DSM-5 Autism vs. DSM-IV Autism

Attribute	DSM-5 Autism	DSM-IV Autism
Diagnostic Criteria	Requires two core domains: social communication deficits and restricted, repetitive patterns of behavior, interests, or activities.	Includes three domains: social interaction, communication, and restricted, repetitive behaviors.
Severity Levels	Includes three levels of severity: Level 1 (requiring support), Level 2 (requiring substantial support), and Level 3 (requiring very substantial support).	Does not include specific severity levels.
Onset	Emphasizes symptoms present in early developmental period, but recognizes that symptoms may not fully manifest until social demands exceed limited capacities.	Does not specifically address onset or developmental period.
Intellectual Disability	Recognizes that individuals with autism may or may not have co-occurring intellectual disability.	Includes a separate diagnosis of "Autistic Disorder" for individuals with co-occurring intellectual disability.
Language Impairment	Includes a separate specifier for individuals with language impairment.	Does not include a separate specifier for language impairment.
Subtypes	Does not include specific subtypes.	Includes subtypes such as Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).
Overall Approach	Emphasizes a dimensional approach, recognizing the wide range of symptom severity and individual differences.	Relies on a categorical approach with distinct diagnostic categories.

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities. Over the years, the diagnostic criteria for autism have evolved, with the most recent version being the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). In this article, we will compare the attributes of DSM-5 Autism and its predecessor, DSM-IV Autism, highlighting the changes and improvements made in the diagnostic criteria.

Diagnostic Criteria

The DSM-IV Autism had three main diagnostic criteria: qualitative impairments in social interaction, qualitative impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. However, the DSM-5 Autism merged these three criteria into two domains: social communication and interaction, and restricted and repetitive behaviors. This change reflects a more comprehensive understanding of the disorder and allows for a more accurate diagnosis.

Social Communication and Interaction

DSM-IV Autism emphasized qualitative impairments in communication, such as delayed language development or lack of spontaneous initiation of conversation. In contrast, DSM-5 Autism broadened the criteria to include both verbal and nonverbal communication. It recognizes that individuals with autism may have difficulties with social-emotional reciprocity, nonverbal communication, and maintaining relationships. This expansion acknowledges the diverse ways in which individuals with autism may struggle with social interactions.

Restricted and Repetitive Behaviors

DSM-IV Autism highlighted restricted and repetitive behaviors as a separate criterion. These behaviors included repetitive motor movements, insistence on sameness, and highly restricted interests. DSM-5 Autism maintains these characteristics but also includes sensory abnormalities as part of this domain. Sensory issues, such as hypersensitivity or hyposensitivity to certain stimuli, are common in individuals with autism and can significantly impact their daily lives. By incorporating sensory abnormalities, DSM-5 provides a more comprehensive understanding of the range of behaviors associated with autism.

Severity Levels

One significant improvement in DSM-5 Autism is the inclusion of severity levels. DSM-IV Autism did not account for the varying degrees of impairment seen in individuals with autism. The severity levels in DSM-5 range from level 1 (requiring support) to level 3 (requiring very substantial support). This addition allows clinicians to better capture the individual differences and needs of those with autism, leading to more tailored interventions and support services.

Onset and Developmental Course

DSM-IV Autism required symptoms to be present before the age of three, emphasizing early childhood onset. However, DSM-5 Autism recognizes that symptoms may not manifest until later in life, and the onset can occur during any developmental period. This change acknowledges that autism can be diagnosed in individuals who were previously missed or misdiagnosed, leading to better identification and support for individuals with late-onset autism.

Intellectual Disability and Language Impairment

DSM-IV Autism included separate diagnostic criteria for individuals with autism and intellectual disability or significant language impairment. In contrast, DSM-5 Autism integrates these conditions into a single diagnosis. This change reflects the understanding that autism can coexist with other developmental disabilities and emphasizes the importance of considering the individual's overall profile rather than focusing solely on autism symptoms.

Conclusion

The transition from DSM-IV Autism to DSM-5 Autism represents a significant advancement in the understanding and diagnosis of autism. The DSM-5 criteria provide a more comprehensive and nuanced approach to capturing the diverse range of symptoms and behaviors associated with autism. By incorporating severity levels, accounting for late-onset autism, and integrating coexisting conditions, DSM-5 Autism allows for a more accurate diagnosis and tailored interventions. These improvements contribute to better support and outcomes for individuals with autism and their families.