The DSM-5 Criteria for ADHD and Autism, in Plain Language

This page is for information, not diagnosis. Only a qualified professional — a psychologist, psychiatrist, physician, or other licensed clinician — can diagnose ADHD or autism. Nothing here is a test, a checklist, or a substitute for an evaluation. Empower ADHD Solutions is a coaching practice, not a clinical one.

Most people meet the diagnostic criteria for ADHD or autism as a wall of clinical language, buried in a manual they'd have to pay to read. That's a bad way to learn something this personal. This page walks through what's actually in the criteria, in plain terms, so the language stops being a barrier.

How diagnosis works

Clinicians in the United States diagnose ADHD and autism using the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (APA). The current edition is the DSM-5-TR ("Text Revision"), released in 2022. It updated wording and background text from the original DSM-5 (2013), but the core criteria for ADHD and autism are the same.

A diagnosis is never just a symptom count. For both conditions, a clinician has to see that (1) enough of the specific traits are present, (2) they showed up early in life, (3) they show up in more than one part of life, and (4) they genuinely get in the way — and that something else isn't explaining the picture better. A good evaluation draws on your history, structured rating scales, and often input from someone who knew you as a child.

Why this is in our own words: the DSM-5-TR criteria are copyrighted by the APA, so we can't reproduce the official text here. Everything below is paraphrased for education. For the exact wording, see the DSM-5-TR or ask the professional doing your evaluation.

ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD is a neurodevelopmental condition — a difference in how the brain develops and regulates attention, activity, and impulses. The criteria are built around two groups of traits: inattention and hyperactivity-impulsivity. You can have a lot of one, or both.

For a diagnosis, the traits have to be present for at least six months, to a degree that's out of step with someone's age and that clearly makes life harder.

Inattention

A clinician looks for a persistent pattern across situations like these (paraphrased):

• Misses details or makes careless slips in work, school, or everyday tasks
• Struggles to hold attention on tasks or activities — including reading, paperwork, or long conversations
• Often seems not to be listening even when spoken to directly, with no obvious distraction
• Starts things but drifts off track and doesn't finish — losing focus or getting sidetracked, not out of defiance
• Finds it hard to organize tasks, materials, and time; work is disorganized; poor time management; misses deadlines
• Avoids, dislikes, or puts off tasks that need sustained mental effort (long reports, forms, detailed review)
• Loses the things needed to get through the day — keys, wallet, phone, paperwork, glasses
• Is easily pulled away by what's happening nearby, or — in adults — by unrelated thoughts
• Is forgetful in daily routines — chores, errands, returning calls, paying bills, keeping appointments

Children up to age 16 need six or more of these; older teens and adults (17+) need five or more.

Hyperactivity and impulsivity

The second group of traits (paraphrased):

• Fidgets, taps hands or feet, or can't sit still
• Gets up when staying seated is expected
• Feels physically restless — in adults this is often an internal restlessness rather than literally running around
• Has trouble doing quiet activities or winding down
• Feels driven "by a motor" — uncomfortable being still for long; others find it hard to keep up
• Talks a lot
• Blurts out answers before a question is finished, or finishes other people's sentences
• Finds waiting — in line, for a turn — genuinely difficult
• Interrupts or intrudes: jumps into conversations or activities, uses others' things without asking, or takes over what someone else is doing

Same thresholds apply: six or more for children, five or more for ages 17+.

The rest of the picture

Meeting the symptom count isn't enough on its own. A clinician also has to see that:

• It started early. Several of the traits were present before age 12.
• It's not just one setting. The traits show up in two or more areas of life — for example home and work, or work and relationships.
• It actually interferes. There's clear evidence the traits reduce the quality of social, school, or work life.
• Something else doesn't explain it better. The pattern isn't better accounted for by another condition, such as an anxiety disorder, a mood disorder, or substance use.

The three presentations

ADHD is described by which traits currently dominate:

• Combined presentation – enough inattentive and enough hyperactive-impulsive traits
• Predominantly inattentive presentation – enough inattentive traits, but not enough hyperactive-impulsive ones
• Predominantly hyperactive/impulsive presentation – the reverse

Because presentation can shift over time, a diagnosis also notes severity (mild, moderate, or severe) and whether someone is in partial remission — they met the full criteria before, and still have some impairing symptoms, but fewer than the full number now.

What changed from the older manual

The DSM-5 (2013) updated ADHD in ways that matter especially for adults: the age-of-onset requirement moved from age 7 to age 12, and from "impairment" to just "several symptoms present." The adult threshold dropped to five symptoms (from six), acknowledging that ADHD traits often look quieter in adulthood. Adult-oriented examples were added. And ADHD and autism can now be diagnosed in the same person — before 2013 they couldn't.

Reading this as an adult

The ADHD criteria were written mostly with children in mind, and it shows. As an adult you may be masking, holding things together at great cost, or only now noticing the pattern because life demands finally outgrew your workarounds. Hyperactivity may have turned into a constant inner restlessness. The "before age 12" piece often has to be reconstructed from report cards, old stories, and family memory. A clinician who assesses adults will expect all of this.

Autism Spectrum Disorder (ASD)

Since 2013 there has been one autism diagnosis. The DSM-5 folded together what used to be separate labels — autistic disorder, Asperger's disorder, childhood disintegrative disorder, and PDD-NOS — into a single autism spectrum disorder. Many adults still identify with "Asperger's"; clinically, it now falls under ASD.

The criteria have two required parts: differences in social communication and interaction, and restricted or repetitive patterns of behavior, interests, or activities. Both have to be present, and traits have to be there from early childhood — even if no one recognized them until later.

Part A: social communication and interaction

All three of the following are needed (paraphrased):

• Social back-and-forth works differently. Starting or sustaining conversation, sharing interests or feelings, responding to others' social approaches, or picking up unspoken social "rules" doesn't come automatically.
• Nonverbal communication works differently. Eye contact, facial expression, gesture, tone, and body language may not line up with speech the way others expect — or may take real conscious effort to produce and to read.
• Relationships are harder to build and keep. Adjusting behavior to different settings, imaginative play (as a child), making or keeping friendships, or interest in peers.

Part B: restricted and repetitive patterns

At least two of the following (paraphrased):

• Repetitive movement, speech, or use of objects – hand movements, rocking, lining things up, repeating or quoting words and phrases, other forms of stimming
• A strong need for sameness and routine – distress at small changes, difficulty with transitions, rigid thinking, rituals, wanting the same foods, routes, or schedule
• Intense, highly focused interests – deep, absorbing passions that stand out for their intensity or their subject
• Sensory differences – being over- or under-sensitive to sound, light, texture, temperature, pain, or smell; strong reactions to certain input; or seeking out and being fascinated by particular sensory experiences

The rest of the picture

• Early development. The traits were present in early childhood, even if they became obvious only when social demands increased, or were hidden by learned coping strategies.
• Real impact. The traits meaningfully affect social life, work, or other important areas.
• Not better explained by something else. Intellectual disability or global developmental delay don't account for the picture on their own. (Autism and intellectual disability can co-occur; social communication is then judged against overall developmental level.)

Support levels

A diagnosis notes how much support a person needs, rated separately for social communication and for restricted/repetitive behaviors:

• Level 1 – "requiring support"
• Level 2 – "requiring substantial support"
• Level 3 – "requiring very substantial support"

These describe support needs at a point in time and in a given environment — not fixed "functioning labels." They can change as circumstances change.

Specifiers

A diagnosis may also note whether it's: with or without an accompanying intellectual difference; with or without an accompanying language difference; linked to a known genetic or medical condition, or an environmental factor; linked to another neurodevelopmental, mental, or behavioral condition; or accompanied by catatonia.

What changed in the Text Revision

The DSM-5-TR (2022) made two small clarifications to autism: Part A wording was tightened to make explicit that all three items are required (the original DSM-5 wording left some clinicians unsure), and one specifier's language was softened from "disorder" to "problem," so clinicians can note associated difficulties that affect well-being even if they aren't formal diagnoses. Neither change was expected to shift how many people get diagnosed.

Reading this as an adult

Like the ADHD criteria, these were shaped around how autism looks in children. Adults — especially those who learned to mask early — often present very differently: fluent, scripted conversation that's exhausting to maintain; sensory needs managed quietly for decades; a childhood that "looked fine" because the environment was forgiving or because the cost stayed invisible. Clinicians who assess autistic adults account for masking and for the gap between how things look and how they feel.

When ADHD and autism happen together

A lot of people are AuDHD — autistic and ADHD at once. They overlap in areas like executive function, sensory needs, communication, and overwhelm, and one can partly mask the other during an evaluation. Since 2013 both can be formally diagnosed in the same person. There's more on how the two interact on our ADHD Comorbidities page.

If you think this describes you

• This isn't a diagnosis. If the descriptions here resonate, the next step is a professional evaluation. Our ADHD + Autism Resources page lists self-assessment tools and places to get evaluated.
• A diagnosis is a door, not a verdict. It can unlock accommodations, the right support, and a lot of self-understanding.
• Support doesn't have to wait for a diagnosis. Coaching works with how your brain actually operates, diagnosed or not.

A reminder: Empower ADHD Solutions is a coaching practice. Nothing on this page is medical advice, a diagnosis, or a substitute for evaluation and care from a licensed professional.

Ready to talk it through? Book a free discovery call