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Just the Facts: The DSM-5 and Autism Spectrum Disorder

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Defining and understanding autism spectrum disorder (ASD or autism) is an evolving process shaped by decades of research across multiple disciplines. Early on, the condition wasn’t clearly defined, and many professionals viewed autistic traits as part of other childhood disorders. As research grew, so did awareness that autism represents a distinct way of thinking and interacting with the world. Over time, different labels were used to describe people with autism, such as Asperger Syndrome, Childhood Disintegrative Disorder, Rett Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). These different labels reflected the growing realization that autism isn’t a single presentation, but a broad spectrum marked by a wide range of communication styles, social patterns, and behavioral differences.

Our understanding of autism, including traits and how these present in different individuals, is reflected in the many revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA). This manual is used by clinicians and researchers to diagnose and classify disorders. The 2022 text revision (DSM-5-TR) offers the latest definition of autism, grounded in current scientific evidence. While not intended for diagnostic purposes, this factsheet provides an overview of the DSM criteria.

The fifth edition of the DSM removed all of the other labels and introduced the overarching term “autism spectrum disorder.” The definition includes severity levels to help clinicians describe individual support needs. This change reflects the spectrum nature of autism and acknowledges that each person has unique strengths and experiences. While originally defined as a mental health disorder, autism is now recognized as a neurodevelopmental difference that shapes how a person perceives and interacts with the world.

DSM-5 Autism Criteria

According to the DSM-5, autism is characterized by persistent challenges in social communication and interaction, along with restricted and repetitive patterns of behavior. To meet the criteria for autism, an individual must demonstrate all of the following:

Deficits in social-emotional reciprocity, the back-and?forth flow of social interaction
Deficits in nonverbal communication
Difficulty developing and maintaining peer relationships

In addition, the DSM-5 requires at least two of the following four types of restricted or repetitive patterns of behavior, interests, or activities:

Preoccupation with topics or objects of interest
Inflexible adherence to routines
Repetitive movements or speech
Hyper- or hyporeactivity to sensory stimulation

These characteristics must be present during early development, though they may be more easily recognized later when social expectations increase or differ across settings.

The severity levels in the DSM-5 are designed to indicate support needs, not define “how autistic” someone is. The levels include:

Level 1: requiring support
Level 2: requiring substantial support
Level 3: requiring very substantial support

These levels are not a ranking of individuals as more or less autistic. Instead, they describe a person’s unique pattern of strengths and support needs. Remember, support needs can change over time and shift depending on the activity, situation, or environment.

Virginia Educational Eligibility

Many autistic individuals, their families, and the professionals who support them have raised concerns about what the DSM-5 changes might mean for special education eligibility. According to the Virginia Department of Education (VDOE), the Virginia Regulations Governing Special Education Programs for Children with Disabilities (2010) contain specific eligibility criteria for “autism” and other disabilities that are not impacted by the changes in the DSM-5.

Medical diagnosis and educational eligibility are distinct processes. While the DSM-5 updated the criteria for receiving a medical diagnosis of autism, these changes do not affect the criteria for educational identification in Virginia. Students with autism in the public school system must still meet the eligibility criteria for autism as outlined in state regulations. An individual may be found eligible for special education and related services as a child with autism if:

The child demonstrates documented characteristics of autism spectrum disorder (ASD),
These characteristics have an adverse effect on the individual’s educational performance, and
The child requires specially designed instruction to meet their educational needs.

Families who suspect their child may qualify for Special Education Services for autism or another disability should contact their local school divisions to initiate the evaluation and eligibility process.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC. https://doi.org/10.1176/appi.books.9780890425596

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Virginia Commonwealth University’s Autism Center for Education (VCU-RRTC-ACE) is funded by the Virginia Department of Education, contract #881-APE61172-H027A240107. Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran’s status, political affiliation, or disability. If special accommodations are needed, please contact Jennifer McDonough at jltodd@vcu.edu.

VCU Autism Center for Education