When looking into a potential autism diagnosis, it can be hard to understand all of the language surrounding autism. There is so much pathologized language that presents all behavior as negative as well as being difficult to understand. Thus, I have taken the DSM-V criteria for autism and broken them down into examples of how each criteria can be met. Each section heading and criteria heading has been left with the original language of the DSM however the examples are meant to be a more inclusive and more positive take on autistic traits.

Please note that in order to qualify for a professional diagnosis, one must meet all three criteria from section A, two of four for section B, and sections C, D, and E.

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.”

  • Differences in social approach
    • Difficulty starting social interactions
    • May not initiate social interactions at all
    • Differences in ways of approaching others
    • Difficulty understanding physical boundaries
  • Differences in flow of conversation
    • Difficulty understanding when it is one’s turn to talk (may result in interrupting others or not speaking out of hesitancy to interrupt)
    • Conversation may be very focused on a particular topic
    • Conversation may be one sided/a monologue
    • Difficulty initiating conversation
    • May not respond when spoken to directly
    • May have difficulty with social norms of conversation (may not clarify if not understood or may not provide background information to what is being said)
    • Lack of engagement in small talk
  • Reduced sharing of interests
    • May not be interested in sharing interests with others
    • May not point out or show interesting objects to other people
    • May have difficulty remaining engaged in conversation about a subject one is not interested in
  • Reduced sharing of emotions/affect
    • May not smile in response to another’s smile
    • May not share enjoyment, excitement, or achievements with others
    • May not respond to praise
    • May not show pleasure in social interactions
    • May have difficulty offering comfort to others
    • May be averse or indifferent to physical affection/contact

2. “Deficits in nonverbal communicative behaviors 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 nonverbal communication, to total lack of facial expression or gestures. ”

  • Differences in use of eye contact
    • May be averse to eye contact
    • May make too much eye contact
    • May not know when to make eye contact
    • May use eye contact only in specific situations such as only with familiar people or only with strangers
  • Differences in body posturing
    • May face away from listener during conversation
    • May appear uninterested in conversation
    • May not use gestures to deliberately communicate
    • May have difficulty understanding other’s body posturing
  • Differences in the use of gestures
    • May not use typical gestures such as pointing, waving, or nodding/shaking head
    • May have difficulty understanding the gestures others make
  • Differences in vocal tone
    • May speak too loudly or too quietly for a situation
    • May speak with different pitch, intonation, rhythm, stress, or prosody than is typical
    • May speak very quickly or very slowly
  • Differences in affect
    • More limited or exaggerated facial expressions than is typical
    • May appear cold or unengaged
    • Limited range of tone of voice
    • May have difficulty conveying emotions via words
    • May have difficulty interpreting or understanding other’s nonverbal communication
  • Difficulty coordinating verbal and nonverbal communication
    • Words may not match up with facial expressions/tone of voice
    • May have difficulty coordinating eye contact and gestures

3. “Deficits in developing, maintaining, and understand 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.”

  • Difficulty developing and maintaining relationships
  • Difficulty taking another’s perspective
  • Difficulty adjusting behavior to fit a situation
    • May not notice another’s lack of interest in an activity
    • May not notice nonverbal social cues indicating a request for change in behavior
    • May express emotions that do not fit a situation (laughing or smiling when something sad has happened, for example)
    • May ask socially inappropriate questions or make socially inappropriate statements
    • May not understand or be aware of social rules
    • May not recognize when not welcome in a social setting
    • May not notice how one’s behavior affects others emotionally
    • May not notice when one is being teased or mocked
  • Difficulty engaging in imaginative play with other’s as a child, though may engage in imaginative play alone
  • Difficulties making friends
    • May not initiate friendships
    • May not engage in cooperative play as a child but rather parallel play only
    • May make friends outside of age range (i.e. may make friends with people significantly older or younger)
    • May have an interest in making friends but doesn’t understand the social conventions involved
    • May not respond to social advances of others
    • May prefer to interact one on one rather than as part of a group
  • May appear to not be interested in other people
    • May prefer solitary activities
    • May prefer to interact with a select group of people
    • May not try to attract the attention of others
    • May have a limited interest in others

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 speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).”

  • Repetitive or patterned speech
    • Unusually formal language
    • Echolalia (immediate or delayed) including the repetition or words, phrases, songs, or dialogue
    • Use of scripts (pre-planned speech)
    • May use language that has meaning specific to oneself that is understood only by those familiar with one’s communication style
    • May have difficulty with pronouns or speak in the third person
    • Repetitive vocalizations such as humming, squealing, or other noises
    • May focus on the accuracy and precision of words used
  • Repetitive motor movements (Stimming)
    • Repetitive hand movements (clapping, flapping, finger flicking, twisting, wringing, etc)
    • Repetitive whole body movements (rocking foot to foot, spinning, dipping and swaying)
    • Differences in posture such as toe walking
    • Tensing different parts of the body
    • Teeth grinding
  • Repetitive use of objects
    • Repetitive play with objects
    • Lining up toys or objects
    • Repetitively opening and closing doors or turning lights on and off

2. “Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).”

  • Adherence to routine
    • Specific, multi-step sequences of behavior that are repeated daily or on specific days
    • Strong need to follow specific routine
    • Routines may seem unusual to others
  • Ritualized patterns of behavior
    • Repetitive questioning about a specific subject
    • Verbal rituals including having to say things in a specific way or needing others to respond in specific ways
    • Compulsions such as needing to perform a specific ritual before leaving a room
  • Strong resistance to change
    • Difficulty transitioning from one activity to another
    • Intense reactions to small changes
    • Much stronger reactions to large changes than others experience
  • Rigid thinking
    • Difficulty understanding typical humor
    • Difficulty understanding nonliteral speech such as irony or implied meaning
    • Very rule oriented
    • Black and white thinking (something is all good or all bad with no area in between)

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 interests).”

  • Special interests
    • Obsession or preoccupation with a particular subject
    • Interest that is more intense than is typical
    • Interest that is very narrow in range
    • Interests that are different in focus than is typical
  • Focused on a small range of objects, topics, or activities
  • Being very perfectionistic
  • Attachments to seemingly unimportant objects such as a piece of string or rubber band
  • Unusual fears such as being afraid of milk

4. “Hyper- or hyporeactivity to sensory input or unusual interest 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).”

  • High tolerance for pain
  • Focus on texture or touch
    • Tactile defensiveness; aversion to being touched by certain textures or objects
    • Significant aversion to haircuts, nail cuttings, or brushing teeth
    • Tactile seeking; seeking out certain textures or objects to come in contact with
  • Atypical visual exploration
    • Visual focus upon objects or self at unusual angles
    • Looking at objects or people out of the corner of the eye
    • Fascination with watching the movement of things such as the spinning wheels of a toy or an electric fan or other revolving object
  • In all senses (sound, smell, taste, sight, touch, vestibular…) the following may be present:
    • Atypical responses to sensory input such as becoming distressed by sounds that do not affect others (sensory aversion)
    • Atypical focus on sensory input (sensory seeking behavior) such as rubbing a fabric to feel the texture

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.”

Sources:

https://www.cdc.gov/ncbddd/autism/hcp-dsm.html

http://depts.washington.edu/dbpeds/Screening%20Tools/DSM-5%28ASD.Guidelines%29Feb2013.pdf