For healthcare professionals in the United States and globally, the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association (APA) stands as the primary resource for diagnosing mental health conditions. This manual provides a standardized set of criteria to ensure accurate and consistent diagnoses.
The fifth edition, DSM-5, released in 2013, outlines specific criteria for an autism diagnosis, now formally termed Autism Spectrum Disorder (ASD). According to DSM-5, an autism diagnosis requires demonstration of persistent challenges in social communication and interaction across various situations. These challenges are specifically manifested by deficits in social-emotional reciprocity, nonverbal communication used for social interaction, and the development, maintenance, and understanding of relationships. With permission from the APA, the complete DSM-5 diagnostic criteria for ASD are detailed below.
In 2022, the APA issued the DSM-5-TR%20was%20published%20in%202022.), a text revision to the DSM-5. This revision brought a crucial clarification to the autism diagnostic criteria. The phrase “manifested by the following” was updated to “as manifested by all of the following”. This change emphasizes that all listed criteria within each section must be met for a diagnosis, reinforcing the intended rigor and clarity of the diagnostic process.
DSM-5 Diagnostic Criteria for Autism Spectrum Disorder: Detailed Breakdown
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history (examples are illustrative, not exhaustive):
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Deficits in social-emotional reciprocity: This ranges from difficulties in typical back-and-forth conversation, to a reduced sharing of interests or emotions, and even a lack of initiation or response to social interactions. For instance, an individual might struggle to engage in the give-and-take of a typical conversation, miss social cues indicating another person’s interest, or not readily share their own feelings or enthusiasm with others.
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Deficits in nonverbal communicative behaviors used for social interaction: These can include challenges with integrating verbal and nonverbal communication, abnormalities in eye contact and body language, difficulties understanding and using gestures, or even a complete absence of facial expressions and nonverbal communication. Examples may include inconsistent use of gestures while speaking, difficulty maintaining eye contact during conversations, or misinterpreting body language in social situations.
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Deficits in developing, maintaining, and understanding relationships: This can manifest as difficulties adjusting behavior across different social contexts, problems engaging in imaginative play or making friends, or a lack of interest in peers. For example, an individual might struggle to adapt their communication style to different social settings (like a classroom versus a playground), have trouble understanding the nuances of friendships, or show limited interest in social interaction with peers.
Specify current severity: Severity levels are determined by the degree of social communication impairments and the extent of restricted, repetitive patterns of behavior.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
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Stereotyped or repetitive motor movements, use of objects, or speech: This can include simple motor stereotypies (like hand-flapping or rocking), arranging toys in lines or repeatedly flipping objects, echolalia (repeating words or phrases), or using idiosyncratic phrases. Examples in this category are diverse, ranging from repetitive body movements to specific ways of playing with toys or using language.
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Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior: This may involve extreme distress at minor changes, difficulties with transitions, rigid thinking patterns, specific greeting rituals, or a need to follow the same route or eat the same food daily. Individuals might exhibit significant anxiety when routines are disrupted or find it challenging to adapt to new situations or unexpected changes.
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Highly restricted, fixated interests that are abnormal in intensity or focus: These are interests that are unusually intense or focused, such as a strong attachment to unusual objects or excessively narrow or perseverative interests. This could involve an intense preoccupation with specific topics to the exclusion of others, or a deep attachment to objects that are not typically considered comforting or interesting to others of the same age.
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Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment: This can include apparent indifference to pain or temperature, negative responses to specific sounds or textures, excessive touching or smelling of objects, or visual fascination with lights or movement. Sensory sensitivities can manifest as either heightened or lowered responses to sensory stimuli, leading to avoidance or seeking behaviors related to sensory experiences.
Specify current severity: Severity levels are based on the degree of social communication impairments and the extent of restricted, repetitive patterns of behavior in this domain.
C. Symptoms must be present in the early developmental period (but may not become fully apparent until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note: Individuals with a prior DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should now receive a diagnosis of autism spectrum disorder. For individuals exhibiting marked social communication deficits who do not fully meet the 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 identify associated medical or genetic conditions.)
- Associated with another neurodevelopmental, mental, or behavioral disorder
- (Coding note: Use additional code[s] to identify associated neurodevelopmental, mental, or behavioral disorders.)
- 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:
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Deficits in using communication for social purposes: This includes difficulties using communication for social interactions like greeting and sharing information in a contextually appropriate manner. For example, an individual may struggle to initiate greetings or share information in a way that is socially expected or understood in a given situation.
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Impairment of the ability to adapt communication to match context or listener needs: This involves difficulty adjusting communication style based on the social setting or the person they are speaking to. Examples include speaking differently in a classroom versus a playground, adjusting communication when speaking to a child versus an adult, and avoiding overly formal or informal language when inappropriate.
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Difficulties following rules for conversation and storytelling: This includes challenges with turn-taking in conversation, rephrasing when misunderstood, and understanding and using verbal and nonverbal cues to regulate interaction. An individual might struggle with the back-and-forth flow of conversation, have difficulty clarifying their message when not understood, or miss social cues that indicate when to speak or listen.
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Difficulties understanding what is not explicitly stated and nonliteral or ambiguous language: This involves challenges with understanding inferences, humor, metaphors, idioms, and multiple meanings of words that depend on context. For instance, an individual might struggle to understand sarcasm, take figurative language literally, or miss implied meanings in conversations.
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of symptoms is in the early developmental period (but deficits may not become fully apparent until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition, low abilities in word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability, global developmental delay, or another mental disorder.
Further Resources
For additional support and information, Autism Speaks offers resources like the Autism Response Team to provide guidance, resources, and opportunities.
