For professionals in the United States and globally who specialize in mental health, the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association (APA) stands as the essential guide for diagnosing mental health conditions. The fifth edition, DSM-5, published in 2013, outlines specific criteria for diagnosing autism spectrum disorder (ASD). A revised version, the DSM-5-TR, released in 2022, further clarifies these criteria, emphasizing the need for all listed manifestations to be present for an ASD diagnosis.
To help understand the diagnostic process, we’ve created a Diagnosis Checklist based on the DSM-5 criteria for autism spectrum disorder. This checklist is derived from the full diagnostic criteria provided by the APA.
DSM-5 Autism Spectrum Disorder Diagnosis Checklist
The DSM-5 outlines specific criteria that must be met for a diagnosis of Autism Spectrum Disorder (ASD). These criteria are categorized into two main areas, along with additional conditions that must be considered. Here’s a breakdown of the ASD diagnosis checklist based on the DSM-5.
Criterion A: Persistent Deficits in Social Communication and Social Interaction
This section of the autism diagnosis checklist focuses on difficulties in social interactions and communication across various situations. To meet this criterion, individuals must demonstrate persistent deficits in social communication and interaction, as evidenced by all three of the following areas:
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Deficits in social-emotional reciprocity: Does the individual exhibit difficulties in the back-and-forth nature of social interactions? This can manifest as:
- Failure of typical give-and-take in conversations.
- Reduced sharing of interests or emotions.
- Lack of initiation or response to social interactions.
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Deficits in nonverbal communicative behaviors used for social interaction: Does the individual struggle with nonverbal communication in social contexts? This may include:
- Poorly integrated verbal and nonverbal communication.
- Abnormalities in eye contact or body language.
- Difficulties understanding and using gestures.
- Limited or absent facial expressions and nonverbal communication.
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Deficits in developing, maintaining, and understanding relationships: Does the individual have challenges in forming and keeping relationships? This can be seen as:
- Difficulties adjusting behavior across different social situations.
- Challenges in engaging in imaginative play or making friends.
- Lack of interest in peers.
Severity Specifier: The DSM-5 also requires specifying the current severity of ASD, which is based on the level of impairment in social communication and the extent of restricted, repetitive behaviors.
Criterion B: Restricted, Repetitive Patterns of Behavior, Interests, or Activities
This part of the diagnosis checklist addresses the presence of restricted and repetitive behaviors or interests. At least two of the following must be present to meet this criterion:
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Stereotyped or repetitive motor movements, use of objects, or speech: Does the individual engage in repetitive behaviors? Examples include:
- Simple motor stereotypies (e.g., hand flapping, rocking).
- Lining up toys or flipping objects.
- Echolalia (repeating words or phrases).
- Idiosyncratic phrases (unusual or repetitive language).
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Insistence on sameness, inflexible adherence to routines, or ritualized patterns: Does the individual show a need for sameness and routine? This might include:
- Extreme distress with minor changes.
- Difficulties with transitions.
- Rigid thinking patterns.
- Ritualistic greetings.
- Need to follow specific routes or eat the same foods daily.
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Highly restricted, fixated interests that are abnormal in intensity or focus: Does the individual have overly focused or intense interests? This can be characterized by:
- Strong attachment to or preoccupation with unusual objects.
- Excessively narrow or perseverative interests.
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Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment: Does the individual exhibit unusual responses to sensory input? This can manifest as:
- Apparent indifference to pain or temperature.
- Adverse reactions to specific sounds or textures.
- Excessive touching or smelling of objects.
- Visual fascination with lights or movement.
Severity Specifier: Similar to Criterion A, severity is also specified based on the impact of these restricted and repetitive behaviors.
Criterion C, D, and E: Additional Diagnostic Considerations
Beyond Criteria A and B, the DSM-5 diagnosis checklist also includes these crucial points:
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Criterion C: Onset in Early Development: Symptoms must have been present in early childhood, though they may not become fully apparent until social demands increase or are masked by learned coping strategies later in life.
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Criterion D: Clinically Significant Impairment: Symptoms must cause significant difficulties in social, occupational, or other important areas of current functioning.
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Criterion E: Not Better Explained by Other Conditions: The symptoms should not be better explained by intellectual disability or global developmental delay, although ASD and intellectual disability can co-occur. In cases of co-occurrence, social communication abilities should be significantly below what is expected for the individual’s general developmental level.
Important Note on Previous Diagnoses: The DSM-5 clarifies that individuals previously diagnosed with DSM-IV autistic disorder, Asperger’s disorder, or pervasive developmental disorder-not otherwise specified should now be diagnosed with autism spectrum disorder. For individuals with social communication deficits who do not meet the full criteria for ASD, Social (Pragmatic) Communication Disorder should be considered.
DSM-5 Social (Pragmatic) Communication Disorder Diagnosis Checklist
In cases where social communication difficulties are present but the full criteria for ASD are not met, Social (Pragmatic) Communication Disorder may be diagnosed. This diagnosis checklist includes the following criteria:
Criterion A: Persistent Difficulties in the Social Use of Communication
Individuals must demonstrate persistent difficulties in the social application of both verbal and nonverbal communication, as shown by all four of the following:
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Deficits in using communication for social purposes: Does the individual struggle to use communication appropriately in social situations? This includes challenges in:
- Greeting and sharing information in a socially appropriate manner.
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Impairment of the ability to adapt communication to context: Does the individual have difficulty adjusting their communication style based on the situation or listener? For example:
- Speaking differently in a classroom versus a playground.
- Talking to children differently than adults.
- Avoiding overly formal language when inappropriate.
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Difficulties following rules for conversation and storytelling: Does the individual struggle with the conventions of conversation? This includes:
- Taking turns in conversation.
- Rephrasing when not understood.
- Using verbal and nonverbal cues to regulate interaction.
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Difficulties understanding non-explicit communication: Does the individual struggle to understand implied meanings? This includes challenges with:
- Making inferences.
- Understanding nonliteral or ambiguous language (idioms, humor, metaphors).
Criterion B, C, and D: Additional Diagnostic Considerations
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Criterion B: Functional Limitations: These communication deficits must result in functional limitations in effective communication, social participation, relationships, academic achievement, or occupational performance.
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Criterion C: Onset in Early Development: Symptoms must begin in early childhood, although they may not fully manifest until social communication demands exceed the individual’s abilities.
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Criterion D: Not Attributable to Other Conditions: These symptoms should not be better explained by other medical, neurological, or developmental conditions, including ASD or intellectual disability.
This diagnosis checklist provides a helpful overview of the DSM-5 diagnostic criteria for both Autism Spectrum Disorder and Social (Pragmatic) Communication Disorder. It is important to remember that this checklist is for informational purposes and a formal diagnosis should always be made by qualified professionals.
Related resources
For further information and support, Autism Speaks’ Autism Response Team offers resources and guidance.
