Diagnostic criteria Autistic Spectrum Disorder (DSM-V)

A. PERSISTENT DEFICITS IN SOCIAL COMMUNICATION AND SOCIAL INTERACTION ACROSS CONTEXTS,

NOT ACCOUNTED FOR BY GENERAL DEVELOPMENTAL DELAYS, AND MANIFEST BY 3 OF 3 SYMPTOMS:

A1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth
conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social
interaction.
Abnormal social approach
Unusual social initiations (e.g. intrusive touching, licking of others)
Use of others as tools
Failure of normal bank and forth conversation
Poor pragmatic/social use of language
(e.g. does not clarify if not understood; does not provide background information)
Failure to respond when name called
Does not initiate conversation
One-sided conversations/monologues/tangential speech
Reduced sharing of interests
Doesn’t share
Lack of showing, bringing, or pointing out objects of interest to other people
Impairments in joint attention (both initiating and responding)
Reduced sharing of emotions/affect
Lack of responsive social smile
(note: the emphasis here is on the response to another person’s smile;
other aspects of emotional expression should be considered under A2)
Failure to share enjoyment, excitement, or achievements with others
Failure to respond to praise
Does not show pleasure in social interactions
Failure to offer comfort to others
Indifference/aversion to physical contact and affection
Lack of initiation of social interaction
Only initiates to get help; limited social initiations
Poor social imitation
Failure to engage in simple social games
A2. Deficits in nonverbal communicative behaviours used for social interaction; ranging from poorly integrated verbal and
nonverbal communication, through abnormalities in eye contact and body language, or deficits in understanding and use of
nonverbal communication, to total lack of facial expression or gestures
Impairments in social use of eye contact
Impairments in the use and understanding of body postures
(e.g. facing away from the listener)
Impairments in the use and understanding of gestures
(e.g. pointing, waving, nodding/shaking head)
Abnormal volume, pitch, intonation, rate, rhythm, stress, prosody or volume in speech
Abnormalities in use and understanding of affect
(note: responsive social smile should be considered under A1,
affect that it inappropriate for the context should be considered under A3)
Impairment in the use of facial expressions
(may be limited or exaggerated)
Lack of warm, joyful expressions directed at others
Limited communication of own affect
(inability to convey a range of emotions via words, expressions, tone of voice, gestures)
Inability to recognise or interpret other’s nonverbal expressions
Lack of coordinated verbal and nonverbal communication
(e.g. inability to coordinate eye contact or body language with words)
Lack of coordinated nonverbal communications (e.g. inability to coordinate eye contact with gestures)
A3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers);
ranging from difficulties adjusting behaviours to suit different social contexts through difficulties in sharing imaginative play
and in making friends to an apparent absence of interest in people
 Deficits in developing and maintaining relationships, appropriate to developmental level
Lack of “theory of mind”; inability to take another person’s perspective
(CA ≥ 4 years)
Difficulties adjusting behaviour to suit social contexts
Does not notice another person’s lack of interest in an activity
lack of response to contextual cues
(e.g. social cues from others indicating a change in behaviour is implicitly requested)
Inappropriate expressions of emotion
(laughing or smiling out of context)
(note: other abnormalities in the use and understanding of emotion should be considered under A2)
Unaware of social conventions/appropriate social behaviour; asks socially inappropriate questions or makes socially
inappropriate statements
Does not notice another’s distress or disinterest
Does not recognize when not welcome in a play or conversational setting
Limited recognition of social emotions
(does not notice when he or she is being teased; does not notice how his or her behaviour impacts others
emotionally)
Difficulties in sharing imaginative play
(Note: solitary imaginative play/role playing is NOT captured here)
Lack of imaginative play with peers, including social role playing
(>4 years developmental age)
Difficulties in making friends
Does not try to establish friendships
Does not have preferred friends
Lack of cooperative play (over 24 months developmental age); parallel play only
Unaware of being teased or ridiculed by other children
Does not play in groups of children
Does not play with children his/her age or developmental level (only older/younger)
Has an interest in friendship but lacks understanding of the conventions of social interaction
(e.g. extremely directive or rigid; overly passive)
Does not respond to the social approaches of other children
Absence of interest in others
Lack of interest in peers
Withdrawn; aloof; in own world
Does not try to attract the attention of others
Limited interest in others
Unaware or oblivious to children or adults
Limited interaction with others
Prefers solitary activities

B. RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR, INTERESTS, OR ACTIVITIES

AS MANIFESTED BY AT LEAST 2 OF 4 SYMPTOMS:

B1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia,
repetitive use of objects, or idiosyncratic phrases).
Stereotyped or repetitive speech
Pedantic speech or unusually formal language
(e.g. child speaks like an adult or “little professor”)
Echolalia (immediate or delayed); may include repetition of words, phrases, or more extensive songs or dialog
“Jargon” or gibberish
(mature jargoning after developmental age of 24 months)
Use of “rote” language
Neologisms or idiosyncratic or metaphorical language
(language that has meaning only to those familiar with the individual’s communication style)
Pronoun reversal
(for example, “You” for “I”; not just mixing up gender pronouns)
Refers to self by own name
(does not use “I”)
Perservative language
(note: for perseveration on a specific topic, consider B3)
Repetitive vocalizations such as repetitive guttural sounds, intonational noise-making, unusual squealing, repetitive
humming
 Stereotyped or repetitive motor movements
Repetitive hand movements (e.g., clapping, finger flicking, flapping, twisting)
Stereotyped or complex whole body movements
(e.g. foot to foot rocking, dipping, & swaying; spinning)
Abnormalities of posture
(e.g. toe walking; full body posturing)
Intense body tensing
Unusual facial grimacing
Excessive teeth grinding
Repetitively puts hands over ears (note: if response to sounds, consider B4)
Perseverative or repetitive action / play / behaviour
(note: if 2 or more components, then it is a routine and should be considered under B2)
Repetitive picking
(unless clear tactile sensory component, then consider B4)
Stereotyped or repetitive use of objects
Non-functional play with objects
(waving sticks; dropping items)
Lines up toys or objects
Repetitively opens and closes doors
Repetitively turns lights on and off
B2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behaviour, or excessive resistance to change;
(such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
Adherence to routines
Routines: specific, unusual multiple-step sequences of behaviour
Insistence on rigidly following specific routines
(note: exclude bedtime routines unless components or level of adherence is atypical)
Unusual routines
Ritualized Patterns of Verbal and Nonverbal Behaviour
Repetitive questioning about a particular topic
(distinguish from saying the same word or phrase over and over, which goes under B1)
Verbal rituals - has to say one or more things in a specific way or requires others to say things or answer questions
in a specific way
Compulsions
(e.g. insistence on turning in a circle three times before entering a room)
(note: repetitive use of objects, including lining up toys, should be considered under B1).
Excessive resistance to change
Difficulty with transitions
(should be out of the range of what is typical for children of that developmental level)
Overreaction to trivial changes
(moving items at the dinner table or driving an alternate route)
Rigid thinking
Inability to understand humour
Inability to understand non-literal aspects of speech such as irony or implied meaning
Excessively rigid, inflexible, or rule-bound in behaviour or thought
B3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation
with unusual objects, excessively circumscribed or perseverative interests).
Note: Consider B1 for perseverative speech
Preoccupations; obsessions
Interests that are abnormal in intensity
Narrow range of interests
Focused on the same few objects, topics or activities
Preoccupation with numbers, letters, symbols
Being overly perfectionistic
Interests that are abnormal in focus
Excessive focus on non-relevant or non-functional parts of objects
Preoccupations
(e.g. colour; time tables; historical events; etc)
Attachment to unusual inanimate object
(e.g. piece of string or rubber band)
Having to carry around or hold specific or unusual objects
(not common attachment objects such as blankets, stuffed animals, etc.)
 Unusual fears (e.g. afraid of people wearing earrings)
B4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent
indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects,
fascination with lights or spinning objects).
High tolerance for pain
Poking own eyes
Preoccupation with texture or touch (includes attraction/aversion to texture)
Tactile defensiveness; does not like to be touched by certain objects or textures
Significant aversion to having hair or toenails cut, or teeth brushed
Unusual visual exploration / activity
Close visual inspection of objects or self for no clear purpose
(for example, holding things at unusual angels) (no vision impairment)
Looks at objects, people out of corner of eye
Unusual squinting of eyes
Extreme interest or fascination with watching movement of other things
(e.g., the spinning wheels of toys, the opening and closing of doors, electric fan or other rapidly revolving object)
In all domains of sensory stimuli (sound, smell, taste, vestibular, visual), consider:
Odd responses to sensory input
(e.g. becoming extremely distressed by the atypical sound)
Atypical and/or persistent focus on sensory input
Unusual sensory exploration with objects (sound, smell, taste, vestibular)
Licking or sniffing objects
(note: as part of a ritual, consider B2;
licking or sniffing people consider A1)

C. SYMPTOMS MUST BE PRESENT IN EARLY CHILDHOOD (BUT MAY NOT BECOME FULLY MANIFEST UNTIL SOCIAL DEMANDS
EXCEED LIMITED CAPACITIES)
* EARLY PRIMARY CAREGIVER REPORT NO LONGER ESSENTIAL
* “EARLY CHILDHOOD” APPROXIMATELY AGE 8 AND YOUNGER (FLEXIBLE)

D. SYMPTOMS TOGETHER LIMIT AND IMPAIR EVERYDAY FUNCTIONING

* SELECT ONE SEVERITY LEVEL SPECIFIER FOR SOCIAL COMMUNICATION AND ONE FOR RESTRICTED INTERESTS AND REPETITIVE
BEHAVIOURS
Severity level for ASD Social Communication Restricted Interests & Repetitive Behaviours
Level 3: ‘Requiring very Severe deficits in verbal and nonverbal social Preoccupations, fixated rituals and/or repetitive
substantial support’ communication skills cause severe impairments behaviours markedly interfere with functioning in
in functioning; very limited initiation of social all spheres. Marked distress when rituals or
interactions and minimal response to social routines are interrupted; very difficult to redirect
overtures from others from fixated interest or returns to it quickly
Level 2: ‘Requiring substantial Marked deficits in verbal and nonverbal social RRBs and/or preoccupations or fixated interests
support’ communication skills; social impairments appear frequently enough to be obvious to the
apparent even with supports in place; limited casual observer and interfere with functioning in
initiation of social interactions and reduced or a variety of contexts. Distress or frustration is
abnormal response to social overtures from apparent when RRBs are interrupted; difficult to
others redirect from fixated interest
Level 1: ‘Requiring support’ Without supports in place, deficits in social Rituals and repetitive behaviours RRB cause
communication cause noticeable impairments. significant interference with functioning in one or
Has difficulty initiating social interactions and more contexts. Resists attempts by others to
demonstrates clear examples of atypical or interrupt RRBs or to be redirected from fixated
unsuccessful responses to social overtures of interest
others. May appear to have decreased interest in
social interactions.