DSM-5 Autism Criteria
The Diagnostic Statistical Manual 5th edition, commonly referred to as the ‘DSM-5’, is the current document that is used within many countries, including Australia and the United States, to define and classify “mental disorders”. The DSM-5 views neurodivergence (i.e. differences in brain function that are not considered typical or ‘normal’) from a pathological lens using the medical model. This means that the DSM-5 considers autism to be a ‘problem’ or ‘deficit’ that must be ‘fixed’ by medical approaches and interventions so that the individual can become ‘fully functioning’; in other words, neuronormative or neurotypical.
But, it doesn’t have to be this way.
It’s true, The DSM-5-TR does outline the qualities and experiences that illustrate the autistic neurotype, but these do not have to be characterised as being ‘negative’. Instead, we can understand the autistic experience as being a different, but equally valid, way of engaging with the world, interacting with others and understanding one’s self. There is no ‘one way’ to be autistic with this neurotype manifesting as a kaleidoscope of presentations. When showing up as authentic versions of themselves in an environment that accommodates their needs and preferences, communicating and connecting in genuine ways and honouring who they are, autistic people are able to have immersive sensory experiences, build meaningful enduring relationships and have a strong sense of self.
Below, our Founder, autistic Speech Pathologist and Autism Assessor, Dasha Kolesik, has reimagined The DSM-5 criteria to capture what the autistic qualities and experiences actually look like using a neuroaffirming lens.
A Criteria: Communication and Connection
A1 - Current Formal DSM-5 Criteria
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
A1 - Social Communication | Through a Neurodiversity Affirming Lens
Autistic people socialise and connect in different ways to non-autistic people. Authentic autistic communication is often interest-driven and may include, but is not limited to, sharing of relevant personal experiences (anecdotal contributions), discussing ‘deep’ topics, interrupting enthusiastically (co-utterances), and the using relatable quotes in conversation (scripting). Autistic social communication has been seen as a “deficit” when judged against neurotypical standards. It is important to note that autistic social skills and communication styles are just as effective, valid and valuable. The communication “breakdown” occurs when people of different neurotypes communicate, particularly when there is a lack of understanding of the different communication styles and preferences, and when different communication styles are not understood or accommodated for.
A2 - Current Formal DSM-5 Criteria
Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal 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.
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A2 - Non-Verbal Communication | Through a Neurodiversity Affirming Lens
Autistic people often prefer direct communication. Unlike in neurotypical connection, non-verbal communication plays a reduced role in autistic culture and does not necessarily contribute to the development and maintenance of authentic and meaningful relationships.
This includes but is not limited to a reduced emphasis on value of eye contact, body language, facial expressions and tone of voice. This difference makes itself apparent when non-autistic and autistic people communicate with each other and, at times, may result in miscommunications, misunderstandings or inaccurate interpretations of one’s intentions.
A3 - Current Formal DSM-5 Criteria
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
A3 - Relationships | Through a Neurodiversity Affirming Lens
Autistic people connect with other people but do so in ways that aren’t in line with neuro-normative standards. The joy of autistic connection is often interest and proximity based, which varies from neurotypical connection which is often interaction driven. Autistic people are often able to form relationships with non-autistic people, particularly when there is mutual understanding of and respect for the differences in the neurotypes and these differences are accommodated. That said, autistic people will likely find it ‘easier’ to form relationships with other autistic people, their ‘neurokin’, due to their ability to connect in a mutually authentic way. This criterion also acknowledges the need of many autistic individuals to ‘recharge’ following extensive social experiences, and recognises that alone time can be a valued and enjoyable part of the autistic experience.
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B Criteria: Movement, Sameness and Routine, Interests and Sensory Processing
B1 - Current Formal DSM-5 Criteria
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
B1 - Stimming and Repetition | Through a Neurodiversity Affirming Lens
Stimming is an integral part of autistic culture and involves body-based movements and actions that regulate the nervous system, and can be a source of joy. While neurotypical people engage in stimming to some extent, autistic people often stim more frequently and in more varied ways. Stimming can be context driven, and can occur at different times, including when experiencing joy, overwhelm, when needing to focus etc. This criterion also covers the tendency of many autistic individuals to find comfort and enjoyment in repetition, such as repeating meals, listening to the same songs, watching the same movies or TV shows, and engaging in other forms of repetition. Additionally, B1 also covers the use of items or speech in a way that is not consistent with neurotypical culture.
B2 - Current Formal DSM-5 Criteria
Insistence on sameness, inflexible adherence to routines, or ritualised patterns or verbal nonverbal behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
B2 - Sameness and Routine | Through a Neurodiversity Affirming Lens
Predictability and familiarity creates a sense of safety and a clear understanding of what will happen next. Autistic people often thrive on routine, rituals and rhythms as part of their experience of the world. Planning and preparing in advance often supports increased predictability and a sense of safety. Lack of advanced notice can disrupt this need and cause distress. Overall, sameness and repetition can be a valuable way of creating predictability, as well as being a source of satisfaction and joy.
B3 - Current Formal DSM-5 Criteria
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
B3 - Interests | Through a Neurodiversity Affirming Lens
Autistic people are often passionate about specific subjects/topics and neutral about (or disinterested in) topics outside of those passions. Autistic people are often more deeply interested in their favourite things or topics compared to neurotypical people. The intensity of these interests can lead to academic, creative or occupational success.
B4 - Current Formal DSM-5 Criteria
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (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).
B4 - Sensory Processing | Through a Neurodiversity Affirming Lens
Autistic people observe, process and engage with sensory stimuli in a way that is different to neurotypicals. This is often defined by a greater sensitivity and therefore autistic people can have more defined sensory preferences and needs. While the focus tends to be on the stimuli that may be dysregulating, autistic people are also often able to cultivate environments and sensory encounters to elevate their experience of the moment and are sometimes able to find greater joy in sensory experiences than their neurotypical counterparts. Though a heightened sensitivity to stimuli can lead to over-stimulation and overwhelm at times, it can also result in greater attention to detail, a deeper understanding and appreciation of the world around them and a better ability to use stimuli to support regulation.
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To be identified as autistic, meet all three A criteria and at least two B criteria. These qualities and experiences should be evident since childhood (C criteria), support is required to manage well in a neurotypical world (D criteria), and not better better explained by an alternative experience (E criteria).