About the DSM and autism spectrum disorder diagnosis
When diagnosing autism spectrum disorder, professionals like paediatricians, psychiatrists, psychologists and speech pathologists use the Diagnostic and statistical manual of mental disorders (5th edition, Text revision), or DSM-5-TR, produced by the American Psychiatric Association.
The DSM-5-TR lists the signs and symptoms of autism spectrum disorder and states how many of these must be present to confirm a diagnosis of autism spectrum disorder. The DSM-5-TR refers to ‘signs and symptoms’, but this article talks about ‘signs and characteristics’.
To find out whether a child has autism signs and characteristics and meets DSM-5-TR criteria for an autism diagnosis, professionals also need to do extra assessments.
DSM-5-TR criteria for autism spectrum disorder diagnosis
Professionals diagnose autism spectrum disorder on the basis of difficulties in 2 areas – ‘social communication’, and ‘restricted, repetitive and/or sensory behaviours or interests’.
To be diagnosed with autism spectrum disorder, children must:
- have difficulties and/or differences from what’s typical in both areas
- have had characteristics from early childhood, even if these aren’t picked up until later in childhood.
Difficulties in social communication
To be diagnosed with autism spectrum disorder, children must have difficulties and/or differences from what’s typical in the area of social communication.
Signs in this area include:
- rarely using language to communicate with other people
- not speaking at all
- rarely responding when spoken to
- not sharing interests or achievements with parents
- rarely using or understanding gestures like pointing or waving
- using only limited facial expressions to communicate
- not showing an interest in friends or having difficulties making friends
- rarely engaging in imaginative play.
Restricted, repetitive and sensory behaviour or interests
To be diagnosed with autism spectrum disorder, children must have difficulties and/or differences from what’s typical in the area of restricted, repetitive and/or sensory behaviours or interests.
Signs in this area include:
- lining up toys in a particular way over and over again
- frequently flicking switches or spinning objects
- speaking in a repetitive way
- having very narrow or intense interests
- needing things to always happen in the same way
- having trouble with changes to their schedule, or changing from one activity to another
- showing signs of sensory sensitivities like becoming distressed by everyday sounds like hand dryers, not liking the feel of clothes labels, or licking or sniffing objects.
Levels of support
An autism spectrum disorder diagnosis includes support levels. These are used to show how much support children need:
- Level 1 – children need support.
- Level 2 – children need substantial support.
- Level 3 – children need very substantial support.
These levels reflect the fact that autism characteristics affect people’s everyday lives in various ways. Some people need a lot of support, and some need only a little support.
The diagnosis indicates support levels for each area. This means that children might have different support levels for their social communication skills compared to their restricted, repetitive and/or sensory behaviours. Or they might have the same support level for both.
Levels of support can change across time. This happens as children grow and go through transitions. These transitions include moving from child care to primary school to secondary school, or changes in family life like the birth of siblings.
The DSM-5-TR says that these levels should not be used to decide whether children are eligible for services.
Criteria for social communication disorder diagnosis
Social communication disorder is similar to autism spectrum disorder. The main difference is that children diagnosed with social communication disorder don’t have restricted, repetitive and/or sensory behaviour.
If children have at least 2 restricted, repetitive and/or sensory behaviours, it could point to a diagnosis of autism spectrum disorder. If not, it could point to a diagnosis of social communication disorder.
Diagnosis: conditions that occur with autism
There are some conditions that occur with autism.
Sometimes children have signs and characteristics of neurodevelopmental, mental or behavioural issues as well as autism. In this situation, children can be diagnosed as having 2 or more conditions – for example, autism spectrum disorder and attention deficit hyperactivity disorder (ADHD) or intellectual disability.
The professionals who are doing the assessment and diagnosis for autism spectrum disorder might also say that children have issues like a risk of self-injury, which isn’t a diagnosable condition.