DSM-5 Autism Diagnostic Criteria: A Comprehensive Guide

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatric Association (APA), serves as the primary resource for healthcare professionals in the United States and globally for diagnosing mental disorders. This manual provides standardized criteria to ensure accurate and consistent diagnoses.

In 2013, the APA released the DSM-5, which significantly updated the diagnostic criteria for autism. According to the DSM-5, an autism spectrum disorder (ASD) diagnosis is characterized by persistent challenges in social communication and interaction across various situations. These challenges are further defined by specific criteria in social-emotional reciprocity, nonverbal communication, and relationship development. The APA has granted permission to present the complete DSM-5 diagnostic criteria for ASD as detailed below.

In 2022, the APA issued the DSM-5-TR%20was%20published%20in%202022.), a text revision to the DSM-5. This revision included a crucial clarification to the autism diagnostic criteria, changing “manifested by the following” to “as manifested by all of the following” [https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-AutismSpectrumDisorder.pdf]. This change emphasizes that all listed features within each criterion must be present for a diagnosis.

DSM-5 Diagnostic Criteria for Autism Spectrum Disorder: Full Breakdown

To meet the DSM-5 criteria for autism spectrum disorder, an individual must fulfill the criteria outlined in sections A, B, C, D, and E.

A. Persistent Deficits in Social Communication and Social Interaction

This criterion must be demonstrated across multiple contexts, both currently or historically. It’s important to note that the examples provided are illustrative and not exhaustive.

1. Deficits in social-emotional reciprocity: This ranges from difficulties with back-and-forth conversation, reduced sharing of interests or emotions, and a lack of initiation or response to social interactions. For instance, an individual might struggle to engage in typical give-and-take conversations, show limited interest in others’ feelings, or rarely initiate social contact.

2. Deficits in nonverbal communicative behaviors used for social interaction: These deficits can include poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language, challenges in understanding and using gestures, or a complete absence of facial expressions and nonverbal communication. Examples include difficulty using gestures to emphasize points while speaking, avoiding eye contact during conversations, or having limited facial expressions that don’t match their verbal communication.

3. Deficits in developing, maintaining, and understanding relationships: This can manifest as difficulties adjusting behavior across different social contexts, struggling with imaginative play or making friends, or a lack of interest in peers. For example, an individual might find it hard to adapt their behavior to different social settings, have trouble engaging in pretend play scenarios with others, or show little desire to form friendships.

Specify Current Severity: The severity of ASD is determined by the level of impairment in social communication and the extent of restricted, repetitive patterns of behavior.

B. Restricted, Repetitive Patterns of Behavior, Interests, or Activities

At least two of the following must be present currently or historically. Again, examples are illustrative, not exhaustive.

1. Stereotyped or repetitive motor movements, use of objects, or speech: This can include simple motor stereotypies (like hand-flapping or rocking), lining up toys, flipping objects repetitively, echolalia (repeating words or phrases), or using idiosyncratic phrases. Examples include repetitive body movements like rocking back and forth, obsessively arranging toys in lines, or consistently repeating phrases heard from others.

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior: This may involve extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, or needing to take the same route or eat the same food daily. For instance, experiencing significant anxiety when routines are disrupted, having difficulty moving from one activity to another, or insisting on following very specific and unchanging daily schedules.

3. Highly restricted, fixated interests that are abnormal in intensity or focus: These are interests that are unusually intense or narrowly focused, such as a strong attachment to unusual objects or excessively circumscribed or perseverative interests. Examples include an intense preoccupation with specific, often unusual, topics to the exclusion of other interests, or forming very strong attachments to particular objects that are not typically considered comforting.

4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment: This can include apparent indifference to pain or temperature, adverse responses to specific sounds or textures, excessive smelling or touching of objects, or visual fascination with lights or movement. Examples include seeming unaware of pain, being overly sensitive to certain noises or textures, frequently touching or smelling objects, or being intensely drawn to visual stimuli like spinning objects or lights.

Specify Current Severity: Similar to Criterion A, severity is based on the degree of impairment in social communication and restricted, repetitive behaviors.

C. Symptoms Must Be Present in Early Development

Symptoms must have been present in the early developmental period, though they may not become fully evident until social demands increase or may be masked by learned coping strategies later in life.

D. Symptoms Cause Clinically Significant Impairment

The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of current functioning. This means the symptoms must significantly impact the individual’s daily life and abilities.

E. Not Better Explained by Other Conditions

These disturbances should not be better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. While intellectual disability and autism spectrum disorder can co-occur, a separate ASD diagnosis requires that social communication deficits are beyond what would be expected for the individual’s general developmental level.

Note: Individuals with prior DSM-IV diagnoses such as autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should now be diagnosed with autism spectrum disorder under DSM-5. Individuals exhibiting marked social communication deficits, but not meeting full ASD criteria, should be evaluated for social (pragmatic) communication disorder.

Specify if:

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
  • (Coding note: Use additional code to identify any associated medical or genetic condition.)
• Associated with another neurodevelopmental, mental, or behavioral disorder
  • (Coding note: Use additional code[s] to identify associated disorders.)
• With catatonia
• Associated with a known medical or genetic condition or environmental factor

Social (Pragmatic) Communication Disorder DSM-5 Diagnostic Criteria

Social communication disorder is a separate condition in DSM-5, distinct from ASD, and is characterized by difficulties in the social use of communication, without the restricted, repetitive behaviors seen in ASD.

A. Persistent difficulties in the social use of verbal and nonverbal communication, as manifested by all of the following:

1. Deficits in using communication for social purposes: This includes challenges in greeting, sharing information, and communicating appropriately for the social context. For example, difficulty initiating greetings or adapting their communication style to different social situations.

2. Impairment of the ability to adapt communication to context or listener needs: This involves difficulty speaking differently in a classroom versus a playground, talking to children versus adults, or avoiding overly formal language when inappropriate. For instance, struggling to adjust their language style based on the social setting or the person they are speaking to.

3. Difficulties following rules for conversation and storytelling: This includes challenges in taking turns in conversation, rephrasing when misunderstood, and using verbal and nonverbal cues to regulate interaction. Examples include interrupting frequently, not knowing how to clarify when they are not understood, or missing social cues in conversation.

4. Difficulties understanding non-explicit communication: This involves challenges with inferences, nonliteral or ambiguous meanings of language (idioms, humor, metaphors), and multiple meanings that depend on context. For example, struggling to understand sarcasm, humor, or implied meanings in conversations.

B. Functional Limitations: These communication deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance.

C. Early Onset: The onset of symptoms is in early childhood, though they may not become fully apparent until social communication demands exceed the individual’s abilities.

D. Not Attributable to Other Conditions: These symptoms are not due to another medical or neurological condition, low abilities in word structure and grammar, autism spectrum disorder, intellectual disability, global developmental delay, or another mental disorder.

Resources for Autism Diagnosis and Support

For more information and support regarding autism diagnosis, consider these resources:

• Autism Speaks Autism Response Team: For personalized guidance, information, and resources, the Autism Response Team at Autism Speaks is an excellent point of contact.
• American Psychiatric Association: The APA website provides further information on the DSM-5 and mental health conditions.

For Spanish speakers, information on autism diagnostic criteria is also available: Haga clic aquí para ver esta página en español.