Proposed changes to the DSM-5 diagnostic criteria include the creation of a single broad autism spectrum disorder (ASD) diagnosis that encompasses current specific DSM-IV-TR diagnoses. They demonstrate marked distress when routines are interrupted, and they are very difficult to redirect. Repetitive behaviors or rituals markedly interfere with functioning in all spheres. Level 3 is characterized for patients requiring very substantial support, as they have severe deficits in verbal and nonverbal social communication skills. These patients become distressed or frustrated when they are interrupted or redirected. Repetitive behaviors and restricted interests are obvious enough to be noticed by a casual observer. They demonstrate limited ability to initiate social interaction and have a reduced or abnormal response to social overtures from others. Level 2 is characterized for patients “requiring substantial support,” as they have marked deficits in verbal and nonverbal social communication skills, which are apparent even with supports in place. They also resist redirection and attempts to be interrupted when involved in restricted interests or repetitive behaviors. Rituals and repetitive behaviors cause significant interference for these individuals. The DSM-5 will use a system of three modifiers to signify level of severity: Level 1 is characterized for patients requiring support as they display difficulty initiating social situations and demonstrate atypical social responses.
The DSM-5 envisions autism as a unitary diagnosis with multiple levels of symptom severity impairing the ability to function. With the advent of the DSM-5, only two major criteria will be included: 1) social communication impairment, and 2) repetitive behaviors/restricted interests. Autism has been conceptualized under this diagnostic rubric as a spectrum of disorders with symptoms ranging from severe to minimally impaired. The three major diagnostic categories include the following: 1) language impairment, 2) social impairment, and 3) repetitive behaviors/restricted interests, with the impairments present prior to the age of three.
Autism Spectrum Disorders, as currently defined by the Diagnostic and Statistical Manual (DSM-IV-TR) criteria, include the diagnoses of Autistic Disorder, Asperger’s Disorder and Pervasive Developmental Disorder NOS.