Autism is no longer considered a rare disorder. About 1 in 59 children has been identified with an autism spectrum disorder (ASD) according to recent estimates from the CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network.
Currently, diagnosis of autism is based on observation of behavioral symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Because symptoms vary considerably from individual to individual, diagnosis can be quite challenging, and because it is a developmental disability, autism may affect an individual differently at different stages of their lifespan.
In the DSM-5 (2013), diagnostic criteria for autism spectrum disorder (ASD) have been categorized into two main areas: 1) social communication and social interaction, and 2) restricted and repetitive patterns of behavior, interests, or activities.
All of the following symptoms describing persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, must be met:
- Problems reciprocating social or emotional interaction, including abnormal social approach, difficulty establishing or maintaining back-and-forth conversations and interactions, inability to initiate or respond to an interaction, and problems with shared attention or sharing of emotions and interests with others.
- Severe problems in developing and maintaining relationships. This can range from difficulties with making friends and lack of interest in other people to difficulties in engaging in pretend play and age-appropriate social activities, and problems adjusting to different social expectations.
- Nonverbal communication problems such as abnormal eye contact, body language, posture, facial expressions, tone of voice and gestures, as well as an inability to understand these.
At least two of the four symptoms related to restricted and repetitive behavior need to be present:
- Stereotyped or repetitive speech, motor movements or use of objects.
- Excessive, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior, or insistence on sameness.
- Highly restricted, fixated interests that are abnormal in intensity or focus.
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment.
Symptoms must be present in early childhood but may not become fully manifest until social demands exceed capacities or may be masked by learned strategies in later life. Symptoms need to be functionally impairing and not better described by another DSM-5 diagnosis such as intellectual developmental disorder or global developmental delay.
With support from the NLM Family Foundation, Massachusetts Advocates for Children has published a fact sheet for parents and educators entitled, DSM-5 Autism Changes: Impact on Special Education. This fact sheet provides a brief explanation of the new DSM-5 ASD diagnostic criteria, and explains how the DSM-5 changes should not change or eliminate a child's IEP services. The fact sheet also describes special education rights and procedures parents can use to ensure that children continue to receive necessary services and supports. You can access the fact sheet by visiting Massachusetts Advocates for Children's website.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
Baio J, Wiggins L, Christensen DL, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ 2018;67(No. SS-6):1–23. DOI: http://dx.doi.org/10.15585/mmwr.ss6706a1.
Hyman, S.L. (2013). New DSM-5 includes changes to autism criteria. AAP News, June 2013.