Evaluating the Implementation of Oregon's DSM-5-Informed Autism Eligibility Revisions: Interest-Holder Perspectives and Policy Implications

Under the Individuals with Disabilities Education Act (IDEA), states establish their own autism spectrum disorder (ASD) eligibility criteria, resulting in substantial interstate variation and frequent misalignment with medical diagnostic standards. In 2019, Oregon revised its ASD eligibility criteria by directly incorporating DSM-5 diagnostic criteria, reflecting proponents' theory of action that this alignment would improve conceptual clarity, identification accuracy, and coherence across educational and medical systems. While an early implementation study documented generally positive early effects reported by evaluators, no research has systematically examined whether the DSM-5 alignment achieved its anticipated effects, how the revised criteria function after multiple years of use, or whether interest-holders view further revision as warranted. This study employed a convergent mixed-methods design to examine the implementation and perceived effects of Oregon's DSM-5–aligned ASD eligibility criteria more than 5 years after adoption. Data sources included a statewide survey of school-based professionals involved in ASD evaluations, a focus group, and interviews with experienced evaluators. Quantitative survey data were analyzed descriptively, while qualitative data underwent inductive content analysis and reflexive thematic analysis. Results indicate the 2019 revisions largely achieved their intended goals of improving conceptual clarity and strengthening cross-system coherence, particularly among evaluators experienced with both pre- and post-2019 criteria. However, important trade-offs emerged. While ambiguity surrounding autism definitions decreased, interpretive and evidentiary demands increased, with implementation challenges concentrated in eligibility qualifiers rather than in identifying core autism characteristics. Participants recognized DSM-5 alignment benefits while describing the relational labor required to compensate for language-related shortcomings in educational contexts.