DSM-5 Autism Criteria in Plain Language
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
Both must be present from the early developmental period, cause significant impairment, and not be better explained by another condition.
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
The inclusion of sensory criteria in DSM-5 was a significant change from DSM-IV.
Levels and Their Limitations
DSM-5 defines three support levels:
- Level 1: requires support
- Level 2: requires substantial support
- Level 3: requires very substantial support
These levels are widely criticized for oversimplifying a complex picture. A person's presentation varies across settings and time, and levels do not predict intelligence, communication ability, or quality of life.
What the Criteria Miss
The DSM-5 criteria were developed primarily from research on white males diagnosed in childhood. They describe that population more accurately than women, girls, people of color, and late-diagnosed individuals who mask effectively. Internal experiences like burnout, alexithymia, and double empathy are largely invisible to the diagnostic framework.