Autism Spectrum Disorder – DSM-5 Diagnostic Criteria

15 question-and-answer flashcards covering all major diagnostic criteria, examples, severity levels, and specifiers for Autism Spectrum Disorder according to DSM-5 guidelines.

What three types of social communication/interaction deficits must ALL be present for an ASD diagnosis?

1) Deficits in social-emotional reciprocity; 2) Deficits in nonverbal communicative behaviors; 3) Deficits in developing, maintaining, and understanding relationships.

What are common examples of deficits in social-emotional reciprocity?

Abnormal social approach, failure of normal back-and-forth conversation, reduced sharing of interests or emotions, and failure to initiate or respond to social interactions.

Which behaviors illustrate deficits in nonverbal communicative behaviors?

Poorly integrated verbal and nonverbal communication, abnormal eye contact and body language, and lack of facial expressions or gestures.

Give examples of difficulties in developing, maintaining, and understanding relationships seen in ASD.

Trouble adjusting behavior to different social contexts, difficulty making friends, and little or no interest in peers.

For restricted/repetitive behaviors, how many of the four symptom types must be present?

At least TWO of the four types are required.

What four categories make up the restricted, repetitive behavior criterion (Criterion B)?

1) Stereotyped or repetitive motor movements, use of objects, or speech; 2) Insistence on sameness; 3) Highly restricted, fixated interests; 4) Hyper- or hyporeactivity to sensory input.

Provide examples of stereotyped or repetitive motor movements, use of objects, or speech.

Echolalia, lining up toys, and use of idiosyncratic phrases.

What are common signs of insistence on sameness in individuals with ASD?

Extreme distress at small changes, inflexible adherence to routines, and rigid thinking patterns.

Which behaviors reflect highly restricted, fixated interests?

Strong attachment to unusual objects and excessively circumscribed or perseverative interests.

List examples of hyper- or hyporeactivity to sensory input seen in ASD.

Apparent indifference to pain/temperature, adverse response to specific sounds or textures, and fascination with lights or movement.

During which developmental period must ASD symptoms be present, and how might they manifest?

Symptoms must be present in the early developmental period, though they may emerge fully only when social demands exceed capacities or may be masked by learned strategies.

How must ASD symptoms affect functioning to meet Criterion D?

They must cause clinically significant impairment in social, occupational, or other important areas of functioning.

When ASD and intellectual disability co-occur, how is ASD distinguished?

Social communication abilities must be noticeably below what would be expected for the individual’s overall developmental level.

How are ASD severity levels structured and rated?

Severity is rated separately for (1) social communication and (2) restricted, repetitive behaviors: Level 1 = requiring support; Level 2 = requiring substantial support; Level 3 = requiring very substantial support.

What specifiers can be added to an ASD diagnosis?

• With or without intellectual impairment
• With or without language impairment
• Associated with a known medical/genetic condition or environmental factor
• Associated with another neurodevelopmental, mental, or behavioral disorder
• With catatonia

What three types of social communication/interaction deficits must ALL be present for an ASD diagnosis?

All three of the following social communication/interaction deficits must be present for an ASD diagnosis: 1) Deficits in social-emotional reciprocity: This involves difficulties with normal back-and-forth conversation, reduced sharing of interests or emotions, abnormal social approach, and a failure to initiate or respond to social interactions. 2) Deficits in nonverbal communicative behaviors: This includes poorly integrated verbal and nonverbal communication, abnormal eye contact and body language, and a lack of facial expressions or gestures. 3) Deficits in developing, maintaining, and understanding relationships: Individuals may have trouble adjusting their behavior to different social contexts, difficulty making friends, and little or no interest in peers.

What are common examples of deficits in social-emotional reciprocity?

Common examples include an abnormal social approach (e.g., unusual or inappropriate ways of initiating interactions, such as approaching too closely or with atypical eye contact); failure of normal back-and-forth conversation (e.g., difficulties with reciprocal dialogue, leading to monologues or lack of engagement); reduced sharing of interests or emotions (e.g., not spontaneously sharing joy, concerns, or achievements with others, or a diminished response when others try to share); and failure to initiate or respond to social interactions (e.g., not starting conversations or interactions, or not responding when others attempt to engage).

Which behaviors illustrate deficits in nonverbal communicative behaviors?

Behaviors illustrating deficits in nonverbal communicative behaviors include poorly integrated verbal and nonverbal communication (e.g., speech that doesn't match facial expressions or gestures); abnormal eye contact and body language (e.g., averted gaze, staring, or unusual postures and movements); and a lack of facial expressions or gestures (e.g., a flat affect or limited use of gestures to convey meaning).

Give examples of difficulties in developing, maintaining, and understanding relationships seen in ASD.

Examples of difficulties in developing, maintaining, and understanding relationships in ASD include trouble adjusting behavior to different social contexts (e.g., acting the same way with a teacher as with a close friend); difficulty making friends (e.g., due to challenges with social reciprocity or understanding social cues); and little or no interest in peers (e.g., preferring solitary activities or showing minimal engagement with age-mates).

For restricted/repetitive behaviors, how many of the four symptom types must be present?

At least TWO of the four types are required.

What four categories make up the restricted, repetitive behavior criterion (Criterion B)?

1) Stereotyped or repetitive motor movements, use of objects, or speech; 2) Insistence on sameness; 3) Highly restricted, fixated interests; 4) Hyper- or hyporeactivity to sensory input.

Provide examples of stereotyped or repetitive motor movements, use of objects, or speech.

Examples include echolalia (repeating words or phrases heard from others); lining up toys or other objects in precise ways; and the use of idiosyncratic phrases (unusual or self-invented expressions).

What are common signs of insistence on sameness in individuals with ASD?

Common signs include extreme distress at small changes (e.g., reacting strongly to a change in daily schedule or furniture arrangement); inflexible adherence to routines (e.g., needing to follow a very specific sequence of events for daily tasks); and rigid thinking patterns (e.g., difficulty adapting to new ideas or problem-solving flexibly).

Which behaviors reflect highly restricted, fixated interests?

Behaviors reflecting highly restricted, fixated interests include a strong attachment to unusual objects (e.g., carrying around specific non-toy items like a piece of string or a light switch); and excessively circumscribed or perseverative interests (e.g., an intense, often encyclopedic knowledge of a narrow topic like train schedules or vacuum cleaners, to the exclusion of other typical activities).

List examples of hyper- or hyporeactivity to sensory input seen in ASD.

Examples include apparent indifference to pain/temperature (e.g., not reacting to hot liquids or minor injuries); adverse response to specific sounds or textures (e.g., covering ears due to loud noises, refusing certain fabrics); and fascination with lights or movement (e.g., staring intensely at spinning objects or flickering lights).

During which developmental period must ASD symptoms be present, and how might they manifest?

Symptoms must be present in the early developmental period, though they may emerge fully only when social demands exceed capacities or may be masked by learned strategies.

How must ASD symptoms affect functioning to meet Criterion D?

They must cause clinically significant impairment in social, occupational, or other important areas of functioning.

When ASD and intellectual disability co-occur, how is ASD distinguished?

Social communication abilities must be noticeably below what would be expected for the individual’s overall developmental level.

How are ASD severity levels structured and rated?

Severity is rated separately for (1) social communication and (2) restricted, repetitive behaviors: Level 1 = requiring support; Level 2 = requiring substantial support; Level 3 = requiring very substantial support.

What specifiers can be added to an ASD diagnosis?

• With or without intellectual impairment

• With or without language impairment

• Associated with a known medical/genetic condition or environmental factor

• Associated with another neurodevelopmental, mental, or behavioral disorder

• With catatonia