It’s been five years since the autism community agonized over the debut of a new iteration of a diagnostic manual that set out to rewrite the definition of autism. In this special report, we revisit the concerns and controversy over the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5).

The concept of autism has evolved significantly with each edition of the DSM. We explain how the term has evolved, and a colorful animation brings this information to life. David Skuse, Catherine Lord and Sally Rogers engage in a live debate about the DSM-5’s criteria for autism and their impact five years after the book’s release.

It’s clear that the criteria set out in the DSM-5 have made autism diagnosis more consistent than before, as the revision committee had hoped; at the same time, as Lina Zeldovich reports, the new definition may exclude some people on the spectrum.

The resculpting of ‘autism’ has not left droves of children without autism services, as many feared it would. In fact, children now seem to be receiving more help than they did before 2013. Many adults remain adrift, however, for reasons beyond the book’s purview, Julia Bascom writes.

Researchers Brian Reichow and Fred Volkmar echo the concern that in refining the definition of autism, the DSM-5 leaves out young children and people with high cognitive ability, among others.

Still, the consolidation of diagnoses — specifically, the move to fold Asperger syndrome and pervasive developmental disorder-not otherwise specified into autism — earns approval from David Skuse. In fact, says Helen Tager-Flusberg, the DSM-5 should also have dispensed with the new diagnosis of social communication disorder.

The DSM-5 is prescient in its nod to gender issues in the diagnosis of autism, although many girls and women on the spectrum still go undiagnosed, says columnist William Mandy. Walter Kaufmann likewise applauds the DSM-5’s new ‘intellectual disability’ diagnosis, which emphasizes adaptive functioning over intelligence quotient scores, but he laments the dearth of data on its impact.

On the research front, the DSM-5 seemed to be in competition with so-called Research Domain Criteria, which aim to prioritize projects that probe the biology of mental health conditions rather than DSM diagnoses. Reporter Sarah DeWeerdt reveals that the U.S. National Institute of Mental Health remains faithful to these criteria.