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Autism Spectrum Disorders

Symptoms

Symptoms

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A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history:

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1. Deficits in social-emotional reciprocity

E.g.

  • being distant, uninvolved, or over-passionate

  • odd mannered behaviours

  • using other persons as mechanical aids to fulfil their wants

  • displaying aversion to physical contact

  • displaying little attachment with parents or close care-takers

  • failure of normal back-and-forth conversation

  • reduced sharing of interests, emotions, or affect

  • failure to initiate appropriate social signalling to others (e.g. socially directed smiles, eye-to-eye gaze)

  • a lack of response to others’ signals in social situations

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2. Deficits in nonverbal communicative behaviors used for social interaction

E.g.

  • poorly integrated verbal and nonverbal communication

  • failure to indicate needs through pointing and eye-gazing

  • restricted facial expression and poor eye contact that cause them appear seemingly rude, uninterested or inattentive in social interactions

  • speaking with high-pitched voices, strange prosody or with robot-like monotone

  • being less capable in understanding social cues from body language and tone of voice

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3. Deficits in developing, maintaining, and understanding relationships

E.g.​​

  • speech and language problems (e.g. weak fund of vocabularies, pronominal reversals), which render them incapable in effective communication with peers 

  • problems in processing complex social cues

  • problems in comprehending implicit social rules

  • problems in adjusting behavior to suit various social contexts

  • problems in adhering to rules based on the communication context

  • problems in comprehending non-literal languages (e.g. jokes, idioms and metaphors)

  • friendships being often one-sided or based solely on shared special interests

  • absence of interest in peers

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

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1. Stereotyped or repetitive motor movements, use of objects, or speech 

E.g.​

  • lining up toys or flipping objects

  • repetitively opening and closing doors

  • stereotyped body movements (e.g. flapping of hands, running back and forth, head banging, rocking of body, self-spinning, finger movements and grimacing) when excited, distressed or agitated

  • repeatedly watching the same films or reading the same books

  • stereotyped verbal language (e.g. rote, a lack of functional communicative intent)

  • echolalia

  • repetitive questioning

  • pedantic speech with vocabularies or phrase that are unusual for age or social groups

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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 (e.g. change in routine, transition from one activity to another, moving to new home or classes with changes of people and environment)

  • maintaining same arrangement for objects

  • rigid thinking patterns, greeting rituals

  • taking the same route every day

  • eating the same food every day 

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3. Highly restricted, fixated interests that are abnormal in intensity or focus 

E.g.​

  • absent or minimal exploratory play or symbolic/fantasy play in early infancy and early childhood

  • play being monotonous and lacking variation, (e.g. spinning and lining activities)

  • being preoccupied unusually with parts of objects

  • having perseverative interests with particular topics

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4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment 

E.g.

  • marked indifference to pain or temperature

  • adverse response to specific sounds or textures

  • excessive smelling or touching of objects

  • visual fascination with lights or movement (e.g. spinning objects)

  • presence of sensory seeking or avoidance behaviours to usual auditory, tactile, or vestibular stimulation, manifested as repetitive and compulsive behaviours

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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)

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 

https://doi.org/10.1176/appi.books.9780890425596

Child Assessment Service, Department of Health. (2017). ASD_Eng. Hong Kong Special Administrative Region Government.

https://www.dhcas.gov.hk/file/conditions/ASD_Eng.pdf

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