Autism is diagnosed through a comprehensive assessment by a multidisciplinary team, evaluating social communication, interaction, and restricted/repetitive behaviors using the DSM-5 criteria.

The process involves reviewing developmental history, conducting structured observations and interviews, and ruling out other conditions.

In 2020, estimates suggested that 1 in 36 children in the United States are autistic, with males being four times more likely to be identified than females.

However, this gender disparity may be due to differences in presentation or underdiagnosis of autistic females rather than males simply being more likely to be autistic.

As our understanding of autism is increasing, the number of people receiving a diagnosis may also increase.

How is Autism Diagnosed?

Autism is diagnosed based on the presence of specific behaviors and characteristics outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The DSM-5 criteria for autism consist of two main categories: persistent deficits in social communication and social interaction (Criterion A) and restricted, repetitive patterns of behavior, interests, or activities (Criterion B).

To meet the diagnostic criteria for autism, an individual must exhibit all three symptoms in Criterion A and at least two of the four symptoms in Criterion B.

These symptoms must be present since early childhood (Criterion C) and cause clinically significant impairment in social, occupational, or other important areas of current functioning (Criterion D). Additionally, the symptoms should not be better explained by intellectual disability or global developmental delay (Criterion E).

The DSM-5 also includes severity specifiers to indicate the level of support needed based on the individual’s adaptive functioning, as well as specifiers for intellectual impairment and language impairment.

Autistic individuals may exhibit a range of characteristics and behaviors that vary in intensity and presentation. The following are examples of how autism may present in individuals that an assessor may look for:

Social Communication and Interaction:

Difficulties with social-emotional reciprocity, such as challenges in initiating and maintaining conversations, and reduced sharing of interests and emotions
Differences in nonverbal communication, including in eye contact (e.g., difficulty maintaining eye contact), limited facial expressions, and difficulties understanding and using gestures and body language
Challenges in developing, maintaining, and understanding relationships, such as adjusting behavior to suit various social contexts, making friends, and showing interest in peers

Restricted and Repetitive Patterns of Behavior, Interests, or Activities:

Stereotyped or repetitive motor movements, use of objects, or speech, such as hand flapping, lining up toys, echolalia (repeating words or phrases), and idiosyncratic language
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior, such as extreme distress at small changes, difficulties with transitions, rigid thinking patterns, and need for predictability
Highly restricted, fixated interests that are high in intensity or focus, such as strong attachment to unusual objects or excessively narrow interests
Hyper- or hypo-reactivity to sensory input or significant interest in sensory aspects of the environment, such as apparent indifference to pain or temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, and visual fascination with lights or movement

It is essential to note that the signs of autism can vary significantly among individuals and may change over time as they develop and learn new skills. Some autistic individuals may exhibit more subtle signs, while others may have more pronounced characteristics.

Additionally, the presence of these signs and how noticeable they are can be influenced by factors such as cognitive abilities, language skills, and co-occurring conditions.

Masking symptoms

It should also be noted that ‘masking’ is very common in autistic individuals, especially if they are diagnosed later in life.

Masking is a strategy often used by neurodivergent individuals (e.g., those with ADHD) to consciously or unconsciously hide parts of their neurodiversity as a way to ‘fit in’ and be accepted.

Masking can, therefore, make it very difficult to identify autism if someone has become so skilled at hiding their autistic traits.

An example of masking can be to force eye contact and display ‘socially appropriate’ facial gestures during conversations, even though it feels unnatural to do so.

The Camouflaging Autistic Traits Questionnaire (CAT-Q) may also be used during the diagnostic process to identify autistic individuals who may not meet the criteria due to their ability to mask their autistic traits.

What to Expect from an Autism Assessment

A comprehensive, multidisciplinary assessment involving psychologists, psychiatrists, speech therapists, and occupational therapists is required. This process typically includes:

A detailed review of developmental, medical, and family history.
Structured observations and standardized interviews using diagnostic tools like the Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R).
Differentiating ASD from other conditions and identifying co-occurring disorders (such as anxiety or ADHD).

Assessments vary slightly based on age, with children undergoing play-based evaluations, and adults typically assessed through structured interviews and questionnaires about their social interactions, interests, and daily challenges.

During my autism assessment, I was asked questions about a lot of areas of my life. I was asked questions about relationships, how I communicate with others, my specific interests, what I enjoy doing in my free time, how I interpret other people's emotions, and what I may struggle with, to name a few. 

I would recommend writing notes of specific things you want to mention before you attend your assessment so that you do not forget anything.

After the assessment

Following the assessment, the team will provide feedback to the individual and their family, discussing the diagnostic findings, recommendations for interventions and support services, and any co-occurring conditions that may require additional evaluation or treatment.

Ongoing monitoring and follow-up may be necessary to ensure that the individual receives appropriate support and accommodations as they navigate various stages of life.

Is it Worth Getting an Autism Diagnosis?

Obtaining an autism diagnosis can have both benefits and drawbacks for individuals and their families.

For children, an early diagnosis can lead to timely access to interventions and support services, which may improve long-term outcomes.

A diagnosis can also help families better understand their child’s unique needs and advocate for appropriate accommodations in educational and social settings.

For adults, a diagnosis may provide a sense of relief and validation, as well as access to support services and accommodations in the workplace or higher education settings.

However, some individuals may worry about the potential stigma associated with an autism diagnosis or feel that a label does not fully capture their experiences.

Some people may self-diagnose as autistic for many reasons, including financial barriers to accessing a diagnosis or long waiting lists.

Ultimately, the decision to pursue a diagnosis is a personal one that should be made in consultation with healthcare providers and with consideration of individual circumstances and goals.

For me, I mainly sought a diagnosis to learn more about myself. I had a lot of unanswered questions when reflecting on my life, and I wondered if autism was the key to answering them. Now that I have a diagnosis, I feel that my life actually makes sense.

Problems with the DSM Criteria

While the DSM-5 criteria for autism provide a standardized framework for diagnosis, there are several concerns and limitations associated with these criteria that may impact the accurate identification and understanding of autism.

Language and terminology:

The DSM-5 uses language that is often confusing and pathology-based. By focusing on deficits and negative symptoms, the manual may not adequately capture the unique strengths and positive traits associated with autism.

Gender bias:

The DSM-5 criteria for autism were primarily developed based on research and clinical observations of males with autism.

As a result, the criteria may not adequately capture the unique presentation of autism in females, who often display different behavioral patterns and coping mechanisms, such as masking or camouflaging their autistic traits.

Cultural and socioeconomic factors:

The DSM-5 criteria for autism may not adequately consider cultural and socioeconomic factors that can influence the expression and recognition of autistic traits.

Differences in social norms, communication styles, and parenting practices across cultures may affect how autism is perceived and diagnosed.

Limited incorporation of neurodiversity perspective:

The DSM-5 criteria for autism do not fully incorporate the neurodiversity perspective, which views autism as a natural variation in human neurocognitive functioning rather than a disorder or deficit.

By focusing primarily on deficits and impairments, the DSM-5 may not adequately recognize the strengths, talents, and unique perspectives of autistic individuals.

Ultimately, seeking an autism diagnosis is deeply personal. For many, including myself, a diagnosis can provide clarity, validation, and pathways to meaningful support and self-understanding.

References

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Pellecchia, M., Dickson, K. S., Vejnoska, S. F., & Stahmer, A. C. (2021). The autism spectrum: Diagnosis and epidemiology. In L. M. Glidden, L. Abbeduto, L. L. McIntyre, & M. J. Tassé (Eds.), APA handbook of intellectual and developmental disabilities: Foundations (pp. 207–237). American Psychological Association. https://doi.org/10.1037/0000194-009

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How Is Autism Diagnosed & Is It Worth Seeking A Diagnosis?