Table 1. Changes in ASD criteria from the DSM-IV to DSM-5.

Changes	DSM-IV	DSM-5
Location in manual	Disorders usually first diagnosed in infancy, childhood, or adolescence	Neurodevelopmental disorder
Sub-criteria	3 sub-criteria	2 sub-criteria
	Qualitative impairment in social interaction	Persistent deficits in social communication and social interaction across multiple contexts
	Qualitative impairments in communication	Restricted, repetitive patterns of behavior, interests, or activities
	Restricted repetitive and stereotyped patterns of behavior, interests, and activities
Needed to diagnose	Triad: 3/3 diagnostic criteria must be met	Dyad: 2/2 diagnostic criteria must be met
Diagnostic criteria	Qualitative impairment in social interaction, manifested by at least 2 of the following:	Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:
	Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction	Deficits in social-emotional reciprocity, (including abnormal social approach and failure of reciprocal conversation, reduced sharing of interests, emotions, or affect, failure to initiate or respond to social interactions)
	Failure to develop peer relationships appropriate to developmental level	Deficits in nonverbal communicative behaviors used for social interaction (poorly integrated verbal and nonverbal communication, eye contact and gesture/body language abnormalities
	A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people	Deficits in developing, maintaining, and understand relationships (including adjusting behavior in various social contexts, difficulties in sharing imaginative play or in making friends, or lack of interest in peers)
	Lack of social or emotional reciprocity	Restricted, repetitive patterns of behavior, interests, or activities, manifested by at least two of the following:
	Qualitative impairments in communication as manifested by at least one of the following:	Stereotyped or repetitive motor movements, use of objects, or speech
	Delay in or total lack of, the development of spoken language	Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
	In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others	Highly restricted, fixated interests that are abnormal in intensity or focus
	Stereotyped and repetitive use of language or idiosyncratic language	Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
	Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
	Restricted repetitive and stereotyped patterns of behavior, interests, and activities, manifested by at least one of the following:
	Encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus
	Apparently inflexible adherence to specific, nonfunctional routines or rituals
	Stereotyped and repetitive motor mannerisms
	Persistent preoccupation with parts of object
Age of development	Onset prior to age 3 years	Symptoms must be present in early developmental period but may not manifest until social demands exceed limited capacities or may be masked by learned strategies
Not better explained by	Rett’s disorder or childhood disintegrative disorder	SPCD
Sensory symptoms	Not addressed	Sensory symptoms are a new criterion introduced in DSM-5 under the sub-criteria of restricted, repetitive patterns of behavior, interests, or actviities

ASD, autism spectrum disorder; SPCD, social (pragmatic) communication disorder.