies would need to be added to significantly change the pooled effect. Funnel plots for the subtypes AD and Asperger's Disorder are found online in Appendix 3; findings of the Classic fail-safe N test suggest that an additional 1455 and 135 studies, respectively, would need to be added to significantly change the pooled effect. The funnel plot for SCD is found online in Appendix 4; findings of the Classic fail-safe N test suggests that an additional 89 studies would need to be added to significantly change the pooled effect. The filled circle represents a study estimated to be missing from the analysis.</p> <p>Graph: Fig. 6 Funnel plot represents differences in proportion of those diagnosed with ASD using DSM-5 versus DSM-IV-TR criteria. Plot shows the standard error of the difference in proportion (Y axis) versus the reported percent not captured by DSM-5 (X axis) using a random effects model. The vertical line indicates the pooled effect estimate. The open circles indicate each of the 33 individual studies included in the meta-analysis. The open diamond indicates the pooled effect size and 95% confidence interval for meta-analysis, and the filled diamond indicates pooled effect size and 95% confidence interval when missing studies suggested by publication bias analysis are included</p> <hd id="AN0143506764-22">Discussion</hd> <p></p> <hd id="AN0143506764-23">Current Study Findings</hd> <p>Despite advances in understanding pathophysiology in ASD, it remains a behaviorally defined clinical syndrome. As such, the diagnosis is often based on several variables including the parental historical presentation of concerns, demonstration of such behaviors during evaluations, clinical providers' experience, rating instruments, and final determination based on clinically agreed upon diagnostic guidelines set forth by the DSM. Revisions in updated DSM classification may change an individual's diagnosis. In reviewing studies published in the five years since publication of the DSM-5, which has more stringent criteria required for an ASD diagnosis, our study findings indicate that a significant number of individuals who qualified for a DSM-IV-TR ASD diagnosis would not meet DSM-5 criteria. With more than one-fifth of individuals with notable SCI difficulties coupled with disruptive RRBs who will no longer qualify for an ASD diagnosis, clinicians, researchers, and public health officials need to recognize that there are individuals lacking a diagnosis but remain in need of services. Early diagnosis and intensive treatment has been linked to improvement across many domains in autism (Reichow et al. [<reflink idref="bib55" id="ref198">55</reflink>]; Rogers [<reflink idref="bib59" id="ref199">59</reflink>]; Salomone et al. [<reflink idref="bib61" id="ref200">61</reflink>]; Schreibman et al. [<reflink idref="bib63" id="ref201">63</reflink>]); however, a recent study examining treatment patterns of ASD among children using nationally representative data found that nearly 30% of US children with ASD are not receiving behavioral or medication treatment (Xu et al. [<reflink idref="bib89" id="ref202">89</reflink>]). A variety of therapies provided by the board of education and insurance carriers are often limited based upon an ASD diagnosis and/or clearly defined developmental delays (Candon et al. [<reflink idref="bib11" id="ref203">11</reflink>]; Turcotte et al. [<reflink idref="bib79" id="ref204">79</reflink>]). Acknowledging their need for treatment, clinicians may be providing ASD diagnoses in addition to other comorbidities, which are common in children with ASD, notably attention-deficit hyperactivity disorder (ADHD), obsessive compulsive behaviors, mood disorders, sensory processing issues, or anxiety (Belardinelli et al. [<reflink idref="bib9" id="ref205">9</reflink>]; Ford [<reflink idref="bib20" id="ref206">20</reflink>]; Soke et al. [<reflink idref="bib69" id="ref207">69</reflink>]).</p> <p>ADDM Network data also continue to demonstrate that ASD prevalence rates are rising even with tightened DSM-5 diagnostic criteria. If true positive diagnoses are actually increasing, parental awareness and acceptance, less stigmatization, better trained clinicians, more thorough data collection methods, and even increasing genetic tendencies could be contributing factors. In addition, comorbid diagnoses are now allowable for ASD under DSM-5, enabling clinicians to give multiple comorbid diagnoses of intellectual disability, ASD, and ADHD, which could also explain why ASD rates have continued to rise since publication of the DSM-5.</p> <p>It is notable that findings from this current systematic literature review and meta-analysis indicate a smaller decrease in ASD diagnoses when comparing DSM-IV-TR to DSM-5 as compared to all earlier reviews. Additionally, all studies which examined DSM-IV-TR ASD subtypes were also found to have smaller decreases in ASD diagnosis when comparing DSM-IV-TR to DSM-5 as compared with the first review. This may be because clinicians now have a greater comfort level with interpreting DSM-5 criteria. It could also indicate that fewer individuals are failing to receive an ASD diagnosis than what previous studies anticipated. Nevertheless, these findings do show that approximately one in five individuals who would have received an ASD diagnosis under DSM-IV-TR would not receive a diagnosis under DSM-5 with only a minority being alternatively captured by SCD. Most recent ADDM Network data show a continued increase in prevalence of ASD; however, the majority of children included in the last data reported from surveillance year 2014 were diagnosed under DSM-IV-TR criteria (Baio et al. [<reflink idref="bib5" id="ref208">5</reflink>]). It will be important to examine the next release of ADDM Network data on autism rates, which is anticipated to be based solely on children diagnosed with DSM-5 criteria; considering the findings of our meta-analyses, we would predict there may be a decrease in autism rates reported. Regardless of whether ASD prevalence rates are on an upward or downward trend, the potential numbers of individuals who may have been previously eligible for a DSM-IV-TR diagnosis of ASD but would not qualify under DSM-5 as reported by this study remains alarming and points to a need for continued research on this topic.</p> <p>Autism remains a behaviorally defined clinical disorder set forth by a multitude of clinicians experienced in caring for this population. These clinical criteria remain diagnostic despite the emergence of biomarkers in blood (Smith et al. [<reflink idref="bib67" id="ref209">67</reflink>]) and saliva (Hicks et al. [<reflink idref="bib26" id="ref210">26</reflink>]) samples, in addition to neuroimaging (Bi et al. [<reflink idref="bib10" id="ref211">10</reflink>]; Li et al. [<reflink idref="bib39" id="ref212">39</reflink>]; Shen et al. [<reflink idref="bib64" id="ref213">64</reflink>]; Zhao et al. [<reflink idref="bib95" id="ref214">95</reflink>]) and electrophysiological (Levin et al. [<reflink idref="bib37" id="ref215">37</reflink>]; Muhle et al. [<reflink idref="bib49" id="ref216">49</reflink>]; Righi et al. [<reflink idref="bib58" id="ref217">58</reflink>]) profiles. Moreover, the use of diagnostic tools to support or refute ASD diagnosis are often created and validated in homogeneous autism cohorts, such as male-dominant groups (Halladay et al. [<reflink idref="bib23" id="ref218">23</reflink>]). There is increasing awareness that females are likely being under- or misdiagnosed with ASD for numerous reasons, including ascertainment bias, differential presentation with more SCI deficits and less RRBs, and a role for a female protective effect which may alter the endophenotype (Goldman [<reflink idref="bib21" id="ref219">21</reflink>]; Jacquemont et al. [<reflink idref="bib30" id="ref220">30</reflink>]; Lai et al. [<reflink idref="bib36" id="ref221">36</reflink>]; Volkmar et al. [<reflink idref="bib83" id="ref222">83</reflink>]). Moreover, autism is being recognized and accepted in black, Hispanic, and other non-Caucasian individuals (Baio et al. [<reflink idref="bib5" id="ref223">5</reflink>]; Singh and Bunyak [<reflink idref="bib66" id="ref224">66</reflink>]).</p> <p>Another question remains regarding who should assign the autism diagnosis. An individual may see a medical doctor, including a psychiatrist, developmental pediatrician, or neurologist, or they may see a psychologist. The use of different tools may aid in diagnosis. Interestingly, where both MDs and PhD/PsyDs were involved in the diagnosis there was the lowest decrease in ASD diagnosis rates between DSM-IV-TR and DSM-5. This would suggest a multidisciplinary evaluation may have more specificity in initial diagnosis than a single provider. An earlier diagnosis is crucial to identify the need for early intensive behavioral interventions which have been proven as the mainstay of ASD treatment (Dawson [<reflink idref="bib15" id="ref225">15</reflink>]; Orinstein et al. [<reflink idref="bib53" id="ref226">53</reflink>]; Weitlauf et al. [<reflink idref="bib84" id="ref227">84</reflink>]).</p> <hd id="AN0143506764-24">Findings of Other Prior Reviews and Meta-Analyses Versus Current Study Findings</hd> <p>The change in ASD diagnostic criteria with introduction of the DSM-5 has been of great interest to the public as well as clinicians and researchers. Three prior systematic literature reviews have studied the impact of the changes in DSM-5 ASD diagnosis criteria on autism rates (Kulage et al. [<reflink idref="bib35" id="ref228">35</reflink>]; Smith et al. [<reflink idref="bib68" id="ref229">68</reflink>]; Sturmey and Dalfern [<reflink idref="bib71" id="ref230">71</reflink>]). Table 4 summarizes the findings of these previous systematic reviews in comparison to the current study. All prior reviews were published within a period of less than two years after publication of the DSM-5 with 56% of the included studies being duplicative at the time of the third review (Smith et al. [<reflink idref="bib68" id="ref231">68</reflink>]). While general findings were consistent across studies, the estimated reduction in ASD rates under DSM-5 criteria varied widely across included studies, ranging from 7 to 62%. Only one previous study included a meta-analysis, reporting a pooled decrease of 31% in ASD across studies (Kulage et al. [<reflink idref="bib35" id="ref232">35</reflink>]). The current five-year follow-up study includes a large number of studies published since April 2013 with only nine being duplicative of articles included in previous reviews. Comparing current study findings for estimated ASD reduction to the first review, the pooled decrease is smaller (20.8% vs. 31%) but remains a concern.</p> <p>Summary of findings of systematic reviews examining the effects of DSM-5 criteria on the number of individuals diagnosed with ASD</p> <p> <ephtml> &lt;table frame="hsides" rules="groups"&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;&lt;p&gt;Study&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;Study type&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;No. of articles&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;No. of duplicate articles included in prior reviews (%)&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;% Reduction in ASD diagnoses under DSM-5&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;No. of articles that included DSM-IV-TR ASD subtypes&lt;/p&gt;&lt;/th&gt;&lt;th align="left"&gt;&lt;p&gt;% Reduction in ASD diagnoses by subtypes&lt;/p&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Kulage et al. (&lt;xref ref-type="bibr" rid="bibr35"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Systematic Review with Meta-Analysis&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;14&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;N/A&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;31% &lt;italic&gt;(95% CI 20&amp;#8211;44)&lt;/italic&gt; pooled decrease across studies, &lt;italic&gt;p&lt;/italic&gt; = 0.006&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;7&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Pooled results: 22% AD, &lt;italic&gt;p&lt;/italic&gt; &amp;#60; 0.001 70% Asperger's, &lt;italic&gt;p&lt;/italic&gt; = 0.38 70% PDD-NOS, &lt;italic&gt;p&lt;/italic&gt; = 0.01&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Sturmey and Dalfern (&lt;xref ref-type="bibr" rid="bibr71"&gt;2014&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Systematic Review&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;12&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;9 (75%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;36.97% median overall reduction across studies; range = 7% &amp;#8722; 54%&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;5&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;19.35% median reduction in more impaired group (i.e., AD); range = 0% &amp;#8722; 26.3%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;Pooled analysis not conducted&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td align="left"&gt;&lt;p&gt;71.27% median reduction in less impaired group (i.e., Asperger's and PDD-NOS); range = 16.6% &amp;#8722; 100%&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left"&gt;&lt;p&gt;Pooled result not conducted&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;Smith et al. (&lt;xref ref-type="bibr" rid="bibr68"&gt;2015&lt;/xref&gt;)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Systematic Review&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;25&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;14 (56%)&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;Reduction ranged between 10% and 62% across studies; 8 studies (32%) reported ranges exceeding 40%&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;13&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;1%&amp;#8722;31% AD&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left"&gt;&lt;p&gt;Pooled analysis not conducted&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char" /&gt;&lt;td align="left"&gt;&lt;p&gt;0%&amp;#8211;44% Asperger's&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left"&gt;&lt;p&gt;0%&amp;#8211;50% PDD-NOS&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left" /&gt;&lt;td align="left" /&gt;&lt;td char="." align="char" /&gt;&lt;td align="left"&gt;&lt;p&gt;Pooled analysis not conducted&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Current follow-up study&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Systematic review with meta-analysis&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&lt;italic&gt;33&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;9 (27%)&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;20.8% (95% CI 16&amp;#8211;27) pooled decrease across studies, p&lt;/italic&gt; &amp;#60; &lt;italic&gt;0.001&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td char="." align="char"&gt;&lt;p&gt;&lt;italic&gt;19&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;td align="left"&gt;&lt;p&gt;&lt;italic&gt;Pooled results: 10.1% AD, p&lt;/italic&gt; &amp;#60; &lt;italic&gt;0.001, 23.3% Asperger's, p&lt;/italic&gt; = &lt;italic&gt;0.001, 46.1% PDD-NOS, p&lt;/italic&gt; = &lt;italic&gt;0.52&lt;/italic&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p> <emph>ASD</emph> autism spectrum disorder; <emph>CI</emph> confidence interval; <emph>AD</emph> autistic disorder; <emph>PDD-NOS</emph> pervasive developmental disorder-not otherwise specified</p> <p>The number of studies included in the three previous systematic literature reviews which examined the impact of the DSM-5 diagnostic criteria on DSM-IV-TR ASD subtypes ranged from five to 13 studies. Across reviews, findings were consistent that the most affected subtype would be PDD-NOS, followed closely by Asperger's Disorder, with AD being the least impacted. Comparing current study findings for estimated reductions in diagnoses by subtype with that of the first review, reductions are less for AD (10.1% vs. 22%) and Asperger's (23.3% vs. 70%); while statistical significance was not achieved, the reduction for PDD-NOS was also less than previously reported (46.1% vs. 70%) (Kulage et al. [<reflink idref="bib35" id="ref233">35</reflink>]). Again, this trend may be reflected in the next release of ADDM Network data (Baio et al. [<reflink idref="bib5" id="ref234">5</reflink>]).</p> <hd id="AN0143506764-25">Social Communication Disorder</hd> <p>In the first review on this topic, 4 of 14 studies (29%) examined the impact of SCD and its potential to capture individuals with a DSM-IV-TR ASD diagnosis but who would not receive a DSM-5 ASD diagnosis (Kulage et al. [<reflink idref="bib35" id="ref235">35</reflink>]). Based on its intended purpose, it is surprising that five years later only five studies captured in the current review examined the potential impact of SCD; we expected to find a substantially higher number of studies exploring the impact of this new DSM-5 diagnosis. Importantly, when examining all nine studies that looked at SCD diagnoses, less than one-third (28.8%) of individuals who did not retain their ASD diagnosis under DSM-5 criteria would qualify for an SCD diagnosis. This is concerning and provides the only data combining results from multiple studies in the literature to date that SCD does not seem to be fulfilling its purpose as a "catch all" or alternative diagnosis for individuals who would have had an ASD diagnosis under DSM-IV-TR but not under DSM-5 criteria. Surprisingly, the PDD-NOS subtype—which was originally targeted by the SCD diagnosis – seems to be the subtype least likely to obtain an alternative SCD diagnosis (only 40% captured); however, across studies that examined DSM-IV-TR subtypes, the subtype sample sizes were small, limiting the scope of this finding. Discussion points in the studies which examined SCD emphasized two themes. Aligning with the results of this study, although SCD was originally described as an alternative diagnosis for individuals with symptoms of PDD-NOS but who would no longer have an autism diagnosis under DSM-5 criteria, it does not seem to be capturing a significant number of these individuals (Dickerson Mayes et al. [<reflink idref="bib16" id="ref236">16</reflink>]; Huerta et al. [<reflink idref="bib29" id="ref237">29</reflink>]; Mazurek et al. [<reflink idref="bib46" id="ref238">46</reflink>]; Ocakoglu et al. [<reflink idref="bib51" id="ref239">51</reflink>]; Wilson et al. [<reflink idref="bib86" id="ref240">86</reflink>]). Second, the few individuals who would receive SCD as an alternative diagnosis did not meet DSM-5 ASD criteria because of insufficient deficiencies in the RRB domain required for an ASD diagnosis (Huerta et al. [<reflink idref="bib29" id="ref241">29</reflink>]; Kim et al. [<reflink idref="bib32" id="ref242">32</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref243">52</reflink>]; Sumi et al. [<reflink idref="bib72" id="ref244">72</reflink>]; Taheri and Perry [<reflink idref="bib75" id="ref245">75</reflink>]).</p> <p>Considering these findings, although limited, further research is clearly needed to evaluate the impact of SCD as a diagnosis and the degree to which it captures individuals who fail to meet DSM-5 ASD criteria, particularly across DSM-IV-TR subtypes and for individuals with significant impairment imposed by RRBs. Currently, the need for SCD to function as an alternative diagnosis for ASD is unclear; while some studies have indicated that an SCD diagnosis could serve as another means of obtaining required treatment and services (Greaves-Lord et al. [<reflink idref="bib22" id="ref246">22</reflink>]; Kim et al. [<reflink idref="bib32" id="ref247">32</reflink>]; Ohashi et al. [<reflink idref="bib52" id="ref248">52</reflink>]), others have questioned this possibility (Dickerson Mayes et al. [<reflink idref="bib16" id="ref249">16</reflink>]; Smith et al. [<reflink idref="bib68" id="ref250">68</reflink>]). The inherent overlap in diagnostic criteria for ASD and SCD poses challenges for its recognition and use as a distinct disorder from ASD (Visser and Tops [<reflink idref="bib82" id="ref251">82</reflink>]). It is essential to view SCD as an independent diagnosis and recognize where it overlaps with ASD before its usefulness can be ascertained and tailored treatments can be developed. Future studies which measure SCD prevalence beyond applying the diagnosis to individuals who do not meet DSM-5 ASD criteria are warranted (Swineford et al. [<reflink idref="bib74" id="ref252">74</reflink>]). Further complicating the applicability of the diagnosis, five years after DSM-5 publication research is still being conducted to design standardized screening and/or diagnostic instruments for SCD (Baird and Norbury [<reflink idref="bib6" id="ref253">6</reflink>]; Norbury [<reflink idref="bib50" id="ref254">50</reflink>]; Visser and Tops [<reflink idref="bib82" id="ref255">82</reflink>]; Yuan and Dollaghan [<reflink idref="bib93" id="ref256">93</reflink>]). Overall, these issues add to the "ongoing debate regarding the validity of SCD as a diagnostic entity" (Visser and Tops [<reflink idref="bib82" id="ref257">82</reflink>]). Indeed, examination of SCD as a diagnosis, relative to other developmental communication disorders, is in its infancy, leaving its impact unknown. Exploring whether SCD is a legitimate diagnosis independent of ASD, as well as its potential to serve as a gateway for eligibility for treatment and services, are important areas for future research.</p> <hd id="AN0143506764-26">Limitations</hd> <p>The findings of this systematic literature review and meta-analysis must be interpreted with some caution. Overall, risk of bias of the included studies was moderate with potential bias stemming from lack of blinding of raters to results of the references standard, DSM-IV-TR diagnosis, and failure to assess interrater agreement in classification of DSM-5 diagnoses. While we took measures to conduct a rigorous systematic review, it has some limitations. Heterogeneity greater than expected by chance alone was present in each meta-analytic model. Six variables were identified that explained some of the heterogeneity; however, it is likely that additional unidentified factors also contributed to heterogeneity both within and between studies but were not explored. Finally, importance of the findings on SCD, which are the products of two separate but related systematic reviews, is limited by the small sample sizes across studies.</p> <hd id="AN0143506764-27">Conclusions</hd> <p>The diagnosis of ASD and the potential impact of SCD for those who do not meet criteria for an ASD diagnosis using DSM-5 criteria is evolving. Findings of this systematic review and meta-analysis provide further insight regarding how DSM-5 is being used both nationally and internationally since the release of the new diagnostic criteria and point to areas of future research, particularly for SCD.</p> <hd id="AN0143506764-28">Funding</hd> <p>This study was not supported by any type of external or grant funding.</p> <hd id="AN0143506764-29">Acknowledgments</hd> <p>This study is a follow-up systematic literature review and meta-analysis to Kulage, K. M., Smaldone, A. M., &amp; Cohn, E. G. (2014). How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. <emph>The Journal of Autism and Developmental Disorders, 44</emph>(<reflink idref="bib8" id="ref258">8</reflink>), 1918–1932, 10.1007/s10803-014-2065-2.</p> <hd id="AN0143506764-30">Author Contributions</hd> <p>KMK conceived of the study, participated in the design and coordination of the study, and drafted and revised the manuscript. JG conducted the initial literature search and JU updated the literature search; both coordinated the study workflow in Covidence, drafted part of the methods section, and revised the manuscript. DR participated in the design and coordination of the study, drafted the introduction, and revised the manuscript. JMB provided clinical context in interpretation of study findings, drafted part of the results and discussion sections, and revised the manuscript. AMS conceived of the study, participated in the design and coordination of the study, performed analyses, and drafted and revised the manuscript. KMK, JG, JU, DR, and AMS participated in the literature screening, quality appraisal, and data extraction. All authors read and approved the final manuscript.</p> <hd id="AN0143506764-31">Compliance with Ethical Standards</hd> <p></p> <hd id="AN0143506764-32">Conflict of interest</hd> <p>All authors declare they have no conflicts of interest.</p> <hd id="AN0143506764-33">Ethical Approval</hd> <p>This manuscript does not contain any studies with human participants or animals performed by any of the authors.</p> <hd id="AN0143506764-34">Electronic supplementary material</hd> <p>Below is the link to the electronic supplementary material.</p> <p>Graph: Supplementary material 1 (docx 82 KB)</p> <hd id="AN0143506764-35">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0143506764-36"> <title> References </title> <blist> <bibl id="bib1" idref="ref9" type="bt">1</bibl> <bibtext> Adak B, Halder S. Systematic review on prevalence for autism spectrum disorder with respect to gender and socio-economic status. Journal of Mental Disorders and Treatment. 2017; 3; 1: 133. 10.4172/2471-271X.1000133</bibtext> </blist> <blist> <bibl id="bib2" idref="ref3" type="bt">2</bibl> <bibtext> Diagnostic and statistical manual of mental disorders — fourth edition, text revison (DSM-IV-TR). 2000: Washington, DC; American Psychiatric Association</bibtext> </blist> <blist> <bibl id="bib3" idref="ref14" type="bt">3</bibl> <bibtext> Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). 2013: Washington, DC; American Psychiatric Association</bibtext> </blist> <blist> <bibl id="bib4" idref="ref27" type="bt">4</bibl> <bibtext> American Psychiatric Association. (2013b). Social (pragmatic) communication disorder. Retrieved from https://<ulink href="http://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA%5fDSM-5-Social-Communication-Disorder.pdf">www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA%5fDSM-5-Social-Communication-Disorder.pdf</ulink>.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref6" type="bt">5</bibl> <bibtext> Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, Dowling NF. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 Sites, United States, 2014. MMWR Surveillance Summary. 2018; 67; 6: 1-23. 10.15585/mmwr.ss6706a1</bibtext> </blist> <blist> <bibl id="bib6" idref="ref253" type="bt">6</bibl> <bibtext> Baird G, Norbury CF. Social (pragmatic) communication disorders and autism spectrum disorder. Archives of Disease in Childhood. 2016; 101; 8: 745-751. 10.1136/archdischild-2014-306944</bibtext> </blist> <blist> <bibl id="bib7" idref="ref68" type="bt">7</bibl> <bibtext> Barton ML, Robins DL, Jashar D, Brennan L, Fein D. Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. The Journal of Autism and Developmental Disorders. 2013; 43; 5: 1184-1195. 10.1007/s10803-013-1817-8</bibtext> </blist> <blist> <bibl id="bib8" idref="ref69" type="bt">8</bibl> <bibtext> Beighley JS, Matson JL, Rieske RD, Cervantes PE, Goldin R, Jang J. Differences in stereotypic behavior in adults diagnosed with autism spectrum disorders using the DSM-IV-TR and the DSM-5. Journal of Developmental and Physical Disabilities. 2014; 26; 2: 193-202. 10.1007/s10882-013-9356-y</bibtext> </blist> <blist> <bibl id="bib9" idref="ref205" type="bt">9</bibl> <bibtext> Belardinelli C, Raza M, Taneli T. Comorbid behavioral problems and psychiatric disorders in autism spectrum disorders. Journal of Childhood &amp; Developmental Disorders. 2016; 2; 2: 1-9. 10.4172/2472-1786.100019</bibtext> </blist> <blist> <bibtext> Bi XA, Liu Y, Jiang Q, Shu Q, Sun Q, Dai J. The diagnosis of autism spectrum disorder based on the random neural network cluster. Frontiers in Human Neuroscience. 2018; 12: 257. 10.3389/fnhum.2018.002576028564</bibtext> </blist> <blist> <bibtext> Candon MK, Barry CL, Epstein AJ, Marcus SC, Kennedy-Hendricks A, Xie M, Mandell DS. The differential effects of insurance mandates on health care spending for children's autism spectrum disorder. Medical Care. 2018; 56; 3: 228-232. 10.1097/mlr.00000000000008635811382</bibtext> </blist> <blist> <bibtext> Centers for Disease Control and Prevention. Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, 14 sites, United States, 2008. MMWR Surveillance Summary. 2012; 61; 3: 1-19</bibtext> </blist> <blist> <bibtext> Christiansz JA, Gray KM, Taffe J, Tonge BJ. Autism spectrum disorder in the DSM-5: Diagnostic sensitivity and specificity in early childhood. The Journal of Autism and Developmental Disorders. 2016; 46; 6: 2054-2063. 10.1007/s10803-016-2734-4</bibtext> </blist> <blist> <bibtext> Dawkins T, Meyer AT, Van Bourgondien ME. The relationship between the childhood autism rating scale: Second edition and clinical diagnosis utilizing the DSM-IV-TR and the DSM-5. The Journal of Autism and Developmental Disorders. 2016; 46; 10: 3361-3368. 10.1007/s10803-016-2860-z</bibtext> </blist> <blist> <bibtext> Dawson G. Early intensive behavioral intervention appears beneficial for young children with autism spectrum disorders. The Journal of Pediatrics. 2013; 162; 5: 1080-1081. 10.1016/j.jpeds.2013.02.049</bibtext> </blist> <blist> <bibtext> Dickerson Mayes S, Black A, Tierney CD. DSM-5 under-identified PDDNOS: Diagnostic agreement between the DSM-5, DSM-IV, and checklist for autism spectrum disorder. Research in Autism Spectrum Disorders. 2013; 7; 2: 298-306. 10.1016/j.rasd.2012.08.011</bibtext> </blist> <blist> <bibtext> Elsabbagh Mayada, Divan Gauri, Koh Yun-Joo, Kim Young Shin, Kauchali Shuaib, Marcín Carlos, Montiel-Nava Cecilia, Patel Vikram, Paula Cristiane S, Wang Chongying, Yasamy Mohammad Taghi, Fombonne Eric. Global Prevalence of Autism and Other Pervasive Developmental Disorders. Autism Research. 2012; 5; 3: 160-179. 10.1002/aur.239</bibtext> </blist> <blist> <bibtext> Foley-Nicpon M, Fosenburg SL, Wurster KG, Assouline SG. Identifying high ability children with DSM-5 autism spectrum or social communication disorder: Performance on autism diagnostic instruments. The Journal of Autism and Developmental Disorders. 2017; 47; 2: 460-471. 10.1007/s10803-016-2973-4</bibtext> </blist> <blist> <bibtext> Fombonne E, Quirke S, Hagen A. Prevalence and interpretation of recent trends in rates of pervasive developmental disorders. McGill Journal of Medicine. 2009; 12; 2: 732997266</bibtext> </blist> <blist> <bibtext> Ford LMing SX, Pletcher BA. Co-occurrence of psychiatric disorders in individuals with autism spectrum disorders. Navigating the medical maze with a child with autism spectrum disorder. 2014: London; Jessica Kingsley Publishers: 36-49</bibtext> </blist> <blist> <bibtext> Goldman S. Opinion: Sex, gender and the diagnosis of autism—a biosocial view of the male preponderance. Research in Autism Spectrum Disorders. 2013; 7; 6: 675-679. 10.1016/j.rasd.2013.02.0063655776</bibtext> </blist> <blist> <bibtext> Greaves-Lord Kirstin, Eussen Mart L. J. M, Verhulst Frank C, Minderaa Ruud B, Mandy William, Hudziak James J, Steenhuis Mark Peter, de Nijs Pieter F, Hartman Catharina A. Empirically Based Phenotypic Profiles of Children with Pervasive Developmental Disorders: Interpretation in the Light of the DSM-5. Journal of Autism and Developmental Disorders. 2012; 43; 8: 1784-1797. 10.1007/s10803-012-1724-4</bibtext> </blist> <blist> <bibtext> Halladay, A. K, Bishop, S, Constantino, J. N, Daniels, A. M, Koenig, K, Palmer, K, ... Szatmari, P. (2015). Sex and gender differences in autism spectrum disorder: Summarizing evidence gaps and identifying emerging areas of priority. Molecular Autism, 6, 36. 10.1186/s13229-015-0019-y.</bibtext> </blist> <blist> <bibtext> Harstad EB, Fogler J, Sideridis G, Weas S, Mauras C, Barbaresi WJ. Comparing diagnostic outcomes of autism spectrum disorder using DSM-IV-TR and DSM-5 criteria. The Journal of Autism and Developmental Disorders. 2015; 45; 5: 1437-1450. 10.1007/s10803-014-2306-4</bibtext> </blist> <blist> <bibtext> Helles A, Gillberg CI, Gillberg C, Billstedt E. Asperger syndrome in males over two decades: Stability and predictors of diagnosis. Journal of Child Psychology and Psychiatry. 2015; 56; 6: 711-718. 10.1111/jcpp.12334</bibtext> </blist> <blist> <bibtext> Hicks SD, Rajan AT, Wagner KE, Barns S, Carpenter RL, Middleton FA. Validation of a salivary RNA test for childhood autism spectrum disorder. Frontiers in Genetics. 2018; 9: 534. 10.3389/fgene.2018.005346237842</bibtext> </blist> <blist> <bibtext> Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327; 7414: 557-560. 10.1136/bmj.327.7414.557192859</bibtext> </blist> <blist> <bibtext> Hiller RM, Young RL, Weber N. Sex differences in autism spectrum disorder based on DSM-5 criteria: evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology. 2014; 42; 8: 1381-1393. 10.1007/s10802-014-9881-x24882502</bibtext> </blist> <blist> <bibtext> Huerta M, Bishop SL, Duncan A, Hus V, Lord C. Application of DSM-5 criteria for autism spectrum disorder to three samples of children with DSM-IV diagnoses of pervasive developmental disorders. The American Journal of Psychiatry. 2012; 169; 10: 1056-1064. 10.1176/appi.ajp.2012.120202766003412</bibtext> </blist> <blist> <bibtext> Jacquemont Sébastien, Coe Bradley P, Hersch Micha, Duyzend Michael H, Krumm Niklas, Bergmann Sven, Beckmann Jacques S, Rosenfeld Jill A, Eichler Evan E. A Higher Mutational Burden in Females Supports a "Female Protective Model" in Neurodevelopmental Disorders. The American Journal of Human Genetics. 2014; 94; 3: 415-425. 10.1016/j.ajhg.2014.02.001</bibtext> </blist> <blist> <bibtext> Jashar DT, Brennan LA, Barton ML, Fein D. Cognitive and adaptive skills in toddlers who meet criteria for autism in DSM-IV but not DSM-5. The Journal of Autism and Developmental Disorders. 2016; 46; 12: 3667-3677. 10.1007/s10803-016-2901-7</bibtext> </blist> <blist> <bibtext> Kim YS, Fombonne E, Koh YJ, Kim SJ, Cheon KA, Leventhal BL. A comparison of DSM-IV pervasive developmental disorder and DSM-5 autism spectrum disorder prevalence in an epidemiologic sample. American Academy of Child &amp; Adolescent Psychiatry. 2014; 53; 5: 500-508. 10.1016/j.jaac.2013.12.021</bibtext> </blist> <blist> <bibtext> Kogan Michael D, Vladutiu Catherine J, Schieve Laura A, Ghandour Reem M, Blumberg Stephen J, Zablotsky Benjamin, Perrin James M, Shattuck Paul, Kuhlthau Karen A, Harwood Robin L, Lu Michael C. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics. 2018; 142; 6: e20174161. 10.1542/peds.2017-4161</bibtext> </blist> <blist> <bibtext> Konst MJ, Matson JL, Goldin R, Rieske R. How does ASD symptomology correlate with ADHD presentations?. Research in Developmental Disabilities. 2014; 35; 9: 2252-2259. 10.1016/j.ridd.2014.05.017</bibtext> </blist> <blist> <bibtext> Kulage KM, Smaldone AM, Cohn EG. How will DSM-5 affect autism diagnosis? A systematic literature review and meta-analysis. The Journal of Autism and Developmental Disorders. 2014; 44; 8: 1918-1932. 10.1007/s10803-014-2065-2</bibtext> </blist> <blist> <bibtext> Lai MC, Lombardo MV, Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry. 2015; 54; 1: 11-24. 10.1016/j.jaac.2014.10.0034284309</bibtext> </blist> <blist> <bibtext> Levin AR, Varcin KJ, O'Leary HM, Tager-Flusberg H, Nelson CA. EEG power at 3 months in infants at high familial risk for autism. Journal of Neurodevelopmental Disorders. 2017; 9; 1: 34. 10.1186/s11689-017-9214-95598007</bibtext> </blist> <blist> <bibtext> Levy SE, Mandell DS, Schultz RT. Autism. Lancet. 2009; 374; 9701: 1627-1638. 10.1016/s0140-6736(09)61376-32863325</bibtext> </blist> <blist> <bibtext> Li G, Liu M, Sun Q, Shen D, Wang L. Early diagnosis of autism disease by multi-channel CNNs. Machine Learning in Medical Imaging. 2018; 11046: 303-309. 10.1007/978-3-030-00919-9_35</bibtext> </blist> <blist> <bibtext> Lucas N, Macaskill P, Irwig L, Bogduk N. The development of a quality appraisal tool for studies of diagnostic reliability (QAREL). Journal of Clinical Epidemiology. 2010; 63; 8: 854-861. 10.1016/j.jclinepi.2009.10.002</bibtext> </blist> <blist> <bibtext> Lucas N, Macaskill P, Irwig L, Moran R, Rickards L, Turner R, Bogduk N. The reliability of a quality appraisal tool for studies of diagnostic reliability (QAREL). BMC Medical Research Methodology. 2013; 13: 111. 10.1186/1471-2288-13-1113847619</bibtext> </blist> <blist> <bibtext> Maenner Matthew J, Rice Catherine E, Arneson Carrie L, Cunniff Christopher, Schieve Laura A, Carpenter Laura A, Van Naarden Braun Kim, Kirby Russell S, Bakian Amanda V, Durkin Maureen S. Potential Impact ofDSM-5Criteria on Autism Spectrum Disorder Prevalence Estimates. JAMA Psychiatry. 2014; 71; 3: 292. 10.1001/jamapsychiatry.2013.3893</bibtext> </blist> <blist> <bibtext> Magana S, Vanegas SB. Diagnostic utility of the ADI-R and DSM-5 in the assessment of latino children and adolescents. The Journal of Autism and Developmental Disorders. 2017; 47; 5: 1278-1287. 10.1007/s10803-017-3043-2</bibtext> </blist> <blist> <bibtext> Matson JL, Kozlowski AM, Hattier MA, Horovitz M, Sipes M. DSM-IV vs DSM-5 diagnostic criteria for toddlers with autsim. Developmental Neurorehabilitation. 2012; 15; 3: 185-190. 10.3109/17518423.2012.672341</bibtext> </blist> <blist> <bibtext> Mattila Marja-Leena, Kielinen Marko, Linna Sirkka-Liisa, Jussila Katja, Ebeling Hanna, Bloigu Risto, Joseph Robert M, Moilanen Irma. Autism Spectrum Disorders According to DSM-IV-TR and Comparison With DSM-5 Draft Criteria: An Epidemiological Study. Journal of the American Academy of Child &amp; Adolescent Psychiatry. 2011; 50; 6: 583-592.e11. 10.1016/j.jaac.2011.04.001</bibtext> </blist> <blist> <bibtext> Mazurek Micah O, Lu Frances, Symecko Heather, Butter Eric, Bing Nicole M, Hundley Rachel J, Poulsen Marie, Kanne Stephen M, Macklin Eric A, Handen Benjamin L. A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. 2017; 47; 9: 2783-2794. 10.1007/s10803-017-3200-7</bibtext> </blist> <blist> <bibtext> Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology. 2009; 62; 10: 1006-1012. 10.1016/j.jclinepi.2009.06.005</bibtext> </blist> <blist> <bibtext> Mugzach O, Peleg M, Bagley SC, Guter SJ, Cook EH, Altman RB. An ontology for autism spectrum disorder (ASD) to infer ASD phenotypes from autism diagnostic interview-revised data. Journal of Biomedical Informatics. 2015; 56: 333-347. 10.1016/j.jbi.2015.06.0264532604</bibtext> </blist> <blist> <bibtext> Muhle RA, Reed HE, Stratigos KA, Veenstra-VanderWeele J. The emerging clinical neuroscience of autism spectrum disorder: A review. JAMA Psychiatry. 2018; 75; 5: 514-523. 10.1001/jamapsychiatry.2017.4685</bibtext> </blist> <blist> <bibtext> Norbury CF. Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications. Journal of Child Psychology and Psychiatry. 2014; 55; 3: 204-216. 10.1111/jcpp.1215424117874</bibtext> </blist> <blist> <bibtext> Ocakoglu FT, Kayan B, Kose S, Ozbaran NB, Erermis HS, Bildik T, Aydin C. Reassessment of pervasive development disorder-not otherwise specified outcome according to DSM-5 diagnostical criteria. Klinik Psikofarmakologi Bulteni. 2015; 25: S64-S65</bibtext> </blist> <blist> <bibtext> Ohashi K, Mizuno Y, Miyachi T, Asai T, Imaeda M, Saitoh S. Concordance of DSM-5 and DSM-IV-TR classifications for autism spectrum disorder. Pediatrics International. 2015; 57; 6: 1097-1100. 10.1111/ped.12704</bibtext> </blist> <blist> <bibtext> Orinstein Alyssa J, Helt Molly, Troyb Eva, Tyson Katherine E, Barton Marianne L, Eigsti Inge-Marie, Naigles Letitia, Fein Deborah A. Intervention for Optimal Outcome in Children and Adolescents with a History of Autism. Journal of Developmental &amp; Behavioral Pediatrics. 2014; 35; 4: 247-256. 10.1097/DBP.0000000000000037</bibtext> </blist> <blist> <bibtext> Persaud R. Misleading meta-analysis. "Fail safe N" is a useful mathematical measure of the stability of results. BMJ. 1996; 312; 7023: 125. 10.1136/bmj.312.7023.125</bibtext> </blist> <blist> <bibtext> Reichow B, Hume K, Barton EE, Boyd BA. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. 2018; 5: Cd009260. 10.1002/14651858.CD009260.pub3</bibtext> </blist> <blist> <bibtext> Rice CAutism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators. Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, six sites, United States, 2000. MMWR Surveillance Summary. 2007; 56; SS01: 1-11</bibtext> </blist> <blist> <bibtext> Rieske RD, Matson JL, Beighley JS, Cervantes PE, Goldin RL, Jang J. Comorbid psychopathology rates in children diagnosed with autism spectrum disorders according to the DSM-IV-TR and the proposed DSM-5. Developmental Neurorehabilitation. 2015; 18; 4: 218-223. 10.3109/17518423.2013.790519</bibtext> </blist> <blist> <bibtext> Righi G, Tierney AL, Tager-Flusberg H, Nelson CA. Functional connectivity in the first year of life in infants at risk for autism spectrum disorder: an EEG study. PLoS ONE. 2014; 9; 8: e105176. 10.1371/journal.pone.01051764139321</bibtext> </blist> <blist> <bibtext> Rogers SRomanczyk RG, McEachin J. Early start denver model. Comprehensive models of autism spectrum disorder treatment: Points of divergence and convergence. 2016: New York; Springer Publishing Company: 45-62</bibtext> </blist> <blist> <bibtext> Romero Marina, Aguilar Juan Manuel, Del-Rey-Mejías Ángel, Mayoral Fermín, Rapado Marta, Peciña Marta, Barbancho Miguel Ángel, Ruiz-Veguilla Miguel, Lara José Pablo. Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis. International Journal of Clinical and Health Psychology. 2016; 16; 3: 266-275. 10.1016/j.ijchp.2016.03.001</bibtext> </blist> <blist> <bibtext> Salomone Erica, Beranová Štěpánka, Bonnet-Brilhault Frédérique, Briciet Lauritsen Marlene, Budisteanu Magdalena, Buitelaar Jan, Canal-Bedia Ricardo, Felhosi Gabriella, Fletcher-Watson Sue, Freitag Christine, Fuentes Joaquin, Gallagher Louise, Garcia Primo Patricia, Gliga Fotinica, Gomot Marie, Green Jonathan, Heimann Mikael, Jónsdóttir Sigridur Loa, Kaale Anett, Kawa Rafal, Kylliainen Anneli, Lemcke Sanne, Markovska-Simoska Silvana, Marschik Peter B, McConachie Helen, Moilanen Irma, Muratori Filippo, Narzisi Antonio, Noterdaeme Michele, Oliveira Guiomar, Oosterling Iris, Pijl Mirjam, Pop-Jordanova Nada, Poustka Luise, Roeyers Herbert, Rogé Bernadette, Sinzig Judith, Vicente Astrid, Warreyn Petra, Charman Tony. Use of early intervention for young children with autism spectrum disorder across Europe. Autism. 2015; 20; 2: 233-249. 10.1177/1362361315577218</bibtext> </blist> <blist> <bibtext> Schieve LA, Rice C, Boyle C, Visser SN, Blumberg SJ. Mental health in the United States: Parental report of diagnosed autism in children aged 4–17 years–United States, 2003–2004. Morbidity and Mortality Weekly Report. 2006; 55; 17: 481-486</bibtext> </blist> <blist> <bibtext> Schreibman L, Dawson G, Stahmer AC, Landa R, Rogers SJ, McGee GG, Halladay A. Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. The Journal of Autism and Developmental Disorders. 2015; 45; 8: 2411-2428. 10.1007/s10803-015-2407-8</bibtext> </blist> <blist> <bibtext> Shen MD, Nordahl CW, Li DD, Lee A, Angkustsiri K, Emerson RW, Amaral DG. Extra-axial cerebrospinal fluid in high-risk and normal-risk children with autism aged 2–4 years: a case-control study. Lancet Psychiatry. 2018; 5; 11: 895-904. 10.1016/s2215-0366(18)30294-36223655</bibtext> </blist> <blist> <bibtext> Signorelli MS, Petrosino B, Magnano di San Lio F, Aguglia E. Asperger syndrome in adults and DSM-5: What does the future hold?. European Neuropsychopharmacology. 2015; 25; Suppl 2: S650. 10.1016/S0924-977X(15)30922-6</bibtext> </blist> <blist> <bibtext> Singh JS, Bunyak G. Autism disparities: A systematic review and meta-ethnography of qualitative research. Qualitative Health Research. 2018. 10.1177/1049732318808245</bibtext> </blist> <blist> <bibtext> Smith AM, King JJ, West PR, Ludwig MA, Donley ELR, Burrier RE, Amaral DG. Amino acid dysregulation metabotypes: Potential biomarkers for diagnosis and individualized treatment for subtypes of autism spectrum disorder. Biological Psychiatry. 2018. 10.1016/j.biopsych.2018.08.0166837735</bibtext> </blist> <blist> <bibtext> Smith IC, Reichow B, Volkmar FR. The effects of DSM-5 criteria on number of individuals diagnosed with autism spectrum disorder: A systematic review. The Journal of Autism and Developmental Disorders. 2015; 45; 8: 2541-2552. 10.1007/s10803-015-2423-8</bibtext> </blist> <blist> <bibtext> Soke GN, Maenner MJ, Christensen D, Kurzius-Spencer M, Schieve LA. Prevalence of co-occurring medical and behavioral conditions/symptoms among 4- and 8-year-old children with autism spectrum disorder in selected areas of the United States in 2010. The Journal of Autism and Developmental Disorders. 2018; 48; 8: 2663-2676. 10.1007/s10803-018-3521-1</bibtext> </blist> <blist> <bibtext> Solerdelcoll Arimany M, Blazquez A, Calvo R, Varela E, Puig O, Lazaro L. Diagnostic stability of autism spectrum disorders with the DSM-5 diagnostic criteria. European Neuropsychopharmacology. 2017; 27: S1104. 10.1016/S0924-977X(17)31916-8</bibtext> </blist> <blist> <bibtext> Sturmey P, Dalfern S. The effect of DSM5 autism diagnostic criteria on number of individuals diagnosed with autism spectrum disorders: A systematic review. Review Journal of Autism and Developmental Disorders. 2014; 1: 249-252. 10.1007/s40489-014-0016-7</bibtext> </blist> <blist> <bibtext> Sumi S, Miyachi T, Ohya K, Ohashi K, Saitoh S. Application of the final DSM-5 criteria for young children with autism spectrum disorder. Autism-Open Access. 2014; 4; 3: 135</bibtext> </blist> <blist> <bibtext> Sung M, Goh TJ, Tan BLJ, Chan JS, Liew HSA. Comparison of DSM-IV-TR and DSM-5 criteria in diagnosing autism spectrum disorders in Singapore. The Journal of Autism and Developmental Disorders. 2018; 48; 10: 3273-3281. 10.1007/s10803-018-3594-x</bibtext> </blist> <blist> <bibtext> Swineford LB, Thurm A, Baird G, Wetherby AM, Swedo S. Social (pragmatic) communication disorder: A research review of this new DSM-5 diagnostic category. Journal of Neurodevelopmental Disorders. 2014; 6; 1: 41. 10.1186/1866-1955-6-41</bibtext> </blist> <blist> <bibtext> Taheri A, Perry A. Exploring the proposed DSM-5 criteria in a clinical sample. The Journal of Autism and Developmental Disorders. 2012; 42; 9: 1810-1817. 10.1007/s10803-012-1599-4</bibtext> </blist> <blist> <bibtext> Taheri A, Perry A, Factor DC. A further examination of the DSM-5 autism spectrum disorder criteria in practice. Journal on Developmental Disabilities. 2014; 20; 1: 116-121</bibtext> </blist> <blist> <bibtext> Tartaglia Nicole R, Wilson Rebecca, Miller Judith S, Rafalko Jessica, Cordeiro Lisa, Davis Shanlee, Hessl David, Ross Judith. Autism Spectrum Disorder in Males with Sex Chromosome Aneuploidy. Journal of Developmental &amp; Behavioral Pediatrics. 2017; 38; 3: 197-207. 10.1097/DBP.0000000000000429</bibtext> </blist> <blist> <bibtext> Treffert DA. Epidemiology of infantile autism. Archives of General Psychiatry. 1970; 22; 5: 431-438. 10.1001/archpsyc.1970.01740290047006</bibtext> </blist> <blist> <bibtext> Turcotte P, Mathew M, Shea LL, Brusilovskiy E, Nonnemacher SL. Service needs across the lifespan for individuals with autism. The Journal of Autism and Developmental Disorders. 2016; 46; 7: 2480-2489. 10.1007/s10803-016-2787-4</bibtext> </blist> <blist> <bibtext> Turygin NC, Matson JL, Adams H, Belva B. The effect of DSM-5 criteria on externalizing, internalizing, behavioral and adaptive symptoms in children diagnosed with autism. Developmental Neurorehabilitation. 2013; 16; 4: 277-282. 10.3109/17518423.2013.769281</bibtext> </blist> <blist> <bibtext> van Steensel FJ, Bogels SM, de Bruin EI. DSM-IV versus DSM-5 autism spectrum disorder and social anxiety disorder in childhood: Similarities and differences. Journal of Child and Family Studies. 2015; 24; 9: 2752-2756. 10.1007/s10826-014-0078-2</bibtext> </blist> <blist> <bibtext> Visser, S, &amp; Tops, W. (2017). Social pragmatic communication disorder and autism spectrum disorder: Two of a kind? A narrative review. Annals of Psychiatry and Mental Health. 5(6).</bibtext> </blist> <blist> <bibtext> Volkmar FR, Szatmari P, Sparrow SS. Sex differences in pervasive developmental disorders. The Journal of Autism and Developmental Disorders. 1993; 23; 4: 579-591. 10.1007/BF01046103</bibtext> </blist> <blist> <bibtext> Weitlauf, A. S, McPheeters, M. L, Peters, B, Sathe, N, Travis, R, Aiello, R, ... Warren, Z. (2014). AHRQ comparative effectiveness reviews. In Therapies for children with autism spectrum disorder: Behavioral interventions update. Rockville, MD: Agency for Healthcare Research and Quality (US).</bibtext> </blist> <blist> <bibtext> Wheeler Anne C, Mussey Joanna, Villagomez Adrienne, Bishop Ellen, Raspa Melissa, Edwards Anne, Bodfish James, Bann Carla, Bailey Donald B. DSM-5 Changes and the Prevalence of Parent-Reported Autism Spectrum Symptoms in Fragile X Syndrome. Journal of Autism and Developmental Disorders. 2014; 45; 3: 816-829. 10.1007/s10803-014-2246-z</bibtext> </blist> <blist> <bibtext> Wilson C. Ellie, Gillan Nicola, Spain Deborah, Robertson Dene, Roberts Gedeon, Murphy Clodagh M, Maltezos Stefanos, Zinkstok Janneke, Johnston Katie, Dardani Christina, Ohlsen Chris, Deeley P. Quinton, Craig Michael, Mendez Maria A, Happé Francesca, Murphy Declan G. M. Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an Adult Autism Spectrum Disorder Diagnostic Clinic. Journal of Autism and Developmental Disorders. 2013; 43; 11: 2515-2525. 10.1007/s10803-013-1799-6</bibtext> </blist> <blist> <bibtext> Wing L, Gould J. Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. The Journal of Autism and Developmental Disorders. 1979; 9; 1: 11-29. 10.1007/BF01531288</bibtext> </blist> <blist> <bibtext> Wong CM, Koh HC. Brief report: Investigating the implications of applying the new DSM-5 criteria for diagnosing autism spectrum disorder in a preschool population in Singapore. The Journal of Autism and Developmental Disorders. 2016; 46; 9: 3177-3182. 10.1007/s10803-016-2841-2</bibtext> </blist> <blist> <bibtext> Xu G, Strathearn L, Liu B. Prevalence and treatment patterns of autism spectrum disorder in the United States, 2016. JAMA Pediatrics. 2018. 10.1001/jamapediatrics.2018.42086439607</bibtext> </blist> <blist> <bibtext> Yaylaci F, Miral S. A comparison of DSM-IV-TR and DSM-5 diagnostic classifications in the clinical diagnosis of autistic spectrum disorder. The Journal of Autism and Developmental Disorders. 2017; 47; 1: 101-109. 10.1007/s10803-016-2937-8</bibtext> </blist> <blist> <bibtext> You Y, Wu B-L, Shen Y. A pilot study on the diagnostic performance of DSM-IV and DSM-V for autism spectrum disorder. North American Journal of Medicine and Science. 2011; 4; 3: 116-123. 10.7156/v4i3p116</bibtext> </blist> <blist> <bibtext> Young RL, Rodi ML. Redefining autism spectrum disorder using DSM-5: the implications of the proposed DSM-5 criteria for autism spectrum disorders. The Journal of Autism and Developmental Disorders. 2014; 44; 4: 758-765. 10.1007/s10803-013-1927-3</bibtext> </blist> <blist> <bibtext> Yuan H, Dollaghan C. Measuring the diagnostic features of social (pragmatic) communication disorder: An exploratory study. American Journal of Speech-Language Pathology. 2018; 27; 2: 647-656. 10.1044/2018_ajslp-16-0219</bibtext> </blist> <blist> <bibtext> Zander E, Bolte S. The new DSM-5 impairment criterion: A challenge to early autism spectrum disorder diagnosis?. The Journal of Autism and Developmental Disorders. 2015; 45; 11: 3634-3643. 10.1007/s10803-015-2512-8</bibtext> </blist> <blist> <bibtext> Zhao F, Zhang H, Rekik I, An Z, Shen D. Diagnosis of autism spectrum disorders using multi-level high-order functional networks derived from resting-state functional MRI. Frontiers in Human Neuroscience. 2018; 12: 184. 10.3389/fnhum.2018.001845960713</bibtext> </blist> </ref> <aug> <p>By Kristine M. Kulage; Johanna Goldberg; John Usseglio; Danielle Romero; Jennifer M. Bain and Arlene M. Smaldone</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib78" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib87" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib56" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib45" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib33" firstref="ref7"></nolink> <nolink nlid="nl6" bibid="bib62" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib17" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib19" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib38" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib42" firstref="ref17"></nolink> <nolink nlid="nl11" bibid="bib12" firstref="ref18"></nolink> <nolink nlid="nl12" bibid="bib35" firstref="ref21"></nolink> <nolink nlid="nl13" bibid="bib71" firstref="ref22"></nolink> <nolink nlid="nl14" bibid="bib68" firstref="ref23"></nolink> <nolink nlid="nl15" bibid="bib52" firstref="ref24"></nolink> <nolink nlid="nl16" bibid="bib72" firstref="ref25"></nolink> <nolink nlid="nl17" bibid="bib74" firstref="ref26"></nolink> <nolink nlid="nl18" bibid="bib47" firstref="ref31"></nolink> <nolink nlid="nl19" bibid="bib40" firstref="ref42"></nolink> <nolink nlid="nl20" bibid="bib41" firstref="ref43"></nolink> <nolink nlid="nl21" bibid="bib27" firstref="ref45"></nolink> <nolink nlid="nl22" bibid="bib54" firstref="ref46"></nolink> <nolink nlid="nl23" bibid="bib44" firstref="ref47"></nolink> <nolink nlid="nl24" bibid="bib32" firstref="ref48"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref50"></nolink> <nolink nlid="nl26" bibid="bib28" firstref="ref51"></nolink> <nolink nlid="nl27" bibid="bib46" firstref="ref53"></nolink> <nolink nlid="nl28" bibid="bib48" firstref="ref54"></nolink> <nolink nlid="nl29" bibid="bib76" firstref="ref55"></nolink> <nolink nlid="nl30" bibid="bib92" firstref="ref56"></nolink> <nolink nlid="nl31" bibid="bib88" firstref="ref60"></nolink> <nolink nlid="nl32" bibid="bib80" firstref="ref63"></nolink> <nolink nlid="nl33" bibid="bib43" firstref="ref65"></nolink> <nolink nlid="nl34" bibid="bib73" firstref="ref66"></nolink> <nolink nlid="nl35" bibid="bib14" firstref="ref70"></nolink> <nolink nlid="nl36" bibid="bib31" firstref="ref72"></nolink> <nolink nlid="nl37" bibid="bib34" firstref="ref73"></nolink> <nolink nlid="nl38" bibid="bib51" firstref="ref76"></nolink> <nolink nlid="nl39" bibid="bib60" firstref="ref77"></nolink> <nolink nlid="nl40" bibid="bib65" firstref="ref78"></nolink> <nolink nlid="nl41" bibid="bib77" firstref="ref81"></nolink> <nolink nlid="nl42" bibid="bib81" firstref="ref82"></nolink> <nolink nlid="nl43" bibid="bib85" firstref="ref83"></nolink> <nolink nlid="nl44" bibid="bib90" firstref="ref84"></nolink> <nolink nlid="nl45" bibid="bib70" firstref="ref96"></nolink> <nolink nlid="nl46" bibid="bib94" firstref="ref98"></nolink> <nolink nlid="nl47" bibid="bib13" firstref="ref99"></nolink> <nolink nlid="nl48" bibid="bib24" firstref="ref111"></nolink> <nolink nlid="nl49" bibid="bib57" firstref="ref114"></nolink> <nolink nlid="nl50" bibid="bib18" firstref="ref120"></nolink> <nolink nlid="nl51" bibid="bib91" firstref="ref154"></nolink> <nolink nlid="nl52" bibid="bib16" firstref="ref179"></nolink> <nolink nlid="nl53" bibid="bib29" firstref="ref180"></nolink> <nolink nlid="nl54" bibid="bib75" firstref="ref181"></nolink> <nolink nlid="nl55" bibid="bib86" firstref="ref182"></nolink> <nolink nlid="nl56" bibid="bib55" firstref="ref198"></nolink> <nolink nlid="nl57" bibid="bib59" firstref="ref199"></nolink> <nolink nlid="nl58" bibid="bib61" firstref="ref200"></nolink> <nolink nlid="nl59" bibid="bib63" firstref="ref201"></nolink> <nolink nlid="nl60" bibid="bib89" firstref="ref202"></nolink> <nolink nlid="nl61" bibid="bib11" firstref="ref203"></nolink> <nolink nlid="nl62" bibid="bib79" firstref="ref204"></nolink> <nolink nlid="nl63" bibid="bib20" firstref="ref206"></nolink> <nolink nlid="nl64" bibid="bib69" firstref="ref207"></nolink> <nolink nlid="nl65" bibid="bib67" firstref="ref209"></nolink> <nolink nlid="nl66" bibid="bib26" firstref="ref210"></nolink> <nolink nlid="nl67" bibid="bib10" firstref="ref211"></nolink> <nolink nlid="nl68" bibid="bib39" firstref="ref212"></nolink> <nolink nlid="nl69" bibid="bib64" firstref="ref213"></nolink> <nolink nlid="nl70" bibid="bib95" firstref="ref214"></nolink> <nolink nlid="nl71" bibid="bib37" firstref="ref215"></nolink> <nolink nlid="nl72" bibid="bib49" firstref="ref216"></nolink> <nolink nlid="nl73" bibid="bib58" firstref="ref217"></nolink> <nolink nlid="nl74" bibid="bib23" firstref="ref218"></nolink> <nolink nlid="nl75" bibid="bib21" firstref="ref219"></nolink> <nolink nlid="nl76" bibid="bib30" firstref="ref220"></nolink> <nolink nlid="nl77" bibid="bib36" firstref="ref221"></nolink> <nolink nlid="nl78" bibid="bib83" firstref="ref222"></nolink> <nolink nlid="nl79" bibid="bib66" firstref="ref224"></nolink> <nolink nlid="nl80" bibid="bib15" firstref="ref225"></nolink> <nolink nlid="nl81" bibid="bib53" firstref="ref226"></nolink> <nolink nlid="nl82" bibid="bib84" firstref="ref227"></nolink> <nolink nlid="nl83" bibid="bib22" firstref="ref246"></nolink> <nolink nlid="nl84" bibid="bib82" firstref="ref251"></nolink> <nolink nlid="nl85" bibid="bib50" firstref="ref254"></nolink> <nolink nlid="nl86" bibid="bib93" firstref="ref256"></nolink> |
|---|---|
| Header | DbId: eric DbLabel: ERIC An: EJ1255361 AccessLevel: 3 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
| IllustrationInfo | |
| Items | – Name: Title Label: Title Group: Ti Data: How Has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-Analysis – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Kulage%2C+Kristine+M%2E%22">Kulage, Kristine M.</searchLink><br /><searchLink fieldCode="AR" term="%22Goldberg%2C+Johanna%22">Goldberg, Johanna</searchLink><br /><searchLink fieldCode="AR" term="%22Usseglio%2C+John%22">Usseglio, John</searchLink><br /><searchLink fieldCode="AR" term="%22Romero%2C+Danielle%22">Romero, Danielle</searchLink><br /><searchLink fieldCode="AR" term="%22Bain%2C+Jennifer+M%2E%22">Bain, Jennifer M.</searchLink><br /><searchLink fieldCode="AR" term="%22Smaldone%2C+Arlene+M%2E%22">Smaldone, Arlene M.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Jun 2020 50(6):2102-2127. – Name: Avail Label: Availability Group: Avail Data: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/ – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 26 – Name: DatePubCY Label: Publication Date Group: Date Data: 2020 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research<br />Information Analyses – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Clinical+Diagnosis%22">Clinical Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Guides%22">Guides</searchLink><br /><searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Followup+Studies%22">Followup Studies</searchLink><br /><searchLink fieldCode="DE" term="%22Meta+Analysis%22">Meta Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Disorders%22">Communication Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Criteria%22">Criteria</searchLink><br /><searchLink fieldCode="DE" term="%22Asperger+Syndrome%22">Asperger Syndrome</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1007/s10803-019-03967-5 – Name: ISSN Label: ISSN Group: ISSN Data: 0162-3257 – Name: Abstract Label: Abstract Group: Ab Data: 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. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2020 – Name: AN Label: Accession Number Group: ID Data: EJ1255361 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1255361 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s10803-019-03967-5 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 26 StartPage: 2102 Subjects: – SubjectFull: Clinical Diagnosis Type: general – SubjectFull: Guides Type: general – SubjectFull: Autism Type: general – SubjectFull: Pervasive Developmental Disorders Type: general – SubjectFull: Followup Studies Type: general – SubjectFull: Meta Analysis Type: general – SubjectFull: Communication Disorders Type: general – SubjectFull: Criteria Type: general – SubjectFull: Asperger Syndrome Type: general Titles: – TitleFull: How Has DSM-5 Affected Autism Diagnosis? A 5-Year Follow-Up Systematic Literature Review and Meta-Analysis Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Kulage, Kristine M. – PersonEntity: Name: NameFull: Goldberg, Johanna – PersonEntity: Name: NameFull: Usseglio, John – PersonEntity: Name: NameFull: Romero, Danielle – PersonEntity: Name: NameFull: Bain, Jennifer M. – PersonEntity: Name: NameFull: Smaldone, Arlene M. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 06 Type: published Y: 2020 Identifiers: – Type: issn-print Value: 0162-3257 Numbering: – Type: volume Value: 50 – Type: issue Value: 6 Titles: – TitleFull: Journal of Autism and Developmental Disorders Type: main |
| ResultId | 1 |
