DSM Criteria for Autism
Understanding Criteria for Autism Spectrum Disorder
Understanding the criteria for Autism Spectrum Disorder (ASD) is essential for fostering accurate awareness, meaningful support, and early intervention. Over the years, misconceptions about autism have led to stereotypes, misdiagnoses, and stigma—often reducing a complex neurodevelopmental condition to oversimplified ideas about social skills or intelligence. As our understanding of autism has evolved, so too has the recognition that it presents differently across individuals, genders, and cultures. Learning the true diagnostic criteria helps professionals, families, and communities move beyond myths and embrace a more compassionate, informed view of what it means to be autistic.
According to the Centers for Disease Control and Prevention’s (CDC) 2022 data (reported in 2025) from the Autism and Developmental Disabilities Monitoring Network (ADDM), about 1 in 31 (≈ 3.2 %) eight-year-old children were identified with ASD. For boys vs girls: ASD is much more common among boys — data shows a ratio of about 3.4 times higher in boys than girls. Racial/ethnic groups: Prevalence was lowest among White children (2.7 %) and higher among American Indian/Alaska Native, Asian/Pacific Islander, and Black children (each around 3.7–3.8 %) in one dataset. For younger children, among 4-year-olds in the same surveillance system, prevalence was about 1 in 34 (≈ 2.9 %).
The rise in prevalence does not mean that many more children are born with autism than before — many experts point to improved screening, broader diagnostic criteria, greater awareness, and more inclusive surveillance as substantial contributors. The fact that prevalence differs by region, by racial/ethnic group, and by sex/gender underscores the need for equitable access to evaluation and services. For our work (supporting neurodivergent kids, families, trauma/therapy contexts), these stats highlight not only how common ASD is but also how vital early detection, nuanced understanding, and informed supportive interventions are.
At our recent clinical team meeting, Kate Bridgers, LPA led an in-depth exploration of the current autism diagnostic criteria, shedding light on key changes and clarifying some common misconceptions. The discussion offered valuable insight into how evolving understanding of autism can improve identification and care for clients across the lifespan.
Key Updates and Clarifications
Kate began by explaining that the current criteria now allow for dual diagnosis of ADHD and Autism Spectrum Disorder (ASD) — a significant shift from previous versions that viewed the two as mutually exclusive. She emphasized that the DSM should be used as a guide rather than a checklist and reminded clinicians that the examples listed in the manual are not exhaustive.
Kate highlighted Donna Henderson’s work as a helpful resource for understanding presentations of autism, particularly among women and girls, whose traits often differ from more “classic” profiles.
Criterion A: Social Communication Differences
One of the biggest misconceptions Kate addressed was that individuals who make eye contact or want friends cannot be autistic. In reality, many autistic people deeply value connection but struggle with the reciprocal and nuanced aspects of relationships. Criterion A focuses on persistent differences in social communication — whether currently present or evident in history — meaning progress with support doesn’t erase diagnostic relevance.
Criterion B: Repetitive Behaviors and Sensory Differences
Kate also clarified that Criterion B includes a range of restrictive or repetitive behaviors and interests. These can appear in subtle ways or even occur privately. Sensory differences, which were added to the criteria in 2013, are now recognized as one of several valid manifestations, though not unique to autism — they are also common in ADHD and other neurodivergent profiles.
Internalized Impairment: Rethinking Criterion D ( Level of Impairment)
Perhaps one of the most meaningful points Kate raised was the idea that impairment can be internalized. For example, a child or adult may appear to “function well” but experience debilitating anxiety beneath the surface. This lens helps clinicians recognize the full impact of symptoms beyond visible academic or social struggles.
Medical Diagnosis vs. Educational Qualification
A frequently asked question is often how autism diagnoses intersect with school-based supports. Kate clarified that a medical diagnosis does not automatically qualify a student for an IEP. Schools use an “educational need” model — meaning the child’s differences must directly affect school performance — while private clinicians use DSM criteria to establish a medical diagnosis.
Diagnostic Tools and the Counselor’s Role
Kate underscored that the clinical interview remains the most essential diagnostic tool, as standardized measures often rely on outdated or gender-biased stereotypes. In North Carolina, counselors and social workers with appropriate training can provide autism assessments, unless otherwise restricted by their licensing board.
Supporting Families Without Labels
Not every family seeks or receives a formal diagnosis, and Kate reminded us that therapy can still focus on strengths, challenges, and practical supports rather than labels. Many families simply want strategies to help their child thrive day-to-day — and our role is to meet them where they are.
Our Role
Meeting with Kate Bridgers or another qualified psychologist can be an invaluable step in understanding your child’s needs and exploring the possibility of an autism diagnosis. A professional evaluation offers more than just answers—it provides clarity, guidance, and a path forward. Psychologists like Kate use evidence-based tools and clinical expertise to assess your child’s strengths, challenges, and developmental patterns in a compassionate, supportive environment. This process helps parents make sense of behaviors that may feel confusing or overwhelming and ensures that the child receives appropriate support at home, in school, and in therapy. Early, accurate understanding can open doors to resources, strategies, and interventions that help your child thrive.