Resource Article

Only a well-qualified, trained medical professional can issue an autism diagnosis. When determining whether or not a person has autism, professionals look to see if they meet specific diagnosis criteria outlined in The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). 

In this article, you will find the following information:

• Diagnostic criteria for autism spectrum disorder under the DSM-5 (the APA’s current diagnostic manual)
• Old diagnostic criteria from the DSM-IV for autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), Asperger’s syndrome
  • In 2013, the APA consolidated these three diagnoses under one diagnosis of “autism spectrum disorder” in the DSM-5.
  • We are providing DSM-IV diagnostic criteria for informational purposes only.

If your child is showing signs of autism and you need to have them evaluated, please read I Think My Child May Have Autism: How to Get a Diagnosis.

Before we go into details about the diagnostic criteria for autism, it is helpful to understand a few things:

• Autism is a clinical diagnosis.
  • This means that doctors will base your child’s diagnosis on their developmental history and behavior. 
  • In other words, a lab test cannot tell you if your child does or doesn’t have autism.
• Because autism symptoms vary and range from mild to severe, it is considered a spectrum disorder.
• After consolidating autistic disorder, PDD-NOS, and Asperger’s syndrome under autism spectrum disorder in the DSM-5, the APA began requiring healthcare providers to categorize individuals into “severity levels” to help identify their support needs.

DSM-5 Diagnostic Criteria for ASD

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
   3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
2. 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):
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
   4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
3. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. 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 well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
• Specify if:
  • With or without accompanying intellectual impairment
  • With or without accompanying language impairment
  • Associated with a known medical or genetic condition or environmental factor.
    Coding note: Use additional code to identify the associated medical or genetic condition.
  • Associated with another neurodevelopmental, mental, or behavioral disorder.
    Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].
  • With catatonia (refer to the criteria for catatonia associated with another mental disorder for definition).
    Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.

Severity Levels for Autism Spectrum Disorder

LEVEL 3: Requiring very substantial support

• Social communication:
  Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
• Restricted, repetitive behaviors:
  Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.

LEVEL 2: Requiring substantial support

• Social communication:
  Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.
• Restricted, repetitive behaviors:
  Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.

LEVEL 1: Requiring support

• Social communication:
  Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
• Restricted, repetitive behaviors:
  Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

The DSM-5 was published in May 2013.

Conclusion

In summary, knowing the specific diagnostic criteria for autism can help you understand what professionals are looking for when determining whether or not your child has autism. Furthermore, because diagnostic criteria is specific and based on behavior and developmental history, it is important that your child is assessed by a qualified and experienced professional. For more information on how to obtain a diagnosis, click here.

Additional Resources

• I Think My Child May Have Autism: How to Get a Diagnosis
• Child Newly Diagnosed with Autism