DSM-5 Autism Criteria in Plain Language
A DSM-5 autism diagnosis requires persistent differences in two areas: social communication and interaction, and restricted or repetitive patterns of behavior, interests, or activities. Signs must be present in the early developmental period (though they may not fully show until social demands exceed a person's capacities, or may be masked by learned strategies later in life), cause clinically significant impairment, and not be better explained by intellectual disability or global developmental delay. Applying these criteria is the work of a qualified professional.
The Two Core Areas
A DSM-5 autism diagnosis requires persistent differences in two areas:
- Social communication and interaction
- Restricted or repetitive patterns of behavior, interests, or activities
Signs must be present in the early developmental period (though they may not fully show until social demands exceed a person's capacities, or may be masked by learned strategies later in life), cause clinically significant impairment, and not be better explained by intellectual disability or global developmental delay.
Area 1: Social Communication
All three of these must be present:
- Back-and-forth social interaction differences
- Nonverbal communication differences (eye contact, body language, facial expressions)
- Difficulty developing or maintaining relationships
Area 2: Restricted and Repetitive Behaviors
At least two of these four must be present:
- Repetitive movements or speech (stimming, echolalia)
- Insistence on sameness
- Highly restricted, fixated interests
- Sensory hyper- or hyporeactivity
Atypical responses to sensory input became a new criterion in DSM-5.
Levels and Their Limitations
DSM-5 defines three severity levels, rated separately for social communication and for restricted, repetitive behaviors:
- Level 1: requires support
- Level 2: requires substantial support
- Level 3: requires very substantial support
A person's presentation can vary across settings and time. DSM-5 records intellectual impairment and language impairment separately, so a level does not tell you a person's intelligence or communication ability.
What the Criteria Miss
Research suggests girls who meet the criteria are at risk of not being diagnosed: a 2017 meta-analysis estimated the true male-to-female ratio is closer to 3 to 1 than the often assumed 4 to 1, and found a diagnostic gender bias. Late-diagnosed people who mask may also be missed, which DSM-5 itself acknowledges when it notes signs can be masked by learned strategies. Internal experiences like burnout, alexithymia, and double empathy are largely invisible to the diagnostic framework.
Sources
- CDC: Clinical Testing and Diagnosis for Autism Spectrum Disorder (DSM-5 criteria)
- Green et al. (2016), DSM-5 Sensory Behaviours in Children With and Without an Autism Spectrum Disorder, J Autism Dev Disord
- Loomes, Hull and Mandy (2017), What Is the Male-to-Female Ratio in Autism Spectrum Disorder? J Am Acad Child Adolesc Psychiatry
Frequently Asked Questions
What are the two core areas of the DSM-5 autism criteria?
A DSM-5 autism diagnosis requires persistent differences in two areas: social communication and interaction, and restricted or repetitive patterns of behavior, interests, or activities. Signs must be present in the early developmental period (though they may not fully show until social demands exceed a person's capacities, or may be masked by learned strategies later in life), cause clinically significant impairment, and not be better explained by intellectual disability or global developmental delay.
How many criteria must be present in each area?
In the social communication area, all three criteria must be present, currently or by history: differences in back-and-forth social-emotional interaction, nonverbal communication differences, and difficulty developing, maintaining, and understanding relationships. In the restricted and repetitive behaviors area, at least two of the four must be present.
What are the DSM-5 support levels?
DSM-5 defines three severity levels, rated separately for social communication and for restricted, repetitive behaviors: Level 1 requires support, Level 2 requires substantial support, and Level 3 requires very substantial support. Intellectual impairment and language impairment are recorded separately, so a level does not tell you a person's intelligence or communication ability.
What changed in the criteria from DSM-IV?
Atypical responses to sensory input, meaning sensory hyper- or hyporeactivity or unusual sensory interests, became a new criterion in DSM-5.
Who do the DSM-5 criteria describe least accurately?
Research suggests the criteria are applied less readily to girls: a 2017 meta-analysis in the Journal of the American Academy of Child and Adolescent Psychiatry found a diagnostic gender bias, with girls who meet criteria at risk of not being diagnosed. DSM-5 itself notes that signs may be masked by learned strategies later in life.
What do the criteria miss?
Internal experiences like burnout, alexithymia, and the double empathy problem are largely invisible to the diagnostic framework.
We are not doctors. We are advocates. Nothing on this site constitutes medical advice. Always consult a qualified healthcare provider about diagnosis, treatment, or any decision regarding your health or your child's health.