On March 18, 2022, the American Psychiatric Association (APA) updated the diagnostic criteria for autism spectrum disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Under criterion A, which describes differences in social communication and social interaction, the phrase “as manifested by the following” has been revised to read “as manifested by all of the following.” 

The APA’s DSM-5-TR work group said its intent was to improve clarity and “maintain a high diagnostic threshold.” It could have been inferred, based on the previous wording, that the presence of any of the criteria would have met the diagnostic threshold (APA, 2022). The new wording aims to prevent that misreading. 

The new phrasing means that to meet the diagnostic threshold, someone would have to experience persistent differences in all of these areas: 

• social–emotional reciprocity  
• nonverbal communication behaviors used in social interactions  
• developing, maintaining, and understanding relationships  

In addition to these social communication and interaction differences, at least two of four types of restricted or repetitive behaviors must also be present to meet the DSM-5-TR diagnostic criteria. Restricted or repetitive behaviors involve: 

When evaluators look at pragmatic skills, they’re generally assessing two primary domains, plus a bridge that connects the two domains: 

• patterns of movement or speech
• sameness of routines or rituals 
• special, highly focused interests 
• strong responses to sensations in the environment 

The text revision also contains another change: The DSM-5 asked clinicians to specify whether a person with an autism diagnosis also had “another neurodevelopmental, mental, or behavioral disorder.” The DSM-5-TR asks whether the autism diagnosis is associated with “another neurodevelopmental, mental, or behavioral problem.” Broadening this specifier allows clinicians to include information about associated problems that affect well-being but that may not be classified as disorders.  

Neither of these revisions is expected to have a major impact on the number of people diagnosed with autism.  

Further Reading on Autism

• The WPS In-Depth Guide Autism and ADHD 
• The WPS In-Depth Guide to Autism Assessment
• Understanding the Complicated Interplay of Autism and ADHD
• How Autism and ADHD Can Disrupt Interoception
• How to Choose the Best Autism Assessment for Your Client
• Best Practices in Autism Assessment
• Autism Conversations: Individualizing Educational Interventions with the MIGDAS-2 Evaluation Process

Videos and Webinars on Autism

• How Cyberbullying Impacts Students On and Off the Autism Spectrum
• Conversation Over Labels: A Better Way to Understand Autism
• Autism Spectrum Brains 'Get Energy' from These Things

Related Links

• WPS: Leading Publisher of Autism Assessments Worldwide
• The Autistic Experience Across the Lifespan: Considerations for Improved Clinical Practice

Research and Resources:  

American Psychiatric Association. (2022). Autism Spectrum Disorder. https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-AutismSpectrumDisorder.pdf  

Centers for Disease Control and Prevention. (2022, April 6). Diagnostic Criteria. https://www.cdc.gov/ncbddd/autism/hcp-dsm.html