Frequently Asked Question

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hypo- reactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

C. 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).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. 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.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Reference: Diagnostic and Statistical Manual of Mental Disorder DSM-Ⅴ(2013) American Psychiatric Association

1. Deficits in intellectual functioning

This includes various mental abilities:

• Reasoning
• Problem solving
• Planning
• Abstract thinking
• Judgment
• Academic learning (ability to learn in school via traditional teaching methods)
• Experiential learning (the ability to learn through experience, trial and error, and observation)

These mental abilities are measured by IQ tests. A score of approximately two standard deviations below average represents a significant cognitive deficit. These scores would occur about 2.5% of the population. Or stated differently, 97.5% of people of the same age and culture would score higher. The tests used to measure IQ must be standardized and culturally appropriate. This is typically an IQ score of 70 or below.

2. Deficits or impairments in adaptive functioning

This includes skills needed to live in an independent and responsible manner. Limited abilities in these life skills make it difficult to achieve age-appropriate standards of behavior. Without these skills, a person needs additional supports to succeed at school, work, or independent life. Deficits in adaptive functioning are measured using standardized, culturally appropriate tests.

Various skills are needed for daily living:
• Communication: This refers to the ability to convey information from one person to another. Communication is conveyed through words and actions. It involves the ability to understand others, and to express one’s self through words or actions.
• Social skills: This refers to the ability to interact effectively with others. We usually take social skills for granted. However, these skills are critical for success in life. These skills include the ability to understand and comply with social rules, customs, and standards of public behavior. This intricate function requires the ability to process figurative language and detect unspoken cues such as body language.
• Personal independence at home or in community settings: This refers to the ability to take care of yourself. Some examples are bathing, dressing, and feeding. It also includes the ability to safely complete day-to-day tasks without guidance. Some examples are cooking, cleaning, and laundry. There are also routine activities performed in the community. This includes shopping for groceries and accessing public transportation.
• School or work functioning: This refers to the ability to conform to the social standards at work or school. It includes the ability to learn new knowledge, skills, and abilities. Furthermore, people must apply this information in a practical, adaptive manner, without excessive direction or guidance.

3. These limitations occur during the developmental period.

This means problems with intellectual or adaptive functioning were evident during childhood or adolescence. If these problems began after this developmental period, the correct diagnosis would be neurocognitive disorder. For instance, a traumatic brain injury from a car accident could cause similar symptoms.

Reference: Diagnostic and Statistical Manual of Mental Disorder DSM-Ⅴ(2013) American Psychiatric Association