Sandbox/Autism spectrum disorder

Diagnostic Criteria

DSM-V Diagnostic Criteria for Autism Spectrum Disorder

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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 ofgestures: 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, repetitivepatterns of behavior (seeTable 2). AND B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by atleast 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., simplemotor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficultieswith transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same 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 interests). 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects ofthe environment (e.g., apparent indifference to pain/temperature, adverse responseto 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, repetitivepatterns of behavior (see Table 2). AND C. Symptoms must be present in the early developmental period (but may not becomefully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life). AND D. Symptoms cause clinically significant impairment in social, occupational, or other importantareas of current functioning. AND E. These disturbances are not better explained by intellectual disability (intellectual developmentaldisorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrumdisorder and intellectual disability, social communication should be below that expectedfor general developmental level.

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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 othenwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder. Specify if; With or without accompanying inteliectual impairment With or without accompanying language impairment Associated with a icnown medicai or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition.) Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].) With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.) .

Epidemiology and Demographics

Prevalence

The prevalence of intellectual disability is approximately 1,000 per 100,000 (1%) of the overall population.

Natural History,Complications and Prognosis

Prognosis

The best established prognostic factors for individual outcome within autism spectrum disorder are presence or absence of associated intellectual disability and language impairment (e.g., functional language by age 5 years is a good prognostic sign) and additional mental health problems. Epilepsy, as a comorbid diagnosis, is associated with greater intellectual disability and lower verbal ability.