1. Autism
  2. Learning about ASD
  3. Assessment & diagnosis

DSM-5: autism spectrum disorder diagnosis

2-18 years

Health professionals use the Diagnostic and statistical manual of mental disorders, or DSM, to diagnose autism spectrum disorder (ASD). The latest version of the Manual is DSM-5. It reflects the current understanding of ASD, based on research.

About the DSM and autism spectrum disorder diagnosis 

When diagnosing autism spectrum disorder (ASD), professionals like paediatricians, psychiatrists and psychologists use the Diagnostic and statistical manual of mental disorders, or DSM, produced by the American Psychiatric Association. 

The DSM lists the signs and symptoms of ASD and states how many of these symptoms must be present to confirm a diagnosis of ASD. 

DSM-5 and autism diagnosis 

The DSM-5 replaced the old manual (DSM-IV) in May 2013.

The DSM-5 made some key changes to autism spectrum disorder (ASD) diagnosis. There’s now a single diagnosis of autism spectrum disorder that replaces the different subdivisions – autistic disorder, Asperger’s disorder and pervasive developmental disorder – not otherwise specified. There’s also a separate diagnosis of social communication disorder.

DSM-5 criteria for ASD diagnosis

Professionals diagnose autism spectrum disorder (ASD) on the basis of difficulties in two areas – social communication, and restricted, repetitive behaviour or interests.

To be diagnosed with ASD, your child must:

  • have difficulties in both areas
  • have had symptoms from early childhood, even if these aren’t picked up until later in childhood.

Difficulties in social communication
A child must have difficulties in the area of social communication to be diagnosed with ASD.

Signs of difficulties in this area include:

  • rarely using language to communicate with other people
  • not speaking at all
  • not responding when spoken to
  • not copying other people’s actions like clapping
  • not understanding gestures
  • not using facial expressions to communicate 
  • not showing an interest in friends
  • not engaging in imaginative play. 

Restricted, repetitive behaviour or interests
A child must have difficulties in the area of behaviour and interests to be diagnosed with ASD.

Signs of difficulties in this area include:

  • lining toys up in a particular way over and over again
  • having very narrow and intense interests
  • needing things to always happen in the same way
  • having trouble with changing from one activity to another
  • showing sensory sensitivities like not liking labels on clothes, or licking or sniffing objects.

Severity ranking 
An ASD diagnosis includes a severity ranking – level 1, 2 or 3. The ranking is used to show how much support your child needs. This reflects the fact that some people have mild ASD symptoms, and others have more severe symptoms.

The rating is given separately for the two areas of difficulty, so your child might have different severity rankings for social difficulties and repetitive behaviours.

Criteria for social communication disorder diagnosis

Social communication disorder (SCD) is similar to ASD. The main difference between SCD and ASD is repetitive behaviour.

If your child has at least two repetitive behaviours, it could point to a diagnosis of ASD. If not, it could point to a diagnosis of SCD.

Diagnosis of two or more disorders 

If your child has other symptoms that meet the criteria for other disorders, she’ll be diagnosed as having two or more disorders – for example, autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD).

Children who have a diagnosis under DSM-IV

If your child already has a diagnosis of autism spectrum disorder (ASD) – autistic disorder, high-functioning autism, Asperger’s syndrome or PDD-NOS – that was made under DSM-IV, you can keep using these terms if you want to. 

In some circumstances, you might need to get a letter confirming your child’s diagnosis under DSM-5. For example, some schools want a new diagnosis letter confirming a DSM-5 diagnosis to ensure funding for your child. 

The DSM-5 states that anyone with ‘a well established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder’. Your child’s health professional will just need to add a severity rating.

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