and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), released in 2022, is the current version of the DSM. It is the predominant mental health diagnostic system used in the United States and Canada, and is often used in Anglophone countries. Its fifth edition, DSM-5, released in May 2013, was the first to define ASD as a single diagnosis, which is still the case in the DSM-5-TR. ASD encompasses previous diagnoses, including Asperger syndrome, childhood disintegrative disorder, PDD-NOS, and the range of diagnoses that included the word autism. Rather than distinguishing among these diagnoses, the DSM-5 and DSM-5-TR adopt a dimensional approach to diagnosing disorders that fall underneath the autism spectrum umbrella in one diagnostic category. Within this category, the DSM-5 and the DSM include a framework that differentiates each individual by dimensions of symptom severity, as well as by associated features (i.e., the presence of other disorders or factors that likely contribute to the symptoms, other neurodevelopmental or mental disorders, intellectual disability, or language impairment). The symptom domains are social communication and restricted, repetitive behaviors, with the option of a separate severity—the negative impact of the symptoms on the individual—being specified for each domain, rather than an overall severity. Before the DSM-5, the DSM separated social deficits and communication deficits into two domains. Further, the DSM-5 changed to an onset age in the early developmental period, with a note that symptoms may manifest later when social demands exceed capabilities, rather than the previous, more restricted three years of age. These changes remain in the DSM-5-TR. Features and characteristics Pre-diagnosis For many autistic people, characteristics first appear during infancy or childhood and follow a steady course without remission (different developmental timelines are described in more detail below). Autistic people may be severely impaired in some respects but average, or even superior, in others. Clinicians consider assessment for ASD when a patient shows: regular difficulties in social interaction or communication restricted or repetitive behaviors (often called "stimming") resistance to changes or restricted interests These features are typically assessed with the following, when appropriate: problems in obtaining or sustaining employment or education difficulties in initiating or sustaining social relationships connections with mental health or learning disability services a history of neurodevelopmental conditions (including learning disabilities and ADHD) or mental health conditions. There are many signs associated with autism; the presentation varies widely: {| class="wikitable" style="width:55em;border:solid 1px #999999; margin:0 0 1em