The Two Core Domains

The DSM-5 defines autism spectrum disorder through two core domains. Domain A involves persistent deficits in social communication and social interaction across multiple contexts, including deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing and maintaining relationships. Domain B involves restricted, repetitive patterns of behavior, interests, or activities, including stereotyped movements, insistence on sameness, restricted interests, and hyper- or hypo-reactivity to sensory input.

Specific Criteria

To receive an autism diagnosis, an individual must meet all three criteria within Domain A and at least two of the four criteria within Domain B. Domain B criteria include: stereotyped or repetitive motor movements, use of objects, or speech; insistence on sameness, inflexible adherence to routines, or ritualized patterns; highly restricted, fixated interests that are abnormal in intensity or focus; and hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.

Severity Levels

The DSM-5 specifies three severity levels based on the amount of support needed. Level 1, requiring support, describes individuals who have noticeable difficulties with social communication and flexibility but can function with some support. Level 2, requiring substantial support, describes marked deficits that are apparent even with support in place. Level 3, requiring very substantial support, describes severe deficits that significantly limit functioning in all areas.

Additional Diagnostic Specifications

The diagnosis also specifies whether autism occurs with or without accompanying intellectual impairment, with or without accompanying language impairment, and whether it is associated with a known medical or genetic condition. The DSM-5 also notes whether catatonia is present. These specifiers help create a more complete clinical picture and guide treatment planning.

The Evaluation Process

A comprehensive diagnostic evaluation typically involves clinical interviews with caregivers, standardized assessment tools like the ADOS-2 and ADI-R, cognitive and language testing, behavioral observation, and review of developmental history. The evaluation is conducted by qualified professionals including psychologists, developmental pediatricians, or multidisciplinary teams. If you are seeking a diagnostic evaluation, Treetop ABA Therapy can help connect you with qualified evaluators in your area.