DSM-V Criteria

Diagnostic Criteria for Autism Spectrum Disorder (DSM-V): - Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following: - Deficits in social-emotional reciprocity: The patient, a 5-year-old male, shows limited ability to engage in back-and-forth conversation and often does not respond to social interactions initiated by others. - Deficits in nonverbal communicative behaviors used for social interaction: The patient rarely makes eye contact and does not use gestures to communicate needs or emotions. - Deficits in developing, maintaining, and understanding relationships: The patient struggles to make friends and does not engage in imaginative play with peers. - Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following: - Stereotyped or repetitive motor movements, use of objects, or speech: The patient frequently flaps his hands and lines up toys in a specific order. - Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior: The patient becomes distressed if his daily routine is altered and insists on eating the same foods every day. - Highly restricted, fixated interests that are abnormal in intensity or focus: The patient is intensely focused on trains and can spend hours watching train videos. - Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment: The patient is hypersensitive to loud noises and covers his ears in noisy environments. - Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). - Describe the onset and developmental history of symptoms: Symptoms were first noticed at age 2 when the patient did not respond to his name and showed limited interest in social play. - Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning. - Describe the impact of symptoms on daily functioning: The patient's symptoms significantly impact his ability to participate in group activities at preschool and hinder his ability to communicate effectively with peers and teachers. - These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level. - Describe differential diagnosis considerations: The patient has been evaluated for intellectual disability, but his cognitive abilities are within the normal range for his age, supporting a diagnosis of autism spectrum disorder.