Evidence map›Paper›PMID 41872583›Full record

ArticleJournal of autism and developmental disorders2026

Prevalence of Autism Spectrum Disorder Severity Levels From the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5) in the Autism and Developmental Disabilities Monitoring Network.

Lauren A Russell, Sarah C Tinker, Kelly A Shaw, Matthew J Maenner, Monica Dirienzo, Anne V Kirby, Ellen M Howerton, Sandra B Vanegas, Maya Lopez

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of autism and developmental disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. [Focusing on profound autism: validity of clinical taxonomy and management of treatment-resistant symptoms].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Lauren A RussellNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S106-4, Atlanta, GA, 30341, USA. rvt8@cdc.gov.ORCID http://orcid.org/0000-0002-6510-0462
Sarah C TinkerNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S106-4, Atlanta, GA, 30341, USA.ORCID http://orcid.org/0000-0002-7610-6288
Kelly A ShawNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S106-4, Atlanta, GA, 30341, USA.ORCID http://orcid.org/0000-0003-2964-8946
Matthew J MaennerNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S106-4, Atlanta, GA, 30341, USA.ORCID http://orcid.org/0000-0002-5963-9090
Monica DirienzoNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S106-4, Atlanta, GA, 30341, USA.ORCID http://orcid.org/0000-0002-9278-1988
Anne V KirbyDepartment of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA.ORCID http://orcid.org/0000-0003-0395-6684
Ellen M HowertonDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.ORCID http://orcid.org/0000-0002-2238-1954
Sandra B VanegasSteve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.ORCID http://orcid.org/0000-0002-1089-0022
Maya LopezUniversity of Arkansas for Medical Sciences, Little Rock, AR, USA.ORCID http://orcid.org/0000-0002-6240-7653

Funding

Intramural CDC HHS CC999999
6 · The paper itself

Abstract

purposeThe fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced severity level specifiers for autism spectrum disorder (ASD) with minimal description of the criteria for categorizing three levels of severity (1 to 3, with 3 being the most “severe”). The objective of the analysis was to assess the prevalence of ASD severity levels using population-based surveillance data.

methodsWe analyzed severity level data on children with ASD ages 4- and 8-years-old in 2018 and 2020 in the multisite Autism and Developmental Disabilities Monitoring (ADDM) Network. Prevalence of any documented severity level and of each individual level were calculated overall and by demographic characteristics. Prevalence ratios adjusted for sex, race/ethnicity, age, intellectual disability, ADDM surveillance year, and site (aPRs) and 95% confidence intervals (CIs) were used for comparisons.

resultsLess than half (40.4%) of children with documented ASD diagnoses had any severity level specified in their records, with wide variation by site (4.8%-73.2%). Severity levels were more common in records of children aged 4, in surveillance year 2020, and more often missing in non-Hispanic Black children and from records also missing information on intellectual disability (ID). Higher prevalence of more severe (level 3) ASD was observed among non-Hispanic Black children, children aged 4 years, children in 2020, and children with ID.

conclusionUtilization of the DSM-5’s severity levels by community professionals varied widely, limiting their potential utility in identifying needed services and supports for children with ASD.

Indexed as

Autism spectrum disorderDSM-5Levels of supportSeverity level

Identifiers

PMID41872583
PMCPMC13267130

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.