Criteria
DSM-5-TR[1]
The DSM-5-TR criteria for diagnosis of ASD are:
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history:
Deficits in social-emotional reciprocity. For example, these can range 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.
Deficits in non-verbal communicative behaviours used for social interaction. For example, these can range from poorly integrated verbal and non-verbal communication; to abnormalities in eye contact and body language or deficits in understanding and using gestures; to a total lack of facial expressions and non-verbal communication.
Deficits in developing and understanding relationships. For example, these can range from difficulties in adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to an absence of interest in peers.
Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least 2 of the following, currently or by history:
Stereotyped or repetitive motor movements, use of objects or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, and idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal or non-verbal behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, and need to take same route or eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, and excessively circumscribed or perseverative interests).
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, and visual fascination with lights or movement).
Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capabilities, or may be masked by learnt strategies in later life).
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
These disturbances are not better explained by intellectual development disorder (intellectual disability) or global development delay. Intellectual development disorder and ASD frequently co-occur; in order to make comorbid diagnoses of ASD and intellectual development disorder, social communication should be below that expected for the general developmental level.
DSM-5-TR states that people with well-established DSM-IV diagnosis of autistic disorder, Asperger's syndrome, or pervasive developmental disorder not otherwise specified should be given the diagnosis of ASD. However, some clinicians and people with DSM-IV diagnoses prefer individuals previously diagnosed to retain their original diagnosis.
People who have marked deficits in social communication, but whose symptoms otherwise meet no ASD criteria, should be evaluated for social (pragmatic) communication disorder.
There are 3 accompanying levels of severity to the DSM-5-TR criteria:
1. Level 3 severity level: requiring very substantial support
Social communication: severe deficits in verbal and non-verbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.
Restricted, repetitive behaviours: inflexibility of behaviour, extreme difficulty coping with change, or other restricted/repetitive behaviours markedly interfere with functioning in all spheres. Great distress and/or difficulty changing focus or action.
2. Level 2 severity level: requiring substantial support
Social communication: marked deficits in verbal and non-verbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others.
Restricted, repetitive behaviours: inflexibility of behaviour, difficulty coping with change, or other restricted/repetitive behaviours appear frequently enough to be obvious to the casual observer and interfere with functioning in various contexts. Distress and/or difficulty changing focus or action.
3. Level 1 severity level: requiring support
Social communication: without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures from others. May appear to have decreased interest in social interactions.
Restricted, repetitive behaviours: inflexibility of behaviour causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organisation and planning hamper independence.
World Health Organization International Classification of Diseases 11th edition (ICD-11)[2]
The ICD-11 criteria are broadly in line with the DSM-5-TR criteria. The ICD-11 includes the same two categories of difficulties in interaction and social communication, along with restricted interests and repetitive behaviours. However, ICD-11 places less emphasis on the type of play children partake in, as this may vary culturally, and focuses more on whether children impose strict rules when they play.
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