Autism is a neurological condition, present from early childhood, characterized by great difficulty in communicating and forming relationships with other people and in using language and abstract concepts.
Since the 2013 change in diagnoses, classical autism and Aspergers now share the same diagnostic criteria, with severity tables indicating “low” or “high” functioning ability.
The shift in diagnostic criteria has caused some disruption in the autistic population, with fears of greater stigma… but I think it’s actually given those with “high” functioning autism a chance to access better services.
As you may know, the condition of autism is a spectrum, so abilities of a person who is considered “high functioning” may not pertain to a complete comfort or “normality” in all areas of their life. As such, the new criteria has allowed all autistics a chance to be seen for their difficulties and their strengths. And in terms of stigma/ discrimination, I fathom this is more a challenge at a social level. Our diagnostic criteria ought not impact this…
Anyway. Without further ado…
The formal diagnostic criteria for Autism Spectrum Disorder, per the new Diagnostic Statistical Manual for Mental Health (299.00, American Psychiatric Association, 2013) is as follows:
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history :
1. 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.
2. Deficits in nonverbal communicative behaviors 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.
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.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (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).
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 perseverative interest).
4. 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).
C. Symptoms must be present in the early developmental period
(Symptoms 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 co-morbid/ dual diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- Associated with a known medical or genetic condition or environmental factor
- With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition)
Specify current severity:
- Severity is based on social communication impairments and restricted,
repetitive patterns of behavior–
Level 1 – Requiring Support – Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.
Level 2 – Requiring Substantial Support – Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. Inflexibility of behavior, difficulty coping with change, or other restricted / repetitive behaviors appear frequently enough to be obvious to the casual observer
and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 3 – Requiring Very Substantial Support – Severe deficits in verbal and non-verbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. Inflexibility of behavior, extreme difficulty coping with change, or other restricted / repetitive behaviors markedly interfere with functioning in all spheres. Great distress / difficulty changing focus or action.
Please be mindful that diagnoses MUST be undertaken by a trained professional, commonly a clinical psychologist or psychiatrist. While you may self-identify, you cannot access services readily without a formal diagnosis.