What is the DSM?
The DSM is the Diagnostic and statistical manual of mental disorders.
It’s a reference and diagnostic tool produced by the American Psychiatric Association to classify and diagnose mental health conditions.
The version of the DSM that professionals currently use is the 5th edition, Text revision, or DSM-5-TR.
How is the DSM used to diagnose autism?
Professionals like paediatricians, psychiatrists, psychologists and speech pathologists use the DSM to diagnose autism (which it refers to as ‘autism spectrum disorder’).
The DSM-5-TR lists the signs and characteristics of autism and states how many of these must be present for children to get an autism diagnosis. (The DSM-5-TR refers to ‘signs and symptoms’, but this article talks about ‘signs and characteristics’.)
To find out whether children have autism signs and characteristics and meet DSM-5-TR criteria for an autism diagnosis, professionals need to do assessments, observations, interviews and reports.
Children who are diagnosed with autism have many strengths, but the DSM-5-TR criteria focuses on deficits. To find out whether children meet the criteria for autism diagnosis, families and professionals need to spend time assessing the things children find difficult or might be expected to do at their age but aren’t yet doing.
What are the DSM-5-TR criteria for autism diagnosis?
Professionals diagnose autism based on 2 areas:
- differences in social communication skills
- repetitive behaviour, intense or special interests, and sensory differences or sensitivities.
To be diagnosed with autism, children must:
- have differences from ‘typical’ development in both areas
- have had characteristics from early childhood, even if these aren’t picked up until later childhood or adolescence.
Differences in social communication skills
Signs of autism in children’s social communication can include:
- expressing themselves differently from others or understanding others differently
- not responding when spoken to or when their name is called
- avoiding eye contact or using it less than expected
- not sharing interests or attention with others – for example, not showing toys to others or pointing to things
- not using or understanding gestures like pointing, clapping or waving
- using or understanding facial expressions differently
- not showing much interest in other children or having difficulties making friends
- not showing much interest in pretend play like pretending to feed a doll.
Repetitive behaviour, intense or special interests, and sensory sensitivities or differences
Signs of autism in children’s behaviour, interests or sensory profile can include:
- playing with toys in a repetitive way, like repeatedly lining up toys or playing a game in the same way
- repeating behaviour with their body or objects – for example, frequently flicking switches, flapping hands or spinning objects
- using repetitive sounds or words – for example, repeating words from a TV show
- having intense or focused interests – for example, collecting things like rocks or buttons, or being very interested in dates, cartoon characters or dolls
- having difficulty with transitions between activities or changes to schedule or routines
- showing signs of sensory sensitivities – for example, becoming distressed by everyday sounds like hand dryers or not liking the feel of certain clothes.
What are the levels of support in an autism diagnosis?
An autism diagnosis includes an estimation of how much support children might need. This is because autism affects children’s lives in various ways. Some children need a lot of support, and some need only a little support.
These are the levels of support in an autism diagnosis:
- Level 1 – children need support.
- Level 2 – children need substantial support.
- Level 3 – children need very substantial support.
An autism diagnosis indicates the levels of support children need for both:
- social communication skills
- repetitive behaviour, special interests or sensory sensitivities or differences.
Children might have the same or different support level for each area.
Children’s support levels can change across time. This happens as children grow and go through transitions like moving from child care to primary school, starting puberty or welcoming new siblings.
The DSM-5-TR says that support levels should not be used to decide whether children are eligible for services.
What does the DSM say about diagnosing autism and co-occurring conditions?
There are some conditions that occur with autism.
Sometimes children have signs and characteristics of neurodevelopmental, mental, physical or behavioural conditions as well as autism. In this situation, children can be diagnosed with 2 or more conditions – for example, autism and ADHD or intellectual disability.
The DSM-5-TR says that an autism diagnosis should include whether children have also met the criteria for a co-occurring intellectual disability, language disability or other known neurodevelopmental, medical or genetic condition.