Autism Spectrum Disorders: Definitions

The American Psychiatric Association's newly revised document and ASD definitions are also available through the DSM-5 website: http://www.psych.org/practice/dsm/dsm5

The APA site includes the Table of Contents, notices of recent updates, and a list of emerging Assessment Measures. Updates to the DSM site are ongoing. A Fact Sheet outlining some of the most significant changes to the Autism diagnosis is also available.

A retrospective summary of earlier descriptions and definitions (including DSM-IV-TR) is available at unstrange.com.

More information on ASD and specific disability criteria is available from the US Department of Education:

http://idea.ed.gov/.

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AUTISM SPECTRUM DISORDER is characterized by persistent deficits in social communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviors used for social interaction, and skills in developing, maintaining, and understanding relationships. In addition to the social communication deficits, the diagnosis of autism spectrum disorder requires the presence of restricted, repetitive patterns of behavior, interests, or activities. Because symptoms change with development and may be masked by compensatory mechanisms, the diagnostic criteria may be met on historical information, although the current presentation must cause significant impairment. 

WITHIN the diagnosis of autism spectrum disorder, individual clinical characteristics are noted through the use of specifiers (with or without accompanying intellectual impairment; associated with known medical/genetic or environmental/acquired condition; associated with another neuro-developmental, mental, or behavioral disorder), as well as specifiers that describe the autistic symptoms (age at first concern; with or without loss of established skills; severity). These specifiers provide clinicians with an opportunity to individualize the diagnosis and communicate a richer clinical description of the affected individuals. For example, many individuals previously diagnosed with Asperger's disorder would now receive a diagnosis of autism spectrum disorder without language or intellectual impairment.

— American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). Washington, DC: Author.  pp. 31-32.

299.00 (F84.0)

A. Persistent deficits in social comunication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Deficits in social/emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharinng of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and noverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specifcy current severity:  Severity is based on social communication impairments and restricted, repetitive patterns of behavior

B.  Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
   
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perserverative interests).
   
4. Hyper- or hyporeativity to sensory input or unusual interest in sensory aspects of the environmment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specifcy current severity:  Severity is based on social communication impairments and restricted, repetitive patterns of behavior

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

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

E.  These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

— American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5). Washington, DC: Author. pp. 50-51.

Individuals with a well-established DSM-IV diagnnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. 

Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify it:
With or without accompanying intellectual impairment

With or without accompanying language impairment

Associated with a known medical or genetic condition or environmental factor (Coding note: Use additional code to identify the associated neurodevelopmental, mental, or bahavioral disorder(s).)

Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code(s) to identify the associated neurodevelopmental, mental, or behavioral disorder(s).)

With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition). (Coding note: Use additional code 293.89 (F06.1) catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)