TABLE 1

DSM-5 Criteria for Autism Spectrum Disorder

DomainsCriteria: DeficitsExamples
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history; must have all 3 symptoms in this domain1. Social-emotional reciprocityAbnormal social approach and failure of normal back-and-forth conversation; reduced sharing of interests, emotions, or affect; failure to initiate or respond to social interactions
2. Nonverbal communicative behaviors used for social interactionPoorly integrated verbal and nonverbal communication; abnormalities in eye contact and body language or deficits in understanding and use of gestures; total lack of facial expressions and nonverbal communication
3. Developing, maintaining, and understanding relationshipsDifficulties adjusting behavior to suit various social contexts; difficulties in sharing imaginative play or in making friends; absence of interest in peers
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following, currently or by history; must have 2 of the 4 symptoms1. Stereotyped or repetitive motor movements, use of objects, or speechSimple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behaviorExtreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day
3. Highly restricted, fixated interests that are abnormal in intensity or focusStrong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environmentApparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, 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 capacities or may be masked by learned 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 disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and ASD frequently co-occur; to make comorbid diagnoses of ASD and intellectual disability, social communication should be below that expected for the general developmental level. Specify whether: with or without accompanying intellectual impairment, language impairment or associated with a known medical or genetic condition or environmental factor. Add code 293.89 if catatonia is also present. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (copyright 2013). American Psychiatric Association. All Rights Reserved.