Am I Autistic? Breaking Down the DSM-5 Criteria for Autism (+ Examples)

1. Part A: Social Communication and Interaction 
   1. Part A.1. Deficits in Social-Emotional Reciprocity
   2. Part A.2. Deficits in Nonverbal Communicative Behaviors Used for Social Interaction
   3. Part A.3. Deficits in Developing, Maintaining, and Understanding Relationships
2. Part B: Restricted, Repetitive Behaviors 
   1. Part B.1. Stereotyped or Repetitive Motor Movements
   2. Part B.2. Insistence on Sameness
   3. Part B.3. Highly Restricted, Fixated Interests
   4. Part B.4. Hyper- or Hypo-Reactivity to Sensory Input
3. Parts C-E: Severity and Duration of Symptoms
   1. Part C. Symptoms Must Be Present in Early Developmental Period
   2. Part D. Symptoms Cause Clinically Significant Impairment
   3. Part E. Lack of Other Clinical Explanations for Symptoms
4. DSM Criteria as a Starting Point on Your Autism Journey

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has been used to diagnose autism in children and adults in the United States since its creation in May 2013. If you’ve sought an autism diagnosis for yourself or your child in the U.S., as well as certain other countries like Canada and Australia, you may be familiar with the extensive list of criteria that an autistic person has to meet before being diagnosed according to DSM-5 standards.

However, because it was written for an audience of clinicians and clinical researchers, the DSM-5’s diagnostic criteria for autism leaves many people who are seeking a diagnosis with more questions than answers. If you’re like many of the adults who have started to wonder whether they’re autistic, we hope this guide provides you with more real-world examples and easy-to-understand definitions to guide you on your discovery journey.

Part A: Social Communication and Interaction 

To be diagnosed with autism according to the DSM-5, a person needs to have shown clinically significant difficulties in three different areas related to social interactions: 

1. Social-emotional reciprocity
2. Nonverbal communication
3. Deficits in your relationships

You will need to meet each of the three criteria within Part A — as well as two out of the four criteria in Part B, which we’ll talk about later — to meet the diagnostic criteria for autism.

You must be able to show that these social difficulties in Part A occur within a range of contexts, meaning they must happen in multiple settings such as at work, school, home, with friends, etc. If you experience any of these parts in only one setting  — i.e. you have trouble having a back-and-forth conversation with work colleagues but not anywhere else — you would not qualify as having met that criteria.

Here is the official language used in Part A of the DSM-5:

Below, we’ll break down what each of these criteria mean, including examples of what each might look like in an autistic person. 

Keep in mind that the examples we use throughout are just a starting point and not an exhaustive list, so if your experiences don’t match the examples word-for-word, this does not necessarily mean you are not autistic. Each autistic person is as unique as any other person is from each other, so your own experiences could equally meet the given criteria.

Part A.1. Deficits in Social-Emotional Reciprocity

Many people think of “deficits in social-emotional reciprocity” as being completely robotic, disengaged and unempathetic, which can keep many of us from thinking we meet the full autistic criteria. After all, who wants to see themselves as an emotionless robot?

However, this stereotypical view of autism doesn’t encompass everyone. In fact, “deficits in social-emotional reciprocity” at a basic level merely means having trouble with the back-and-forth, give-and-take of social interactions, which opens the door to many more behaviors falling under this category.

Difficulties in reciprocating socially or emotionally in social situations might include:

• Taking turns in conversations, which includes (but is not limited to) talking nonstop without giving others a chance to chime in, or staying quiet because you don’t know when it is your turn to speak.
• Initiating conversations
• Sharing your thoughts or feelings with others
• Understanding other people’s intentions, i.e. being easy to take advantage of or, alternatively, being suspicious of everyone’s intentions
• Having a social filter and understanding what is socially appropriate to say and what is considered oversharing
• Managing yourself in conversations with two or more people
• Using an unnatural amount of energy to prepare for and navigate within social situations
• Understanding and/or showing interest in how to make friends

This part of the diagnostic criteria can further be complicated if you’re someone who has learned to mask their behavior, meaning you’ve been able to pick up certain social norms and use them with effort in conversations. 

Because masking can be so common in undiagnosed autistic people, it’s important to think about your inner experiences. Even if you tend to navigate social situations in a way that no one else would notice anything is wrong, does it take you significant effort and intentionality to do so? If so, masking may be a factor at play in your social give-and-take.

Part A.2. Deficits in Nonverbal Communicative Behaviors Used for Social Interaction

Nonverbal communication includes the classic lack of eye contact that many people think of when talking about autism. But it includes many other potential behaviors and experiences, which is particularly helpful to keep in mind if you’re someone who is able to make eye contact with others.

In basic terms, this section of the criteria just means having trouble with using or understanding body language, facial expressions and/or other nonverbal ways that people “talk” to each other without words. You might have difficulties with things like:

• Eye contact, i.e. you tend to look away for large amounts of time, such as when you’re talking, or you look at people for a length of time they consider uncomfortable
• Gesturing, i.e. pointing and waving
• Personal space
• Volume or tone, i.e. people say your voice is very flat or often tell you to use your indoor voice
• Understanding other people’s nonverbal cues
• Understanding other people’s emotions based off their facial expressions and body language
• Recognizing faces

Again, because masking can affect how these symptoms present, ask yourself how you feel about nonverbal communication, even if others would consider you good at it. Does it feel uncomfortable to maintain eye contact for long periods of time, for example? Are you only able to make eye contact when you’re listening but not when you’re trying to form an answer, or vice versa? Do you have to verbally ask people over and over if they’re ok because you’re unsure based on their body language? Questions like these can help you identify your inner experiences surrounding nonverbal communication.

Part A.3. Deficits in Developing, Maintaining, and Understanding Relationships

The section of autism criteria talking about developing, maintaining and understanding relationships is perhaps the one that confuses most potentially autistic people. I’ve often heard people say “I’ve had good friends growing up, so I can’t be autistic” as part of their self-discovery journey.

While it’s true that many autistic people have few friends and some don’t have interest in making friends, this is not the case for everyone and is not entirely what is meant by “deficits in relationships.” Many autistic people can have close friendships throughout their lifetime, particularly if those friends share common interests. Many of us as children — especially if we mask our autistic behaviors — are more likely to play with younger kids versus being complete loners, and we may look like we’re blending in with other kids from the outside in situations like recess.

At its core, “deficits in developing, maintaining and understanding relationships” means having trouble making friends, keeping friends long-term once you’ve made them, or understanding the basics of how relationships work. This might include difficulties with some or all of the following:

• Understanding social motivation, i.e. knowing if someone is flirting with you or making fun of you
• Being socially flexible, i.e. having trouble navigating friendships with someone who has other friends or different social needs
• Managing conflict in relationships
• Being particularly naive in relationships, i.e. having trouble understanding when you’re being used or abused
• Grasping social rules, such as taking turns or sharing
• Adjusting behaviors to fit different situations, i.e. difficulties acting differently around friends than you would around teachers
• Remembering to connect with friends ongoingly, i.e. keeping up a friendship with someone you don’t see often

These difficulties might show up in different ways at different points of your life as you age. For example, I made friends easily when I was younger, though my family said I seemed awkward and out of place compared to other children. However, even though I made friends easily, I struggled to keep many of them, particularly if we ran into any kind of conflict or if they had other good friendships. 

As I aged, it became harder to make friends, though when I did make a new relationship I would work incredibly hard to keep that relationship without understanding when it had become toxic or even abusive. This switch in how relationship deficits present themselves is common as kids reach adolescence and then again as people move into adulthood and struggle to learn the rules of adult friendships and romantic relationships.

Part B: Restricted, Repetitive Behaviors 

As well as meeting all three parts of Part A’s relationship-based criteria, a person needs to prove they have ongoing restricted or repetitive behaviors. However, unlike Part A, you only need to meet two of the four criteria in Part B to be diagnosed with autism. So if, for example, you become distressed when your routine is changed and you have very specific hyperfixations, you may still be autistic even if you don’t have any kind of sensitivities to things like noises or textures.

The official language used in Part B of the DSM-5 is as follows:

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Below we’ll break down what each of these four criteria mean, including examples of what each might look like in the life of the average autistic person. Again, keep in mind that everyone’s experiences are unique, and your version of these criteria might not look exactly like the examples below.

Part B.1. Stereotyped or Repetitive Motor Movements

The DSM-5 gives several examples of repeated movements, including lining up toys in a row versus playing with them, and flipping objects repeatedly. Many people also think of autistic children flapping their arms over and over or spinning around in circles for minutes at a time.

While these behaviors can certainly be common in many autistic children, other children may present more subtle repeated motor movements. Plus, autistic adults may learn repeated behaviors that don’t bring as much attention to themselves. So, it’s important to understand what these “other” behaviors might look like. 

“Stereotypes or repeated motor movements” means making the same movement or noise over and over without a specific reason, commonly known as “stimming” within the autistic community. Here are some additional examples of repeated behaviors that might not immediately come to mind as potential autistic traits:

• Humming or making unusual noises
• Toe walking, particularly in childhood
• Watching the same TV show or movie, or reading the same book or series, over and over again
• Listening to the same song (or part of a song) over and over
• Skin picking
• Nail biting
• Hair pulling
• Using very formal language or basing your language in conversations off of phrases you heard on TV or in a movie
• Rocking back and forth or side to side
• Repetitive tapping or clapping
• Ecolalia, which is the act of repeating a word or phrase said by someone else repeatedly
• Palilalia, which is the act of repeating your own words over and over
• Repeatedly using a fidget toy such as a fidget spinner, fidget cube or brush
• Swinging on a swing for long periods of time
• Chewing, such as on your hair, clothes or items like pens
• Tapping your feet or fingers
• Hair twirling

Of course, keep in mind that these symptoms on their own are not a sole indicator of autism. Most people engage in stimming at some points in their life, such as when they’re nervous or excited. 

The difference is the extent and severity of these behaviors, as well as having them in addition to the social deficits we mentioned in Part A above. Many autistic people stim for hours at a time, or to a level of severity that can be harmful to themselves. Dermatillomania (obsessive skin picking) and trichotillomania (obsessive hair pulling) are two examples of stims that can themselves become compulsive mental health conditions.

Stims might also not present as stereotypically as some of the examples above. For example, many people think of echolalia as repeating a single word over and over and over. However, it might be more subtle, such as whistling a song you just heard for long periods of time.

Part B.2. Insistence on Sameness

Autistic people are often known for their insistence on sticking with a routine, and having meltdowns when their schedules are changed. But an autistic “insistence on sameness” doesn’t always have to be this overt. 

To feel uncomfortable with change and need to keep things familiar and predictable might look like:

• Difficulty with transitions, i.e. having trouble getting off your phone to go do chores
• Difficulty with change, i.e. getting upset if your plans change suddenly
• Eating the same foods every day or wearing the same limited clothing options
• Arranging things in one specific order and getting upset if they are moved
• Perfectionism
• Black-and-white thinking and a strong sense of morality and justice
• Strict rule following
• Literal thinking, i.e. having trouble understanding humor or sarcasm

Not every autistic person shows outward behavioral issues around change, so these struggles may be more internal than something that others can see.

Part B.3. Highly Restricted, Fixated Interests

We’ve all heard the stereotypes of autistic boys who love trains or are obsessed with learning facts about dinosaurs, or the autistic man who memorizes airport schedules. This stereotype comes in part from the truth that many autistic people have incredibly strong passions for certain things they take interest in which they spend a substantial amount of time on. Many people in the autistic community call these “special interests.”

However, this section of the DSM-5 is not very specifically explained, which causes many people to discount their own experiences with highly restricted, fixated interests.

First, this criteria includes interests that are either atypical or intense, or both.

• Atypical: Your special interest is not very common or well-known, i.e. you have an intense interest in comparing early photography to their present-day locations. You might not go into intense deep-dives where you memorize tons of facts, and you might not know all the details of the subject offhand, but the interest is nontraditional enough to be considered unique. Or, you might be incredibly attached to specific collections or objects.
• Intense: You may feel like you can never get enough information about the subject and spend hours deep-diving into research, personal accounts or other facets of the subject. So even if your interest is one that is common among people of your gender or age range, your interest in the subject may be far more intense than the interest that the people around you show towards that subject.

Many high-masking autistic people lean towards more typical special interests that might not be seen as overly odd by non-autistic people. These might include:

• Celebrities such as popstars
• Social justice, i.e. Greta Thunberg’s interest in climate activism
• Psychology
• Makeup
• Sports
• Fanfiction
• Video games
• Certain TV show/movie/book characters
• Stuffed animals such as Squishmallows

Part B.4. Hyper- or Hypo-Reactivity to Sensory Input

While this section of the DSM-5 criteria might sound overly complex, in reality it just means that you have stronger or weaker reactions to sensory experiences than most people. You might hear things more loudly, have a weakened sense of smell, be intolerant of certain textures or clothing styles, or even seek out extra sensory input by staring at bright lights.

Hyperreactivity means having a stronger reaction to sensory input than most people. This might include:

• Being very sensitive to loud noises, bright lights or tight clothes
• Getting upset by sounds that don’t bother most people, such as cars passing by on the street or a vacuum cleaner running in another room
• Disliking being touched or hugged
• Feeling overwhelmed in crowded noisy places, places with bright flashing lights like clubs or concert venues, or places with strong smells such as the perfume section at a department store
• Feeling averse to specific foods based on texture, smell or taste
• Finding certain hygiene routines overwhelming, such as showering or hair brushing
• Finding it incredibly challenging to filter out conversations around you when trying to focus

Hyporeactivity, on the other hand, means you have weaker reactions to certain sensory inputs than most people and might “crave” certain sensory stimuli. Hyporeactivity might look like:

• Not noticing pain and having an unusually high pain tolerance
• Not responding to loud noises or bright flashes of light
• Seeking out intense sensory experiences, such as spinning around, touching textured items, staring into lights or eating spicy foods that most people can’t tolerate

Parts C-E: Severity and Duration of Symptoms

Finally, if you believe you meet all three criteria in Part A and at least two out of the four criteria in Part B, think about the length of time you’ve been experiencing these symptoms and how much of your life has been impacted by them. According to the DSM-5, three final criteria must be met to be diagnosed as autistic:

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Below, we’ll cover what each of these mean in everyday terms.

Part C. Symptoms Must Be Present in Early Developmental Period

Autism is a neurodevelopmental condition, which means someone is either born with autism or they aren’t. Autism is not a condition that can be acquired later in life by someone who was not born with it. Part C is meant to determine whether your condition started at birth and continued to today, or whether your symptoms are better explained through a non-neurodevelopmental lens.

Many diagnosticians of potentially autistic adults conduct interviews with parents to learn more about what someone was like during childhood, or they might ask you to watch home movies to learn more about your experiences with autistic traits as a baby, toddler and child. Some common autistic traits in babies and young children might include:

• Developmental delays, particularly if a developmental disability is also present
• Extreme sensitivity to touch or sound, i.e. a baby screaming when their hair is brushed or they’re in a crowded place
• Extreme sensitivity to certain clothes, i.e. a toddler insisting on only wearing sweatpants
• Unique play patterns, i.e. lining up toys instead of playing with them
• Reduced interest in playing with other children
• Stimming behaviors such as rocking

Many autistic traits can also be signs of mental health conditions like OCD and PTSD, which can be acquired later in life. So, if you never struggled with social challenges until adulthood, a condition like anxiety might be a better descriptor of your struggles than autism.

However, it’s important to remember this line from the DSM-5: “[Symptoms] may not become fully manifest until social demands exceed limited capacities.” You may have internalized many of your autistic traits as a child and appeared “normal” to your parents or teachers, only to later start to act “more autistic” as an adolescent once the social demands of school and friendships took more and more of a toll on your social challenges. So, just because nobody noticed your autistic traits until later years does not disqualify you from meeting this criteria.

Secondly, autism is not something that ever goes away. There is no “cure” for autism, so someone who is born autistic and develops these autistic traits will always be autistic. For example, if you had social challenges as a kid but grew out of them, you may have been experiencing social anxiety or separation anxiety versus a neurodevelopmental disorder like autism. This section of the criteria is also meant to assess your condition as a lifelong disorder versus something more fleeting.

With that, keep in mind that the DSM-5 specifies that your symptoms “may be masked by learned strategies in later life.” Just because you might not “look” autistic on the outside as an adult doesn’t mean you aren’t autistic or aren’t struggling — you could be a high-masking individual who is working hard to keep up appearances of being neurotypical to the outside world.

Part D. Symptoms Cause Clinically Significant Impairment

Obviously, many of the challenges and symptoms we talked about in each section above are not exclusive to autism — they’re a part of being human. Many non-autistic people have trouble making friends, or have been bullied, or pick at their nails, or prefer a routine-driven lifestyle. But this doesn’t mean that everyone is a little autistic — far from it. The difference lies in how significantly these symptoms are impacting your life.

It’s common for autistic people to struggle significantly throughout their lifetime due to the symptoms they experience. For example, autistic children might work hard all day to mask their symptoms at school, and then come home and break down due to the stress of having to blend into a non-autistic lifestyle. Or, an autistic adult might go into autistic burnout and be unable to work or to visit with loved ones. Relationships can break apart due to miscommunications, or conditions like severe depression and anxiety can emerge. Ultimately, autism is a disability and will cause challenges in everyday life.

I love how Psy.D. Donna Henderson sums up this criteria in her own DSM-5 guide: “Clearly, individuals who are seeking either an evaluation or therapy do have clinically significant challenges.” If you’re struggling enough to be considering autism as a possible cause and seeking out help, you are clinically impaired enough to meet this criteria.

Part E. Lack of Other Clinical Explanations for Symptoms

Finally, any issues in relationships, communication and behaviors should be evaluated to make sure the cause isn’t due to an intellectual disability. Intellectual disabilities and autism do frequently co-occur, but if an intellectual disability is suspected, extra considerations should be made to ensure your symptoms aren’t able to be explained just by the intellectual disability on its own.

DSM Criteria as a Starting Point on Your Autism Journey

Ultimately, no one knows yourself and your experiences and how they fit into the diagnostic puzzle that is the DSM-5 criteria like you do. While this guide can be a helpful starting point, it’s important to examine your own experiences and how they relate to the relational and behavioral challenges outlined above.

Something that many autistic people find helpful is to create a journal or document where they copy each piece of the diagnostic criteria and list every life experience they can remember that relates to each part. When I was diagnosed, I made a binder with pages outlining my experiences throughout life and which criteria each experience met. After seeing pages of experiences pointing to challenges with each piece of criteria, it became clear to both me and my diagnostician that autism clearly explained the challenges I’d been having throughout my life.

Don’t be afraid to reach out on communities like Reddit or autism support groups to ask about specific criteria and how your personal experiences might relate. While each person’s expression of autism is as unique as the person themselves, you’ll often find many people that relate to specific parts of your experiences and autism journey and may find new insights into how your experiences relate to the broader DSM-5 criteria for autism.