The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is the primary resource for healthcare professionals in the United States and globally when diagnosing mental health conditions. Think of it as the essential guide for understanding and diagnosing conditions like Autism Spectrum Disorder (ASD).
In 2013, the APA released the DSM-5, which detailed specific criteria for diagnosing autism. According to DSM-5, an autism diagnosis requires demonstrating ongoing challenges in social communication and interaction across various situations. These challenges are evident in: difficulties with social-emotional give-and-take, problems with nonverbal communication in social settings, and struggles in developing, maintaining, and understanding relationships. Below is the detailed breakdown of the DSM-5 diagnostic criteria for ASD, reprinted with permission from the APA.
In 2022, the APA updated the manual with the DSM-5-TR%20was%20published%20in%202022.), a text revision to the DSM-5. This revision clarified the autism diagnostic criteria by changing “manifested by the following” to “as manifested by all of the following”. This change aimed to emphasize that all listed criteria points must be met for a diagnosis, enhancing the clarity and precision of the diagnostic guidelines.
DSM-5 Autism Spectrum Disorder Diagnostic Criteria: A Detailed Checklist
A. Persistent difficulties in social communication and social interaction across multiple contexts, currently or by history, as demonstrated by ALL of the following (examples provided are illustrative, not exhaustive):
- Challenges in Social-Emotional Reciprocity: This ranges from noticeable difficulties in initiating or responding in social interactions, failing to engage in typical back-and-forth conversation, showing reduced sharing of interests or emotions, to not initiating social interactions at all.
- Difficulties with Nonverbal Communicative Behaviors: These are used for social interaction and can include poorly coordinated verbal and nonverbal communication, atypical eye contact and body language, challenges in understanding and using gestures, or a complete absence of facial expressions and nonverbal communication.
- Difficulties in Developing, Maintaining, and Understanding Relationships: This can range from struggles adjusting behavior in different social contexts, problems with sharing imaginative play or making friends, to a lack of interest in peers.
Specify current severity: The level of severity is determined by the degree of social communication impairments and restricted, repetitive behaviors.
B. Restricted, repetitive patterns of behavior, interests, or activities, as shown by at least TWO of the following, currently or by history (examples provided are illustrative, not exhaustive):
- Stereotyped or Repetitive Movements, Use of Objects, or Speech: Examples include simple motor stereotypies (like hand flapping), arranging toys in lines or flipping objects, echolalia (repeating words or phrases), or using idiosyncratic phrases.
- Insistence on Sameness, Inflexible Adherence to Routines, or Ritualized Behaviors: This is evident through extreme distress with minor changes, difficulties with transitions, rigid thinking patterns, specific greeting rituals, or needing to follow the same route or eat the same food daily.
- Highly Restricted, Fixated Interests Abnormal in Intensity or Focus: This involves strong attachment to or intense preoccupation with unusual objects, or excessively narrow or perseverative interests.
- Hyper- or Hyporeactivity to Sensory Input or Unusual Sensory Interests: This can include apparent indifference to pain or temperature, adverse reactions to specific sounds or textures, excessive touching or smelling of objects, or visual fascination with lights or movement.
Specify current severity: The level of severity is determined by the degree of social communication impairments and restricted, repetitive behaviors.
C. Symptoms must be present from early childhood (though they may not become fully apparent until social demands increase or may be masked by learned strategies later in life).
D. Symptoms must cause significant distress or impairment in social, occupational, or other important areas of current functioning.
E. These difficulties are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. While intellectual disability and autism spectrum disorder can occur together, a diagnosis of both ASD and intellectual disability requires that social communication skills are significantly below what is expected for the individual’s general developmental level.
Note: Individuals previously diagnosed with DSM-IV disorders like autistic disorder, Asperger’s disorder, or pervasive developmental disorder-not otherwise specified should now be diagnosed with autism spectrum disorder. For individuals who show marked social communication deficits but do not meet all criteria for autism spectrum disorder, Social (Pragmatic) Communication Disorder should be considered.
Specify if:
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- (Coding note: Use additional code to indicate any associated medical or genetic condition.)
- Associated with another neurodevelopmental, mental, or behavioral disorder
- (Coding note: Use additional code[s] to indicate any associated neurodevelopmental, mental, or behavioral disorder[s].)
- With catatonia
- Associated with a known medical or genetic condition or environmental factor
Social (Pragmatic) Communication Disorder: DSM-5 Diagnostic Criteria
A. Persistent difficulties in the social use of verbal and nonverbal communication, as manifested by ALL of the following:
- Deficits in using communication for social purposes: Such as greeting and sharing information in a way that is appropriate for the social context.
- Impairment in Adapting Communication to Context: Difficulty changing communication style to match the listener or setting, like speaking differently in class versus on the playground, or to a child versus an adult, and avoiding overly formal language when inappropriate.
- Difficulties Following Conversation Rules: Such as taking turns in conversation, rephrasing when not understood, and understanding and using verbal and nonverbal cues to regulate interaction.
- Difficulties Understanding Non-Explicit Communication: Problems understanding what is implied (making inferences) and nonliteral or ambiguous language (idioms, humor, metaphors, multiple meanings).
B. These deficits lead to functional limitations in effective communication, social participation, social relationships, academic achievement, or job performance, individually or in combination.
C. The onset of symptoms is in early childhood (but may not fully manifest until social communication demands exceed capabilities).
D. Symptoms are not due to another medical or neurological condition, low abilities in grammar and word structure, autism spectrum disorder, intellectual disability, global developmental delay, or another mental disorder.
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