DSM-5 Autism Criteria in Plain Language
The Two Core Areas
DSM-5 autism diagnosis requires persistent differences in two areas: social communication and interaction, and restricted or repetitive patterns of behavior, interests, or activities. These must be present from the early developmental period, cause significant impairment, and not be better explained by another condition.
Area 1: Social Communication
Three domains are required: back-and-forth social interaction differences, nonverbal communication differences (eye contact, body language, facial expressions), and difficulty developing or maintaining relationships. All three must be present.
Area 2: Restricted and Repetitive Behaviors
At least two of four types are required: repetitive movements or speech (stimming, echolalia), insistence on sameness, highly restricted fixated interests, and 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 includes 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. 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.