A. Persistent deficits in social communication and social interactions across multiple contexts, as manifested by the following, currently or by history:
-Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approachand failure of normal back-and-forth conversation; to reduce 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 abnormailities in eye contact and body language or deficits in understanding and use of gestures to a lack of facial expressions and nonverbal communication.
-Deficits in developing, maintaining and understanding relationships, ranging, for example from difficulties adjusting bheavior to suit various social contexts to difficulties in sharing imaginative play or in making friends to absence of interests 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:
-Stereotyped or repetitive motor movements, use of objects, or speech ( e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
-Insistence on sameness, inflexible adhrence to routines, or ritualized patterns of verbal and non verbal 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).
-Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachemnet to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
-Hyper or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment(e.g, apparent indefference to pain/ temperature, adverse respond 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. Symtoms 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 signficant impairment in social, occupational, or other importan areas of current functioning.
E. These disturbances are not better explained by intellectual disability ( intellectual development 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.