diagnosing autism

Find a Diagnosis

Autism Spectrum Disorder (ASD)

ASD is not diagnosed through medical tests. An accurate autism diagnosis is made by a team of multidisciplinary professionals and is based on the observation of an individual’s communication, behavior, and developmental levels. However, because ASD shares behavioral characteristics with other disorders, medical tests or other autism diagnosis tests may be ordered to rule out other possible causes for the symptoms being exhibited.

A brief observation in a single setting cannot present a true picture of an individual’s abilities and behaviors. Input from parents and other caregivers, plus the individual’s developmental history, are very important components of making an accurate diagnosis. Listed below are resources that might be useful in reaching a diagnosis. Our Autism Resource Specialists can help direct and guide families in requesting a diagnosis as well as connect them to additional options.

For children younger than 3:

The North Carolina Infant-Toddler Program site includes a list of Children’s Developmental Service Agencies (CDSAs) by county.

For children ages 3-5:

Contact Preschool Services in your county to be directed to the program that can evaluate your child for your county or school system.

For children in kindergarten through 12th grade:

Send a written request to the principal of your local school asking for an evaluation based upon the suspicion of autism.

Child psychologists, child psychiatrists, developmental pediatricians, and pediatric neurologists are able to diagnose autism.

The UNC TEACCH Autism Program provides clinical services such as diagnostic evaluations for people at any age.

Diagnostic Criteria

The American Psychiatric Association released its Fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on May 22, 2013.

DSM-5 Criteria, Requirements and Level of Severity for ASD

Diagnosis requires meeting criteria across four categories:

A.

Persistent deficits in social communication and social interaction across contexts meeting all of the following:

  • Social-emotional reciprocity (e.g., conversation, joint attention)
  • Nonverbal communicative behaviors (e.g., eye contact, body language, facial expressions, gestures)
  • Developing and maintaining relationships (e.g., imaginative play, making friends)

B.

Restricted, repetitive patterns of behavior, interests, and activities meeting at least two of the following:

  • Stereotyped/repetitive speech, motor movements, or use of objects
  • Excessive adherence to routines/rituals or excessive resistance to change
  • Highly restricted fixated interests, abnormal in intensity or focus
  • Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment

C.

Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D.

Symptoms together limit and impair everyday functioning. Also, three levels of severity:

  • Requiring support (Mild)
  • Requiring substantial support (Moderate)
  • Requiring very substantial support (High)

A new, additional diagnostic category (not under ASD) was also added to the DSM-5: Social Communication Disorder.

The DSM-5 criteria were established in an attempt to increase accuracy in diagnosis, combining overlapping symptoms into one category, loosening the 3-year-old age requirement such that for children with milder symptoms their symptoms would be allowed to become evident later in childhood, and the inclusion of a severity range (mild to high).

An additional notation in the DSM-5 criteria specifies that “individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the new diagnosis of autism spectrum disorder.” This may alleviate some concerns about people losing their diagnosis and services. A study reported by Tamara Dawkins, Allison T. Meyer, and Mary E. Van Bourgondien with Division TEACCH at the University of North Carolina suggested that the majority of children and adults with Pervasive Developmental Disorder are not likely to be affected by the changes in DSM-5.

 

By Alexander M. Myers, Ph.D., LP, HSP; Clinical Director, ASNC