A. Persistent deficits in social communication and social interaction (at least 1 of the following)
Deficiencies in socio-emotional reciprocity
Deficiencies in non-verbal communicative behaviors (used in social interaction)
Deficiencies in the development, maintenance and understanding of relationships
B. Restricted, repetitive patterns of behavior, interests, or activities (at least 2 of the following)
Repetitive movements, use of stereotyped or repetitive objects or speech
Insistence on monotony, excessive inflexibility of routines, or ritualized patterns of verbal or nonverbal behavior
Very restricted and fixed interests that are abnormal in their intensity or focus of interest
Hyper or hyporeactivity to sensory stimuli or unusual interest in sensory aspects of the environment
C. Symptoms must be present from the first phases of development
D. Symptoms cause clinically significant impairment in social, occupational, or other areas
E. These alterations are not better explained by intellectual disability or global developmental delay. The difficulties in socialization are disproportionate to the degree of development.
Result
A. Persistent deficits in social communication and social interaction.
– Across multiple contexts.
– Currently or by history.
– Below that expected for developmental level (criterion E).
Manifested by the following:  
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.
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.
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.
B. Restricted, repetitive patterns of behavior, interests, or activities:
– Currently or by history.
– Manifested by at least two of the following:
Stereotyped or repetitive motor movements, use of objects, or speech.
  • Simple motor stereotypies.
  • Lining up toys or flipping objects.
  • Echolalia.
  • Idiosyncratic phrases.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior.
  • Extreme distress at small changes;
  • Difficulties with transitions;
  • Rigid thinking patterns;
  • Greeting rituals;
  • Need to take same route or eat food every day.
Highly restricted, fixated interests that are abnormal in intensity or focus.
  • Strong attachment to or preoccupation with unusual objects;
  • Excessively circumscribed or perseverative interest;
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment;
  • Apparent indifference to pain/temperature;
  • Adverse response to specific sounds or textures;
  • Excessive smelling or touching of objects;
  • Visual fascination with lights or movement.

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.

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 must be below that expected for the general developmental level.

Specifiers
Severity

The severity is based on social communication impairments and restricted, repetitive patterns of behavior.

Comorbidity
  1. With or without accompanying intellectual impairment.
  2. With or without accompanying language impairment.
  3. Associated with a known medical or genetic condition or environmental factor.
  4. Associated with another neurodevelopmental, mental, or behavioral disorder.
  5. With catatonia.