The autism diagnosis criteria in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) define Autism Spectrum Disorder (ASD) as a neurodevelopmental condition characterized by persistent challenges in social communication and interaction, alongside restricted, repetitive patterns of behavior, interests, or activities. The DSM-5 uses a unified diagnosis of ASD, replacing previous separate diagnoses like Asperger syndrome and classic autism, to reflect the spectrum nature of the condition.
To be diagnosed with ASD according to DSM-5, an individual must meet criteria in two main domains:
1. **Persistent deficits in social communication and social interaction across multiple contexts**, manifested by all three of the following:
– Deficits in social-emotional reciprocity, such as difficulties in back-and-forth conversation, reduced sharing of interests or emotions, or failure to initiate or respond to social interactions.
– Deficits in nonverbal communicative behaviors used for social interaction, including abnormalities in eye contact, body language, or understanding and using gestures; a total lack of facial expressions and nonverbal communication can also be present.
– Deficits in developing, maintaining, and understanding relationships, which may range from difficulties adjusting behavior to suit various social contexts, to problems sharing imaginative play or making friends, and in some cases, an apparent absence of interest in peers.
2. **Restricted, repetitive patterns of behavior, interests, or activities**, as manifested by at least two of the following:
– Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys, echolalia, idiosyncratic phrases).
– 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).
– 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).
– Hyper- or hyporeactivity 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).
Additionally, the symptoms must be present in the early developmental period, though they may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies later in life.
The symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning. Furthermore, these disturbances cannot be better explained by intellectual disability or global developmental delay, although ASD can co-occur with these conditions.
The DSM-5 also specifies **three levels of severity** to indicate the amount of support an individual requires:
– **Level 1: Requiring support**
Individuals at this level have noticeable difficulties with social communication without supports in place. They may struggle with initiating social interactions and show inflexibility of behavior that interferes with functioning in one or more contexts. They can speak in full sentences and engage in communication but may have difficulty organizing and planning.
– **Level 2: Requiring substantial support**
At this level, social communication deficits are more pronounced, and individuals exhibit marked difficulties coping with change or restricted behaviors that are obvious to the casual observer. They require substantial support to function effectively in daily life.
– **Level 3: Requiring very substantial support**
This is the most severe level, where individuals show severe deficits in verbal and nonverbal social communication skills, causing severe impairments in functioning. They exhibit extreme difficulty coping with change and have very restricted, repetitive behaviors that markedly interfere with daily life.
The DSM-5 criteria emphasize that autism is a spectrum, reflecting a wide range of presentations and support needs rather than a single, uniform condition. The diagnosis is behaviorally based, focusing on observable symptoms rather than underlying cause
