Do you think you might be on the Autism Spectrum?

Let’s talk about the official criteria for a diagnosis

Disclaimer: I am not a medical professional, and I don’t have the ability or permission to diagnose anyone. In this post I will interpret the DSM-5 criteria according to what they mean to me. If you think you might be on the Autism Spectrum, please reach out to your preferred medical provided to start your diagnosis process.

The Diagnostic and Statistical Manual of Mental Disorders, now in its 5th edition (DSM-5), is the diagnostic manual used by certified psychiatrists, psychologists and neurologists across the world. It defines every mental health condition and gives the criteria that determine if a person has a condition. 

When you go online searching for the “symptoms of Autism, you will find people talking about lack of eye contact, being non-verbal (not speaking), and knowing a lot about a specific topic. Those are signs exhibited by a lot of autistic people. But, they are also things that people can do even if they are not autistic. In order to get diagnosed you have to present a very specific set of symptoms. We’ll discuss them in a moment, but first, some basic background info.

Starter Info

For Autism, the DSM-5 has seven criteria. A person needs to show five, out of those seven criteria, since childhood, in order to be diagnosed. 

There is only one  Autism diagnosis, you either have it or you don’t. However, at the same time you receive an Autism diagnosis, you will receive a number that represents the amount of support you need. One (1) means “requires support” and three (3) means “requires very substantial support”.

If you receive an Autism 1 diagnosis, it does not mean that you have less Autism. I have an Autism 1 diagnosis and I meet all 7 of the DSM criteria. However, someone else might only meet 5 out of the 7 criteria and get a diagnosis of Autism 3. The number only represents how much support you need. People who have Autism 1 still need support, just less than someone who has Autism 3 diagnosis. For example, someone with Autism 3 might be non-verbal (doesn’t speak) and will definitely need more support than someone who can ask for food or help.

Now that the introduction is out of the way and you know the basics, let’s jump right in.

Group A: Poor social communication and interactions across different contexts.

The DSM provides 3 examples of how this might present in people. A person must have all 3 in order to be considered for a diagnosis. However, the DSM states that these examples are not the only way Autism may present itself. I’ll explain what that means as we go along.

Example 1: Lacks reciprocity.

This can present as you not knowing how to approach people you don’t know to start a conversation. Not knowing when is “your turn” to talk. Or, not talking unless someone asks you a question directly.

Example 2: Poor non-verbal communication.

This might feel like not wanting to look at people in the eyes or forcing yourself to look people in the eye yet constantly wondering if that’s enough eye contact. It also means you might not know what some gestures mean. Or, not knowing what to do with your face when people are talking to you.

Example 3: Difficulty in developing, maintaining, and understanding relationships.

This one goes in hand with example #1, not knowing how to approach people. You want friends, but don’t know how to make the friendships happen. You don’t know what to say or what people expect of you. Maybe you even feel like people are not worth the trouble and you’re better on your own. 

Group A Extras

Under group A also falls the idea of rehearsing your conversations upfront, practicing what you’re going to say and how they might react.

When assessing this part of the examples, good care has to be taken as to not confuse social anxiety or PTSD with Autism. Social anxiety is a different diagnosis, and while they might seem similar on the outside, the thought process that is happening inside the person can determine which condition the person has. That’s why, a good doctor will not only evaluate you for Autism, but for many other conditions as well. 

Group B: Restricted, repetitive patterns of behavior, interests, or activities.

In this group the DSM presents four examples but a person only needs to meet two in order to be considered for an Autism diagnosis.

Example 1: Repetitive movements, use of objects or speech.

People who don’t know much about Autism will probably immediately think about a boy rocking back and forth or moving their hands uncontrollably. And, while this is the classic presentation of stimming, it is not the only one. Stimming is self-stimulation. It is the repetitive movements a person might do to release energy or soothe themselves. It can look like shaking a leg or foot, tapping your fingers, or humming. In females and afab it might look like biting their nails, or playing with their hair.

In this example we also have echolalia, which is the repetition of things you hear. Like hearing an animal making a sound and repeating it. Or maybe you can recite your favorite movie by heart when you watch it. Or you take on someone else’s accent or way of speaking without noticing.

This example also includes the lining up of things. It is liking order in what you see. Clutter makes your mind feel the same way. You might not line up your toys, especially if you are female/afab, but maybe you lined up your shoes, or teddy bears, or you have a specific organization for your closet or your bookcase.

Example 2: Insistence on sameness, inflexible routines, or ritualized patterns of verbal or nonverbal behavior.

This presents as anxiety whenever your plans change. You might also take the same route to school/work everyday, even if its longer or takes more time. This might also mean, you always get dressed using the same order of clothing items, or maybe you use your skincare routine in one specific way.

Also, maybe you like eating the same food every day, over and over, like you are fixated, until it changes and now you don’t want to eat that food anymore. (More on food in example 4)

Example 3: Very specific and restrictive interests that are very intense and are not considered “normal”.

This is the classic kid who can recite a book from mind or knows everything there is to know about trains. However, your special interest can be anything: an artist, a book, an animal, the universe, etc.

When I was a kid, I was obsessed with Harry Potter. I would read the books over and over, even when going to the supermarket or on the car. And when I wasn’t reading the books I was watching and reciting the movies. I also would buy any paper or magazine that had an article about Harry Potter and i would cut up the article and put it in my mega Harry Potter binder.

So for girls/afab, special interests can go unnoticed, as they might look like regular fangirling. 

Example 4: Too much or too little sensory response.

Maybe you forget to eat, because you don’t feel hungry. Or maybe you don’t feel thirsty until you’re actually dehydrated. Sleep does not come easily. You might be tired but your body just doesn’t get the signal to shut off. Also, maybe you don’t have interest in sex, you might find people beautiful to look at, but looking at them doesn’t inspire a desire to do anything, except look at them. 

On the other end of this example, some fabrics might feel scratchy and uncomfortable, like socks. The clothes tag might poke you too hard and be too uncomfortable. Cold water on your skin might feel painful. And loud sounds can cause ear ache and become overwhelming.

Other things to consider

All of these symptoms must be present since childhood and significantly impaire social and occupational areas of your life. Since Autism is a neurological condition (the brain is wired in a different way than neurotypical brains are), it is not spontaneously developed during adulthood. It might be hidden, or masked, but it must have been present in childhood. One very important note is that Autism might not manifest until your limit capacity is reached. 

Think about this: you grow up in a quiet neighborhood, wearing soft and comfy clothes and your parents always make you the foods you like. You go to a small school and since you are very bright, you don’t have trouble getting good grades. You might not know you are autistic because the symptoms or criteria haven’t had a chance to show up. It is only when you are put in stressful positions and the demand of the world and society exceeds your capabilities, that the symptoms will start to show.

Also, if you’re really good at masking (hiding your symptoms), even if you aren’t aware that you’re masking, your symptoms wont be as clear or as visible. This might make it difficult to realize you have Autism.

One last key and indispensable note on the Autism diagnosis process: these symptoms mentioned above should not be better explained by other diagnoses like Intellectual Development Disorder, Social Anxiety, PTSD, OCD, or others. A person can have comorbidity, having more than one diagnosis at the same time, but they need to meet the criteria for all the diagnoses. 

On Autism self-diagnosis

Getting diagnosed can be tricky. Just because you have difficulty in relationships doesn’t mean you are Autistic. Maybe you have Social Anxiety or trauma from a past relationship. Having routines that can’t be changed can be part of an OCD diagnosis. A good doctor will test for all possible options and come up with the mos accurate result.

If you can’t afford to pay for a diagnosis and looking for input to self-diagnose, analyze where your behaviors are coming from, check the list of secondary symptoms to Autism and read up on the symptoms of other Neurodivergencies, as they tend to be similar.

I do hope this guide helps you in your journey to understand and accept yourself or a loved one. Please feel free to browse more content in this blog to learn more about what it is like to live with Autism.