The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines the criteria for Autism Spectrum Disorder (ASD) as a single disorder that encompasses previous diagnoses like Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). ASD is characterized by deficits in social communication and interaction, along with restricted, repetitive patterns of behavior, interests, or activities.

DSM-5 Diagnostic Criteria for Autism Spectrum Disorder (ASD)

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:

1. Deficits in social-emotional reciprocity, ranging 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 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 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.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, 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 the same route or eat the 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 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, visual fascination with lights or movement).

C. 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).

D. Symptoms cause clinically significant 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 ASD and intellectual disability, social communication should be below that expected for general developmental level.

Specifiers

• With or without accompanying intellectual impairment.
• With or without accompanying language impairment.
• Associated with a known medical or genetic condition or environmental factor.
• Associated with another neurodevelopmental, mental, or behavioral disorder.
• With catatonia.

Severity Levels

The DSM-5 also includes a severity rating system for both social communication impairments and restricted, repetitive behaviors:

• Level 1: Requiring support.
• Level 2: Requiring substantial support.
• Level 3: Requiring very substantial support.

The severity of ASD is assessed based on the level of support required for daily functioning, social interaction, and managing restricted and repetitive behaviors.

Key Features of ASD

• Heterogeneity: ASD presents differently in each individual, with some showing significant intellectual or language impairments, while others may have normal to above-average intelligence but struggle with social interaction.
• Spectrum nature: The term “spectrum” reflects the wide range of symptoms, skills, and levels of disability in individuals with autism.
• Early diagnosis: Symptoms typically become noticeable in the first two years of life, and early intervention is important for improving outcomes. However, in some cases, symptoms may not become fully apparent until later in childhood or adulthood.

Reference:
American Psychiatric Association, DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing, Inc.. https://doi.org/10.1176/appi.books.9780890425596

DSM Cover image source:

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