Understanding how autism is diagnosed is an important step in supporting children who experience developmental differences. The Diagnostic and Statistical Manual of Mental Disorders, currently in its text‑revision edition known as the DSM‑5‑TR, is the main framework used by clinicians to diagnose autism worldwide. It outlines the characteristics that define autism spectrum disorder (ASD), the number of features a child must show, and the early-life onset required before a diagnosis can be made. It also includes guidelines for estimating the level of support a child is likely to need.

For many families, however, the DSM can feel technical and overwhelming. This article breaks down the DSM‑5‑TR in a clear, accessible way—explaining what professionals look for, how the features of autism appear in everyday life, and how an autism diagnosis leads to meaningful support for your child.

What Is the DSM‑5‑TR?

The DSM‑5‑TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) is published by the American Psychiatric Association and used globally to diagnose developmental, mental, and behavioural conditions. In 2022, the DSM‑5 received a text revision—hence DSM‑5‑TR—which clarified some of the autism diagnostic wording. For example, where the DSM‑5 once said social communication differences must be “manifested by the following,” the DSM‑5‑TR clarified this as “manifested by all of the following,” making the criteria more precise.

This update didn’t change the core definition of autism but strengthened how clinicians interpret the criteria to ensure more consistent diagnoses.

Core Features Required for an Autism Diagnosis

According to the DSM‑5‑TR, autism spectrum disorder is defined by two main groups of characteristics:

1. Persistent differences in social communication and social interaction, across multiple settings.
2. Restricted or repetitive behaviours, special interests, or sensory differences.

A child must show characteristics from both groups to receive an autism diagnosis. These features must be present from early childhood (even if they become clearer later) and must affect a child’s daily functioning in noticeable ways.

Let’s take a closer look at these criteria and what they may look like in everyday life.

1. Social Communication Differences

To meet the DSM‑5‑TR criteria, a child must show all three types of social communication differences listed below. These features may appear in varying ways depending on age, developmental stage, or communication strengths.

a. Social‑emotional reciprocity differences

This refers to the back‑and‑forth nature of social interaction. A child may:

• Seem unsure how to start or maintain conversations.
• Share their own interests but show less response to what others share.
• Prefer solitary play or need adult support to engage with peers.
  These characteristics are described in the DSM‑5‑TR as differences in “social-emotional reciprocity.”

b. Differences in nonverbal communication

Children may:

• Use fewer gestures (like pointing or waving).
• Show limited eye contact or facial expressions.
• Have a communication style that feels not fully coordinated—e.g., body language may not match what they’re saying.
  The DSM describes these as differences in “nonverbal communicative behaviours used for social interaction.”

c. Differences in developing, maintaining, and understanding relationships

This may appear as:

• Difficulty adjusting behaviour to different social situations.
• Finding imaginative play with peers challenging.
• Preferring predictable interactions or having fewer friendships than expected for age.
  These are described in the DSM as “deficits in developing, maintaining and understanding relationships.”

2. Repetitive Behaviours, Special Interests, and Sensory Sensitivities

Along with social communication differences, the DSM‑5‑TR also requires at least two features from the following group. These characteristics often help families recognise autism early.

a. Repetitive movements, speech, or play

These might include:

• Hand flapping, rocking, or spinning.
• Repeating phrases (echolalia) or using language in unique ways.
• Lining up toys or repeating specific play routines.
  These behaviours fall under “stereotyped or repetitive motor movements, use of objects, or speech.”

b. Insistence on sameness or routines

Autistic children often thrive on predictability. They may:

• Become distressed when routines change (e.g., leaving the house at a different time).
• Rely on rituals such as repeating certain steps before bedtime.
• Prefer the same foods, clothing, or daily patterns.
  The DSM describes this as “inflexible adherence to routines or ritualized patterns.”

c. Special interests

A child may have topics, objects, or hobbies they’re deeply passionate about, such as:

• Dinosaurs, trains, space, animals, numbers.
• Maps, machines, or highly specific facts.
• Watching certain videos repeatedly or collecting particular items.
  These are described as “highly restricted, fixated interests that are abnormal in intensity or focus.”

d. Sensory sensitivities

This includes being:

• Very sensitive to sounds, lights, textures, or smells.
• Less responsive to pain or temperature.
• Fascinated by sensory experiences such as watching lights move or feeling vibrating surfaces.
  These behaviours fall under “hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.”

Autism Characteristics Must Start in Early Childhood

DSM‑5‑TR criteria require signs of autism to be present from the early developmental period. This does not mean parents must have noticed symptoms right away—it simply means the traits were there, even if they became more obvious as social demands increased.

Some children learn coping strategies or mask their differences, especially in highly structured environments like school. A diagnosis can still occur later if a specialist identifies that the characteristics have been lifelong.

Autism Must Affect Daily Life

To meet DSM‑5‑TR criteria, the characteristics must have a meaningful impact on a child’s everyday functioning. This might show up in:

• Social interactions and relationships
• Communication and play
• Behavioural regulation
• Participation in routines
• Learning in educational settings

The DSM‑5‑TR emphasises that autism characteristics must lead to challenges in social, academic, or other important areas of daily life.

A diagnosis is only made when the traits significantly influence how a child navigates their world.

How the DSM‑5‑TR Helps Estimate Support Needs

One important aspect of the DSM‑5‑TR is its focus on support levels. Autism exists on a spectrum, which simply means autistic people have a wide range of strengths and challenges. To reflect this, clinicians use the DSM‑5‑TR guidelines to estimate how much support a child may need in everyday life.

Support levels range from:

• Level 1 – requiring support
• Level 2 – requiring substantial support
• Level 3 – requiring very substantial support

These levels are based on:

• How significantly social communication differences impact daily interactions
• How intense or disruptive repetitive behaviours or sensory sensitivities are
• How much extra help a child needs to participate in home, school, and community settings

It’s important to remember that support levels are not labels. They don’t reflect intelligence, potential, or worth. Many children move between support levels over time depending on their environment and the strategies that work for them.

The aim is to guide professionals and families so the child receives the right supports—whether that includes speech therapy, occupational therapy, psychology, or educational accommodations.

How Clinicians Use the DSM‑5‑TR During Diagnosis

Professionals who diagnose autism—such as developmental paediatricians, psychologists, neurologists, or multidisciplinary teams—use the DSM‑5‑TR as one part of a broader assessment process. Diagnosis typically involves:

• Parent or caregiver interviews
• Observations of the child
• Standardised developmental assessments
• Reports from educators or therapists
• Tools such as the ADOS (Autism Diagnostic Observation Schedule)

Diagnosis relies on combining these tools with the DSM‑5‑TR criteria. No single test can diagnose autism on its own.

The DSM‑5‑TR ensures that all professionals use the same framework, creating consistency and reliability across assessments.

Why Understanding the DSM‑5‑TR Matters for Families

The DSM‑5‑TR can feel clinical, but it plays a vital role in helping children receive the support they need. Understanding it empowers parents and caregivers in several ways:

1. It clarifies what autism looks like.

Families often notice differences early and wonder if they are meaningful. Knowing the DSM‑5‑TR criteria makes it clearer which characteristics professionals look for.

2. It supports early intervention.

Children do best when they receive support early. The DSM‑5‑TR helps guide timely identification so children can access services such as speech therapy, occupational therapy, behavioural support, and educational accommodations.

3. It helps families understand their child’s strengths and differences.

Autism is not a list of deficits—it’s a neurodevelopmental profile with strengths like:

• Strong memory
• Deep focus
• Creativity
• Passionate interests

Understanding the DSM‑5‑TR helps families appreciate both the challenges and the unique abilities of autistic children.

4. It leads to support tailored to the individual.

The DSM‑5‑TR’s support levels help professionals offer targeted recommendations. This might include:

• Therapy frequency
• School‑based adjustments
• Sensory supports
• Communication tools

Each plan is customised to the child’s needs.

A Strength‑Based Perspective on Autism

While the DSM‑5‑TR is necessarily clinical, it’s essential to balance it with a strength‑based approach. Autism is diverse, and autistic children bring extraordinary strengths to their families, classrooms, and communities. A diagnosis helps unlock understanding—not limitations.

At Supporting Learning for Children with Needs (SLCN), we see every child as capable, curious, and full of potential. The DSM‑5‑TR is simply a roadmap that helps us provide the right support at the right time.

Final Thoughts

The DSM‑5‑TR outlines the signs and characteristics of autism to help professionals identify children who would benefit from support. A diagnosis requires:

• Social communication differences (all three areas)
• Repetitive behaviours, special interests, or sensory sensitivities (at least two)
• Characteristics that began in early childhood
• Characteristics that impact daily life
  

A diagnosis also helps estimate how much support a child may need—whether minimal or substantial—so families and teachers can create an environment where the child can thrive.

If you’re considering whether your child may benefit from an autism assessment, or if you’d like support interpreting a recent diagnosis, SLCN is here to guide you every step of the way.