Autism diagnosis criteria: explained (DSM-5)

Sam introduces the Diagnostic Statistical Manual (DSM) criteria used for autism diagnosis in the United States and parts of Europe, developed by the American Psychiatric Association. The DSM serves as a textbook for psychologists, but its complex language can be difficult for non-experts. Sam, an adult autism self-diagnose, aims to break down the criteria into more understandable terms. He also mentions the ICD 11 as an alternative used internationally. Sam clarifies that he is not a registered psychologist but has personal experience with the DSM diagnosis process. He discusses the DSM and ICD's disorder-based model, which can be disheartening, but emphasizes that meeting the criteria does not diminish one's worth and aligns with the neurodiversity movement's perspective.

The script delves into Category A of the DSM criteria, focusing on social interaction difficulties. It explains the three points under this category that must be met for an autism diagnosis. The first point addresses social emotional reciprocity, where individuals may struggle with neurotypical social interaction models, such as maintaining conversation or understanding small talk. Sam shares personal experiences of masking emotions and having difficulty with emotional reciprocity. The second point discusses challenges with nonverbal communication, including eye contact, facial expressions, and reading others' body language. Sam recounts a childhood incident where he inappropriately smiled while conveying sad news. The third point involves difficulties in forming, maintaining, and understanding friendships. Sam reflects on his own challenges with friendships and the evolution of his understanding of what friendship means.

The video script continues with Category B, which covers restricted, repetitive patterns of behavior. To meet the criteria, two out of four points must be present. The first point is about self-stimulatory behavior, or stimming, which can include hand flapping, vocalizations, or echolalia. Sam identifies with this point. The second point addresses insistence on sameness, where changes in routine or environment can cause distress. Sam admits to some rigidity, especially regarding food habits in her youth. The third point is about intense, focused interests, which Sam finds distasteful to pathologize, as they can bring joy and open up new experiences. She shares her own history of intense interests, from gymnastics to autism. The fourth point is sensory issues, which can range from hypersensitivity to hyposensitivity. Sam describes her own experiences with noise sensitivity and visual seeking, highlighting the neurological basis of autism.

Category C emphasizes the importance of symptoms being present since childhood, indicating that autism is a lifelong condition. Sam discusses the challenges of identifying these traits, especially if one has had a stress-free or accommodating environment. She shares her personal journey, noting that her traits became more apparent during puberty and worsened over time due to increased social and executive function demands. The script touches on the concept of masking and how it can delay the recognition of autistic traits until they cause significant stress.

Sam expresses her least favorite category, Category D, which requires the symptoms to cause clinically significant distress or impairment in daily functioning. She argues that this criterion is flawed, as autism can be present without current distress, especially if one has a supportive environment. Sam suggests that not diagnosing someone who is not currently distressed overlooks the potential for future challenges. She emphasizes that an autism diagnosis often comes at a breaking point, such as during periods of depression, anxiety, or significant life changes, all of which are valid reasons for diagnosis.

The final category, E, involves ruling out other conditions that might cause similar symptoms, to ensure that the diagnosis is specific to autism. Sam recounts her experience of having other conditions like intellectual disability, personality disorders, and psychosis ruled out during her assessment. She criticizes the medical and deficit-based model of autism for focusing on box-ticking and comparing behaviors against a 'normal' benchmark. Sam also discusses the challenges of self-reporting and the potential for misinterpretation by clinicians. She concludes with a critique of the lack of recognition for the joy and value that special interests bring to autistic individuals and the broader implications of the diagnosis process.