What are the DSM-V diagnostic criteria for autism?
In 2013, the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The text revision (DSM-V-TR) was published on March 18, 2022, that provided tweaks to this diagnosis. The DSM-V is now the standard reference that healthcare providers use to diagnose mental and behavioral conditions, including autism.
You can read the full text of the diagnostic criteria for Autism Spectrum Disorder (ASD) below. Related diagnoses are listed at the bottom of this page.
Autism Spectrum Disorder (ASD)
DSM-V Autism Diagnostic Criteria
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history (examples are illustrative, not exhaustive, see text):
- Deficits in social-emotional reciprocity, ranging, for example, 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 nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to the absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests 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, visual fascination with lights or movement).
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; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for the general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder/syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS) should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet the criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
Specify if:
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- (Coding note: Use additional code to identify the associated medical or genetic condition.)
- Associated with another neurodevelopmental, mental, or behavioral problem
- (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral problem[s].)
- With catatonia
- Associated with a known medical or genetic condition or environmental factor
Sources
- American Psychiatric Association. “Diagnostic Criteria for the 299.00 Autism Spectrum Disorder” (2022). Diagnostic and Statistic Manual, Fifth Edition (DSM-5-TR).
- Peter Hess, “DSM-5 revision tweaks autism entry for clarity” (Mar. 17, 2022) Spectrum.
Medical Codes
- DSM-5-TR: 299.00
- ICD-10: F84.0 “Autistic Disorder”
- ICD-11: 6A02 “Autism Spectrum Disorder”
Severity Levels for Autism Spectrum Disorder (ASD)
Patients may or may not receive a severity level with their autism diagnosis. If you do, please consider not using it when talking about autism by learning more about how and why functioning labels are inaccurate and harmful to autistic people.
| Severity Level | Social Communication | Restricted, repetitive behaviors |
|---|---|---|
| Level 1 | Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. | Inflexible behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence. |
| Level 2 | Marked deficits in verbal and nonverbal social communication skills. Social impairments are apparent even with supports in place. Limited initiation of social interactions. Reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication. | Inflexible behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action. |
| Level 3 | Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning. Very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. | Inflexible behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action. |
Autism Self-Diagnosis
Receiving a clinical diagnosis for autism, especially as an adult, is difficult. Very few studies of autistic adults have been performed so the scientific and medical communities are largely uninformed about how autism presents in adults, sex, gender, ethnicity, etc. so many autistics are misdiagnosed or not diagnosed at all. Self-diagnosis is valid.Editor's Note: This article was originally published on , and was last reviewed on . This page was updated to the diagnostic criteria from the DSM-5-TR version on April 14, 2022. You can view the former DSM-5 version of this page here.
