Factors associated with DSM-5 severity level ratings for autism spectrum disorder

Autism. 2019 Feb;23(2):468-476. doi: 10.1177/1362361318755318. Epub 2018 Feb 1.


The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5) introduced substantial changes to the diagnostic criteria for autism spectrum disorder, including new severity level ratings for social communication and restricted and repetitive behavior domains. The purpose of this study was to evaluate the use of these new severity ratings and to examine their relation to other measures of severity and clinical features. Participants included 248 children with autism spectrum disorder who received diagnostic evaluations at one of six Autism Treatment Network sites. Higher severity ratings in both domains were associated with younger age, lower intelligence quotient, and greater Autism Diagnostic Observation Schedule-Second Edition domain-specific symptom severity. Greater restricted and repetitive behavior severity was associated with higher parent-reported stereotyped behaviors. Severity ratings were not associated with emotional or behavioral problems. The new DSM-5 severity ratings in both domains were significantly associated with behavioral observations of autism severity but not with measures of other behavioral or emotional symptoms. However, the strong associations between intelligence quotient and DSM-5 severity ratings in both domains suggest that clinicians may be including cognitive functioning in their overall determination of severity. Further research is needed to examine clinician decision-making and interpretation of these specifiers.

Keywords: DSM-5; autism spectrum disorder; diagnosis; need for support; severity level.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Autism Spectrum Disorder / diagnosis*
  • Autism Spectrum Disorder / physiopathology
  • Child
  • Child, Preschool
  • Cognition
  • Communication*
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Female
  • Humans
  • Intelligence Tests
  • Male
  • Problem Behavior
  • Severity of Illness Index*
  • Social Behavior*
  • Stereotyped Behavior*