DSM 5 Changes: Autism Spectrum Disorder

By Heidi Tobe on August 7, 2017

Last month we discussed the removal of the multiaxial system between the DSM-IV-TR and the DSM 5. This month we’ve decided to take on one of the most talked about changes to the DSM 5: the new Autism Spectrum Disorder diagnosis. This DSM 5 diagnosis represents one of the major shifts between the DSM-IV-TR and the DSM 5. The DSM 5’s Autism Spectrum Disorder diagnosis encompasses four separate DSM-IV-TR diagnoses that were previously under the category of Pervasive Developmental Disorders: Asperger’s Disorder, Childhood Disintegrative Disorder, Autism Disorder, and Pervasive Developmental Disorder NOS. These four disorders no longer exist independently and are all captured within the Autism Spectrum Disorder diagnosis. For the purposes of the exam, these changes make it a bit simpler as there are no longer four separate diagnoses to differentiate between. The change was made in hopes of greater reliability and consistency in the diagnosis of Autism Spectrum Disorder and with general agreement that these four conditions all fall within one condition with varying levels of severity.


For a DSM 5 diagnosis of Autism Spectrum Disorder there must be deficits in BOTH social communication/interaction as well as restricted/repetitive patterns, with the severity in each of the areas being specified based on the levels of support required. For the first category, you must see a persistent deficiency in social communication and interaction. For example, you may notice a child who has abnormal social engagement. They may lack eye contact, have little interest in receiving or exchanging non verbal communication, or have a lack ability to understand the emotions or affect of others. This can impact their ability to play with friends and is therefore often observed and diagnosed when children enter school for the first time.

The second area is a restricted/repetitive pattern of behavior, interests, or activities. This can include motor movements such as clapping, or echolalia (repeating what someone says). You may observe inflexibility in functioning, in which the child experiences distress when their schedule is changed or interrupted. Hypo OR hypersensitivity to external stimuli can also be present, in which a child could either be indifferent to pain, temperature, etc., or they could be highly sensitive to touch, sound, etc.

For a diagnosis of Autism Spectrum Disorder, criteria for BOTH of these categories must be met. For individuals who have deficits in the social use of language, but do not show restricted interests or repetitive behavior, the diagnosis of Social Communication Disorder would be used (Social Communication Disorder is a new diagnosis in the DSM 5). This diagnosis does not fall within Autism Spectrum Disorder, but is a Communication Disorder.

Even before these changes were officially rolled out in the DSM 5, they were the cause of much conversation and controversy. There was concern that lumping these diagnoses together could result in less services and coverage for individuals who were higher functioning (namely those with a previous diagnosis of Asperger's Disorder). For those of you working within this population, what has your experience been since the implementation of the DSM 5? What have the practical implications been of these changes? We encourage you to share in the comments section below.

If you are preparing for your licensure exams and still haven’t signed up for an exam preparation program, our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE. We look forward to helping you PASS your exam with confidence!



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