ASD diagnostic criteria should be a little bit more broad

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Autism Spectrum Disorder should be a little bit broader. It will look like Social (Pragmatic) Communication Disorder, but to meet diagnostic criteria for Autism Spectrum Disorder, there should be at least two symptoms of restricted, repetitive patterns of behavior, interests, or activities. The diagnostic criteria B for Autism Spectrum Disorder remain the same.

The problem with the current diagnostic criteria A for Autism Spectrum Disorder is that symptom 3 for Autism Spectrum Disorder says that there should be deficits in developing, maintaining, and understanding relationships, but that is not the case with some people with Autism Spectrum Disorder. The question of what if some individuals with Autism Spectrum Disorder developed understanding of social cues on time, but have but have suffiesnt problems with social-emotional reciprocity and restricted, repetitive patterns of behavior, interests, or activities.


Right now, the current diagnostic criteria A for Autism Spectrum Disorder looks like this:


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.


But diagnostic criteria for A for Autism Spectrum Disorder should be persistent deficits in social communication and social interaction across multiple contexts, as manifested by at least two of the following, currently or by history of:


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).



This how diagnostic criteria for Autism Spectrum Disorder should look like:

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).

B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history:

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).

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).


There also has to be a clinical impairment:

D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.

But the problem with diagnostic criteria C for Autism Spectrum Disorder:

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).


Autism Spectrum Disorder is indeed a neurodevelopmental disorder, but the symptoms of it might not fully manifest due to masking or until social rules become more complex.

For example:

1) What is normal to do in early childhood, it may be abnormal to in late childhood (That is if the symptoms fully manifested at that time)

2) What is normal to do in late childhood, it may be abnormal to do early adolescents (That is if the symptoms didn't fully manifest until a bit later)

3) What may be normal to do in early adolescents, may be abnormal to do late adolescents (That if the symptoms didn't fully manifest until much later)

(4) What may be normal to do in late adolescents, it may be abnormal to do in early adulthood (That is if the symptoms didn't fully manifest until much, much later)

5) What is normal to do in young adulthood, it may be abnormal to do in full-adulthood (That is if the symptoms didn't fully manifest until way later in life, and may not even fully manifest until very much later in life)

The problem is that a person can have internalized autistic traits, but look neurotypical, but with some complaints of subtle problems with social-emotional reciprocity, restricted interests, and repetitive behaviors overtime, it's very hard to spot those symptoms early on.

Perhaps. I feel like social stuff (criteria A) is such a broad category that doesn't at all exhaustively cover all the examples of social issues.

I'll also highlight the stuff that I know applies to me.

That makes sense. I wonder what better diagnostic criteria for Autism Spectrum Disorder would be, and if my suggestion would also make sense.

I think that the criteria for ASD should be very like criteria of Asperger syndrome in DSM-IV and ICD-10 - only two social symptoms required and only one of four behavioral symptoms required. Three social symptoms from DSM-V should be still present, but two instead of three should be sufficient and only one, not at least two, of behavioral symptoms should be required, at least when this one symptom is associated with special interests or hyperfixations.

Rigid behaviors or insistence of sameness are like OCD or obsessive-compulsive personality disorder, stimming and stereotyped behaviors are like hyperactive part of ADHD and stereotyped movement disorder and sensory hypersensitivity or hypersensitivity is like sensory processing disorder or sensory integration disorder, I would say that these three are less autism-specific than special interests, hyperfascinations and hyperfixations.

From ICD-10 criteria "lack of spontaneous attempts to share enjoyment, interests, or achievements with others" is pointless or misleading because some autistic are rather opposite - inappriopiately expansive socially and one-sided in social interactions (autism has not to mean extreme introversion!) and "preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate)" is replaced with sensory issues in DSM-V criteria.