DSM-5-TR Autism Criteria Explained (and ICD-11 6A02)

The DSM-5-TR autism criteria require persistent differences in all three areas of social communication and interaction, plus at least two of four types of restricted or repetitive behaviors, interests, or sensory responses. Signs must start in early development, cause real difficulties in daily life, and not be better explained by intellectual disability or global developmental delay alone [1][2].

What is the DSM-5-TR?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) was published by the American Psychiatric Association (APA) in 2022. It updated the text for most conditions and clarified the criteria for more than 70 disorders [3]. For autism, the most noticeable change was in criterion A: the phrase “as manifested by the following” became “as manifested by all of the following.” The APA says this was done to make clear that all three social communication criteria are required, keeping a high diagnostic threshold [2].

The summary below follows the CDC’s description of the criteria [1]. The exact wording is copyrighted by the APA, so this guide explains the DSM-5-TR autism criteria in plain language.

The DSM-5-TR autism criteria, A to E

Criterion A: Social communication and interaction (all three needed)

Persistent differences across several settings, now or in the past, in [1]:

1. Social-emotional reciprocity. For example, difficulty with back-and-forth conversation, sharing interests or feelings, or starting and responding to social interaction.
2. Nonverbal communication. For example, differences in eye contact, gestures, facial expressions, and body language, or difficulty combining them with speech.
3. Developing, keeping, and understanding relationships. For example, difficulty adjusting behavior to different social situations, sharing imaginative play, making friends, or showing interest in peers.

Criterion B: Restricted, repetitive behaviors, interests, or activities (at least two of four)

1. Repetitive movements, use of objects, or speech, such as hand-flapping, lining up toys, or echolalia.
2. Insistence on sameness, rigid routines, or ritualized patterns, with distress at small changes.
3. Highly restricted, fixated interests that are unusually intense or focused.
4. Over- or under-reactivity to sensory input, or unusual sensory interests, such as indifference to pain, strong reactions to sounds or textures, or fascination with lights or movement.

Criterion C: Early development

Signs must be present in the early developmental period. They may not become fully obvious until social demands exceed a child’s capacities, or may be masked by learned strategies later in life [1]. This is one reason some children, especially girls, are diagnosed later; see autism in girls.

Criterion D: Real impact on daily life

The signs must cause clinically significant difficulties in social, school, work, or other important areas of life [1].

Criterion E: Not better explained by intellectual disability

The differences are not better explained by intellectual disability or global developmental delay. Autism and intellectual disability can occur together, and in that case social communication should be below what is expected for the child’s overall developmental level [1].

What the criteria can look like in a toddler

The DSM-5-TR autism criteria apply at every age, but the signs look different in young children. In a toddler, social-emotional reciprocity differences might show as rarely bringing toys to show a parent. Nonverbal differences might show as little pointing or few gestures, and relationship differences as little interest in other children or in pretend play. Repetitive behaviors might include lining up toys, spinning wheels, or strong distress at small changes [4][5].

Severity levels and specifiers

Clinicians also describe how much support a person needs, using three levels: “requiring support,” “requiring substantial support,” and “requiring very substantial support” [6]. The APA has proposed a wording clarification, open for public comment until April 30, 2026, stating that severity should be specified separately for social communication (criterion A) and for restricted, repetitive behaviors (criterion B), rather than as a single rating [7]. Read more in autism levels explained.

The DSM-5-TR autism criteria also include specifiers that clinicians record if they apply [7][1]:

• With or without accompanying intellectual impairment.
• With or without accompanying language impairment.
• Associated with a known genetic or other medical condition or environmental factor (for example, fragile X syndrome).
• Associated with a neurodevelopmental, mental, or behavioral problem (for example, ADHD or anxiety).
• With catatonia.

What happened to Asperger syndrome and PDD-NOS?

Before 2013, the DSM-IV had several separate diagnoses, including autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). The DSM-5 brought these together under autism spectrum disorder [8]. People with a well-established earlier diagnosis should be given a diagnosis of autism spectrum disorder. People with marked social communication difficulties who do not meet the full autism criteria may be evaluated for social (pragmatic) communication disorder instead [1].

How ICD-11 (6A02) compares

The World Health Organization’s ICD-11 lists autism spectrum disorder under code 6A02. NICE notes that the NHS adopted ICD-11 in March 2022, and its diagnostic guideline now refers to ICD-11 or DSM-5 criteria [9]. The core features are very similar to the DSM-5-TR autism criteria [10]:

• Persistent difficulties starting and sustaining social communication and back-and-forth social interaction.
• Persistent restricted, repetitive, and inflexible patterns of behavior, interests, or activities, including sensory differences.
• Onset in the developmental period, though signs may not be fully clear until social demands increase.
• Significant impact on functioning. ICD-11 adds that some people function well in many settings only through exceptional effort, and a diagnosis is still appropriate.

Instead of support levels, ICD-11 uses subcodes for intellectual development and functional language, from 6A02.0 (without intellectual disability, with mild or no language impairment) to 6A02.5 (with intellectual disability and complete or almost complete absence of functional language). It also records whether there has been a loss of previously acquired skills [10].

What you can do at home

• Use the criteria as a guide for notes, not as a self-diagnosis checklist. Write examples under each heading: conversation, gestures, friendships, routines, interests, sensory reactions.
• Think about the past as well as now. The criteria count signs “currently or by history,” so early videos and baby records can help.
• Note what support your child needs in different settings, such as at home, in childcare, and with family.

See what happens at an autism assessment for how clinicians use this information.

When to talk to a professional

If you recognize your child in several of these areas, talk to your child’s doctor and ask about screening or a referral. Only trained clinicians can decide whether the DSM-5-TR autism criteria are met. NICE advises clinicians to combine information from all sources with clinical judgment, and not to rely on any single tool [9].

Frequently asked questions

What changed for autism in the DSM-5-TR?

The main change in 2022 was a wording clarification in criterion A. It now says the social communication differences must be shown in all of the three listed areas, rather than the earlier phrase that some read as meaning any of them. The APA said this matched the original intent to keep a high threshold. The text describing autism was also updated to reflect newer research.

How many criteria are needed for an autism diagnosis?

Under the DSM-5-TR, a child needs all three social communication and interaction criteria, plus at least two of the four restricted and repetitive behavior criteria. The signs must start early in development, cause real difficulties in daily life, and not be better explained by intellectual disability or global developmental delay. Signs can be current or in the child’s history.

Is ICD-11 different from DSM-5-TR for autism?

The core features are very similar in both systems. The main difference is how extra detail is recorded. DSM-5-TR uses three support levels and specifiers. ICD-11 uses subcodes that record whether there is an intellectual disability and how much functional language a person has, plus whether skills have been lost. Both are used to diagnose the same condition.

Can my child be diagnosed if they only meet some criteria?

Not with autism spectrum disorder under the DSM-5-TR, which requires all three social communication criteria and two of four repetitive behavior criteria. However, a child who does not meet full criteria may still have real needs. Clinicians may consider other diagnoses, such as a language disorder or social (pragmatic) communication disorder, and should point you to suitable support.

References

1. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. Last reviewed May 8, 2025. Link
2. American Psychiatric Association. DSM-5-TR Fact Sheet: Autism Spectrum Disorder. Washington, DC: APA; 2022. Link
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA Publishing; 2022. Overview page. Link
4. Centers for Disease Control and Prevention. Signs and Symptoms of Autism Spectrum Disorder. Last reviewed May 16, 2024. Link
5. American Academy of Pediatrics. 3 Early Signs of Autism in Children. HealthyChildren.org. Last updated September 26, 2025. Link
6. Hyman SL, Levy SE, Myers SM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020;145(1):e20193447. Link
7. American Psychiatric Association. View and Comment on Recently Proposed Changes to DSM-5-TR: Clarification of Criterion A and Criterion B Severity Specifiers for Autism Spectrum Disorder (public comment period ended April 30, 2026). Link
8. American Academy of Pediatrics Council on Children With Disabilities Autism Subcommittee. Understanding Autism: Information for Families. HealthyChildren.org. Last updated February 20, 2026. Link
9. National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: recognition, referral and diagnosis. Clinical guideline CG128. Published 28 September 2011; last updated 20 December 2017 (minor changes 2021-2025). Link
10. World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR). Geneva: WHO; 2024. ISBN 9789240077263. Section 6A02 Autism spectrum disorder. Link

Professional review: this guide is waiting for review by a qualified clinician. It was written and checked against the published sources listed above. How we check our guides.

This guide is general education, not medical advice. Always talk to your child’s doctor or care team. Last checked: October 2026.