Autism Spectrum Disorder – DSM-5
- Persistent deficits in social communication and interaction, as evidenced by:
deficits in social-emotional reciprocity
deficits in the non-verbal communicative behavior usual for social interaction
deficits in establishing, maintaining and understanding relationships
- Restricted repetitive behavior patterns, interests and activities, as evidenced by:
stereotypical or repetitive motor movements, use of objects or speech
stubbornly sticking to the same thing, rigidly attached to routines or ritualized patterns of behavior
very limited, fixed interests that are abnormally intense or focused
over- or under-reaction to sensory stimuli or unusual interest in sensory aspects of the environment
- The symptoms are present from early childhood (but are sometimes only recognized later).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of life.
- The disorders cannot be better explained by intellectual disability or global developmental delay and social communication must be less than appropriate for the cognitive level.
Level 1: “support required”.
Without support, deficits in social communication are noticeable, lack of flexibility leads to problems in various life situations and independent functioning is hampered by poor organization and planning.
Level 2: “substantial support required”.
The problems are obvious to everyone and without support the person involved will be in need.
Level 3: “very substantial support required”.
Severe deficits in verbal and non-verbal social communication skills cause serious impairments in functioning: very limited social interactions and minimal response to contact provoked by others. One should think of someone with very little intelligible speech.
with or without intellectual disorder
with or without language disorder
with medical or genetic condition or environmental factor
with another developmental, mental or behavioral disorder
with catatonia (excessive motor aimless movement or immobility).
DSM-IV criteria for autism spectrum disorders:
This appendix lists the criteria that the DSM-IV-TR uses for:
1 The autistic disorder (299.00)
- A total of six (or more). At least six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
(1) Qualitative impairment in social interactions as evidenced by at least two of the following:
(a) marked impairment in the use of various forms of nonverbal behavior, such as eye contact, facial expression, posture, and gestures to determine social interaction
(b) failure to establish relationships with peers appropriate to developmental level
(c) a deficit in spontaneously seeking to share pleasure, activities, or achievements with others (e.g., not showing, bringing, or pointing out objects of significance)
(d) absence of social or emotional reciprocity
(2) Qualitative impairment in communication as evidenced by at least one of the following:
(a) delay in, or complete absence of, development of spoken language (failure to attempt to compensate by alternative means such as gestures or facial expressions)
(b) in individuals with sufficient speech-clear impairment in the ability to initiate or maintain conversation with others
(c) stereotypical and repetitive language or idiosyncratic use of words
(d) absence of varied, spontaneous pretend play (pretend play) or socially imitative play (imitate play) appropriate to the developmental level
(3) Restricted, repetitive stereotypical patterns of behavior, interests, and activities as evidenced by at least one of the following:
(a) strong preoccupation with one or more stereotypical and limited patterns of interest that is abnormal either in intensity or direction
(b) markedly rigid adherence to specific non-functional routines or rituals
(c) stereotypical and repetitive motor mannerisms (e.g. flapping or twisting of hand or fingers or complex movements of the whole body)
(d) persistent preoccupation with parts of objects
- Delay in or abnormal functioning in at least one of the following areas with onset before age 3: (1) social interactions, (2) language as used in social communication, or (3) symbolic or fantasy play.
- The disorder cannot be better attributed to Rett’s disorder or childhood disintegrative disorder.
2 Asperger’s disorder (299.80)
- Qualitative impairment in social interaction as evidenced by at least two of the following:
(1) marked impairment in the use of frequent nonverbal behaviors such as eye contact, facial expression, body postures and gestures to determine social interaction
(2) failure to develop developmentally appropriate relationships with peers
(3) deficit in spontaneously trying to share pleasure, activities, or achievements with others (e.g., not showing, bringing, or pointing out objects of significance)
(4) absence of social or emotional reciprocity
- Restricted, repetitive, and stereotypical patterns of behavior, interests, and activities as evidenced by at least one of the following:
(1) strong preoccupation with one or more stereotypical and limited patterns of interest that is abnormal in either intensity or focus.
(2) markedly rigid adherence to specific non-functional routines or rituals
(3) stereotypical and repetitive motor mannerisms (e.g., flapping or twisting with the hand or fingers or complex movements with the whole body).
(4) persistent preoccupation with parts of objects
- The disorder causes significant impairment in social, occupational or other important areas of functioning.
- There is no significant general delay in language development (e.g., use of single words at age two, communicative sentences at age three).
- There is no significant delay in cognitive development or in the development of age-appropriate skills for self-help, behavioral adjustment (other than within social interactions), and curiosity about the environment.
- Criteria for another specific pervasive developmental disorder or schizophrenia are not met.
3 Pervasive developmental disorder not otherwise specified (including Atypical autism) (299.80)
This category should be used when there is a severe and pervasive impairment in the development of reciprocal social interaction together with deficits in either non-verbal communication skills or by the presence of stereotypical behavior, interests and activities while the criteria are not met for a specific pervasive developmental disorder, schizophrenia, schizotypal personality disorder or avoidant personality disorder. This category also includes ‘atypical autism‘ images that do not meet the criteria for the autistic disorder due to an onset at a later age, atypical symptomatology or too few symptoms or all of these.
Differences between DSM-5 and DSM-IV:
- Instead of several separate disorders, only one disorder.
- In the DSM-IV three main criteria (social, communicative and behavioral), in the DSM-5 two main criteria (deficit in social-communicative reciprocity and repetitive behavior).
- The disorder exists from early childhood, even if it is not recognized until later.
- Introducing a continuum of severity.