Autism DSM-5-TR Criteria 🧠

Autism Spectrum Disorder

Autism Spectrum Disorder is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction across multiple contexts, together with restricted, repetitive patterns of behavior, interests, or activities. Symptoms must be present in the early developmental period, cause clinically significant impairment in social, occupational, or other important areas of current functioning, and not be better explained by intellectual developmental disorder or global developmental delay.

Criterion A: Persistent Deficits in Social Communication and Social Interaction

All three areas must be present, currently or by history, across multiple contexts.

A1. Deficits in social-emotional reciprocity

• Abnormal social approach or difficulty with normal back-and-forth conversation
• Reduced sharing of interests, emotions, or affect
• Failure to initiate or respond to social interactions

A2. Deficits in nonverbal communicative behaviors used for social interaction

• Poorly integrated verbal and nonverbal communication
• Abnormalities in eye contact or body language
• Deficits in understanding or using gestures
• Reduced or absent facial expressions and other nonverbal communication

A3. Deficits in developing, maintaining, and understanding relationships

• Difficulty adjusting behavior to suit different social contexts
• Difficulty sharing imaginative play or making friends
• Reduced or absent interest in peers
• Difficulty developing, maintaining, or understanding relationships

Criterion B: Restricted, Repetitive Patterns of Behavior, Interests, or Activities

At least two of the following four must be present, currently or by history.

B1. Stereotyped or repetitive motor movements, use of objects, or speech

• Simple motor stereotypies or repetitive movements
• Repetitive use of or interaction with objects, such as lining up toys or flipping objects
• Echolalia or other repetitive speech
• Idiosyncratic or stereotyped phrases

B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

• Extreme distress at small changes
• Difficulty with transitions
• Rigid thinking patterns
• Ritualized verbal or nonverbal behaviors
• Need for sameness or predictable routines, such as taking the same route or eating the same foods

B3. Highly restricted, fixated interests that are abnormal in intensity or focus

• Strong attachment to or preoccupation with particular objects or topics
• Excessively circumscribed interests
• Interests that are unusually intense, focused, or perseverative

B4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

• Apparent indifference to pain or temperature
• Adverse responses to specific sounds, textures, or other sensory input
• Excessive smelling or touching of objects
• Visual fascination with lights or movement
• Other unusually strong or reduced responses to sensory input

Criterion C: Symptoms Present in the Early Developmental Period

Symptoms must be present in the early developmental period. They may not become fully manifest until social demands exceed limited capacities, or they may be masked by learned strategies in later life.

Criterion D: Clinically Significant Impairment

Symptoms must cause clinically significant impairment in social, occupational, or other important areas of current functioning.

Criterion E: Not Better Explained by Intellectual Developmental Disorder or Global Developmental Delay

The disturbances are not better explained by intellectual developmental disorder or global developmental delay. Intellectual developmental disorder and Autism Spectrum Disorder frequently co-occur. When both diagnoses are present, social communication should be below that expected for the person's general developmental level.

DSM-5-TR Specifiers and Severity

Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior:

• Requiring support
• Requiring substantial support
• Requiring very substantial support

Also specify:

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with a known genetic or other medical condition or environmental factor
• Associated with another neurodevelopmental, mental, or behavioral problem
• With catatonia

When a known genetic or other medical condition is present, use an additional code to identify the associated condition. When catatonia is associated with Autism Spectrum Disorder, use additional code F06.1.

Additional DSM-5-TR Diagnostic Notes

• Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given a diagnosis of Autism Spectrum Disorder.
• Individuals with marked deficits in social communication whose symptoms do not otherwise meet criteria for Autism Spectrum Disorder should be evaluated for Social (Pragmatic) Communication Disorder.

F Code / ICD-10-CM

F84.0 — Autism spectrum disorder

Use F84.0 for Autism Spectrum Disorder in ICD-10-CM coding. The DSM-5-TR diagnosis of Autism Spectrum Disorder corresponds to this code.

DSM-5-TR Specifiers

Document applicable specifiers for:

• With or without accompanying intellectual impairment
• With or without accompanying language impairment
• Associated with a known genetic or other medical condition or environmental factor — use an additional code to identify the associated condition when applicable.
• Associated with a neurodevelopmental, mental, or behavioral problem
• With catatonia — use additional code F06.1 when applicable.

Current Severity

Specify current severity based on the level of support required for social communication impairments and restricted, repetitive patterns of behavior:

• Requiring support
• Requiring substantial support
• Requiring very substantial support

Clinical Assessment Note

A diagnosis should not be made from a checklist or screening score alone. Comprehensive assessment should integrate developmental history, current presentation, functioning across contexts, direct clinical observation, collateral information when appropriate, and consideration of differential diagnoses and co-occurring conditions.

Screening instruments can identify whether further evaluation may be warranted; they do not by themselves establish an Autism diagnosis.