04/09/2025
DSM-5 Autism Spectrum Disorder Criteria & Clinical Application for Diagnosticians|
When conducting autism assessments, as diagnosticians we must strictly adhere to the DSM-5 criteria. These are not “checklists” of isolated behaviours, but integrated domains that require careful, nuanced observation across the entire assessment process, including both structured and unstructured moments.
Our role as diagnosticians is to evaluate pervasive, consistent patterns of difference, not one-off skills or behaviours.
For example:
Criterion A2 in Practice
• This criterion focuses on whether a child (or individual) naturally coordinates non-verbal communication; such as eye contact, facial expressions, body language, and gestures with speech and social intent. It is not just whether these skills exist in isolation, but how well they are integrated to convey meaning in a socially effective way.
Example of social quality:
• A neurotypical child might look toward their parent, raise their eyebrows, smile, and point to a toy while saying “Look!” The eye gaze ensures joint attention, the facial expression signals excitement, the gesture directs the other’s attention, and the spoken word ties it all together.
Autistic presentation:
• A child may point to the toy but not check back with the adult’s eyes to see if they are sharing the moment. They may use a neutral facial expression or speak without accompanying gesture. Each element could be present, but they don’t come together to create a socially reciprocal communication bid.
Importance in Assessment
• During assessment, it is essential to tease apart the nuances of these behaviours:
Presence vs. Integration
A child may make fleeting eye contact or occasionally smile, but does this happen at the same time as their verbal or gestural communication? Integration is the key marker, not the isolated skill.
Spontaneous vs. Prompted-
Some children can show these behaviours when directly prompted (“look at me,” “show me happy face”) but not spontaneously in natural interaction. Assessors will observe across contexts.
Functional Use vs. Performance
Does the behaviour serve a communicative purpose (e.g., checking an adult’s reaction, inviting them into play), or does it appear more as a learned or mechanical skill without social intent?
Quality and Timing
Even subtle mismatches such as delayed eye gaze after speaking, or gestures not aligning with facial affect can reduce the social quality of the exchange and indicate differences in integration.
Why This Matters?
Teasing out these details helps distinguish between:
-A child who is shy, anxious, or second-language learning (may reduce eye contact but still integrate facial and gestural cues when comfortable) & In comparison
An autistic child, where the pattern is consistent and pervasive across contexts and is not solely explained by environment or temperament.
