The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is a widely used diagnostic manual in the field of mental health, including the diagnosis of Autism Spectrum Disorder (ASD). In the DSM-5, ASD is characterized by specific diagnostic criteria. To receive a diagnosis of ASD according to the DSM-5, an individual must exhibit symptoms in two core domains: social communication and restricted, repetitive behaviors. The diagnostic criteria for ASD in the DSM-5 include the following:
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:
- Deficits in social-emotional reciprocity, such as difficulty with back-and-forth conversation and reduced sharing of interests or emotions.
- Deficits in nonverbal communicative behaviors, including abnormalities in eye contact, body language, and facial expressions.
- Deficits in developing and maintaining relationships, characterized by difficulties adjusting behavior to suit various social contexts, and difficulties in sharing imaginative play or making friends.
B. 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., hand-flapping, lining up toys, echolalia) .
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
- Highly restricted, fixated interests that are abnormal in intensity or focus.
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain or temperature, adverse responses to specific sounds or textures)
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, but the social and communication impairments in ASD are more severe than those typically associated with general developmental delays.
The DSM-5 no longer includes distinct subtypes or categories (e.g., Asperger’s disorder, childhood disintegrative disorder, pervasive developmental disorder—not otherwise specified) that were used in previous editions. Instead, it classifies all individuals who meet the criteria under the single umbrella diagnosis of autism spectrum disorder, recognizing the wide variability in symptom severity and presentation within the spectrum.
It’s important to note that the DSM-5 provides a standardized framework for diagnosing ASD, but diagnosis should be made by qualified healthcare professionals with expertise in developmental disorders who conduct a comprehensive evaluation and consider the individual’s unique characteristics and needs. Early diagnosis and intervention are key to improving outcomes for individuals with ASD.