Autism Spectrum Disorder

Criterion A: Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays and manifested by all three of the following:

  1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
  2. Deficits in non-verbal 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 communication, to total lack of facial expression or gestures,
  3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behaviour to suit the different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

Criterion B: Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following:

  1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases)
  2. 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)
  3. 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)
  4. 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)

Criterion C: Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities).

Criterion D: Symptoms together limit and impair everyday functioning.

Modifiers and Specifiers

With the new criteria, if the child meets for ASD, he/she will receive a diagnosis with the etiology as a specifier (e.g. ASD with Rett Syndrome or ASD with Fragile X Syndrome) or with a modifier indicating another important factor (e.g. ASD with tonic-clonic seizures or ASD with intellectual disabilities).

Early history is also specified:

  • Age of perceived onset
  • Pattern of onset (e.g. whether there was a loss of skills or not, when the loss of skills occurred)


  • ASD with onset before 20 months and loss of words
  • ASD with onset before 32 months and loss of social skills
  • ASD with no clear onset and no loss
  • ASD – Aspergers type

Levels of Severity

Level 1: Requires support

  • Social Communication – without support, some significant deficits in social communication
  • Restricted Interests and Repetitive Behaviour – significant interference in at least one context

Level 2: Requires substantial support

  • Social Communication – marked deficits with limited initiations and reduced or atypical responses
  • Restricted Interests and Repetitive Behaviour – obvious to the casual observer and occur across contexts

Level 3: Requires very substantial support

  • Social Communication – minimal social communication
  • Restricted Interests and Repetitive Behaviour – marked interference in daily life

Clinical Implications:

ADHD can now be diagnosed along with ASD.

Assessment measures (e.g. the ADOS) will need to be redeveloped.


APA, 2011

Dr Doreen Granpeesheh