My issue with DSM-5-TR's ASD criteria.

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That is actually a good point and if makes sense.

The diagnostic criteria for Autism Spectrum Disorder in DSM-5-TR need to be changed, to also include people who developed an understanding of social cues on time, but have deficits in social-emotional reciprocity.


Current diagnostic criteria for Autism Spectrum Disorder in DSM-5-TR:


A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by all of
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 of gestures; 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.




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 motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).
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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).

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 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).



Current diagnostic criteria for Social (Pragmatic) Communication Disorder:



A. Persistent difficulties in the social use of verbal and nonverbal
communication as manifested by all of the following:


1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).





We can remove the diagnostic criteria A for Autism Spectrum Disorder and change it into this:


1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).





So, this is what the diagnostic criteria for ASD should look like:


(At least two symptoms of persistent deficits in social or other communication, for Autism Spectrum Disorder)



1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).


Diagnostic criteria B symptoms for Autism Spectrum Disorder:


(And at least two symptoms of diagnostic criteria B for Autism Spectrum Disorder)


1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).

57

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).

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 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).

This is great!! I’d love to see the word “deficits” be replaced by “differences.” I’d also like to see something added to the criteria to guide professionals more clearly in the area of masking and how it can cause some criteria to appear as though they aren’t being met during an assessment. Really, it’d be great if all professionals knew how to ask the right questions that can more effectively rule in or out each criteria.

Oh no, I love the clinical! I completely agree and I think it is great that you have spelled it out with such detail! Now if we could just propose that to the APA. It’s interesting, I was just speaking with a nearly retired psychologist who was talking about how confusing it can be to clinicians between the differences between autism & pragmatic communication disorder, so I was excited to see somebody bring it up and incorporate it like you did, that was awesome!!

Was that what you inputted or what it spit out?

That makes sense.