Part B of the diagnostic criteria causes Part A (2023)

In this blog post we consider the DSM-5 (2013) diagnostic criteria for ASD (Autism Spectrum Disorder). In this version of the DSM, all the diagnoses related to autism, such as Asperger Syndrome have been conflated into one diagnosis: Autism Spectrum Disorder.

The DSM-5 diagnostic criteria consist of two checklists: Part A which is about symptoms regarding communication and social communication and Part B which is about other symptoms found in autism. Normally,clinicians establish that the criteria for Part A are met before examining the criteria for Part B.

At Aspiedent, in order to find ways of helping autistic people, we identify what is causing the symptoms - the underlying issues. We have found that Part B of the diagnostic criteria for autism actually explain the Part A symptoms.

DSM-5 Diagnostic Criteria

Part A:social communication and social interaction – across multiple contexts

  • Deficits in social emotional reciprocity - for example,abnormal social approach and failure of normal back-and-forth conversation, reduced sharing of interests, emotions, or failure to initiate or respond to social interactions.
  • Deficits in non-verbal communication, - for example,poorly integrated verbal and nonverbal communication; abnormalities in eye contact and body language or deficits in understanding and use of gestures; including lack of facial expressions and nonverbal communication.
  • Deficits in developing, maintaining and understanding relationships-for example, difficulties adjusting behaviour to suit various social contexts; or difficulties in sharing imaginative play or in making friends.

Part B:Restricted, Repetitive, Patterns of Behaviour, Interests or Activities (at least 2 of the following)

  • Stereotyped or repetitive motor movements, use of objects, or speech,e.g., simple motorstereotypes (such as flapping hands), lining up toys or flipping objects, echolalia, idiosyncratic phrases.
  • Insistence on sameness, inflexible adherence to routines, ritualised verbal or non-verbal behaviour,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 attachment to or preoccupation with unusual objects, excessivelypursuedinterest.
  • Hyper- or hypo-reactivity to sensory input or unusual interests 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).

Part Bcauses Part A

So let's consider this from a different perspective. What if we look at the Part B diagnostic criteria and see if these can explain Part A. How would that work?Here are some examples taken from the DSM-5 Diagnostic criteria but looking at it in reverse.

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Stereotyped, Repetitive Movements or speech

Stereotyped repetitivemovements can be avariety of repetitive and uncontrolled movementsfrom flapping hands, flicking fingers in front of eyesand flipping objects to head banging or picking at ones skin. When applied to speech this is repetition of words or blurting out random words that make no sense.

When speech does not make sense or is difficult to follow, communication and conversation is also difficult or impossible. If you are unable to have a conversation, then you will struggle to make friends.

On the face of it, minor repetitive movements such as flapping hands should not prevent conversation. For the autistic person, such movements may make it possible to have a conversation. But such movements can be very off putting and it would need a very tolerant, patient and understanding person to make the effort to communicate with and make friends with the person.

Sensory Issues

You do not have to be Autistic tohavesensory issues. Estimates are that sensory issues affect around 90% of the autistic population. But these sensory issues vary widely from person to person. In many cases, sensory issues do not prevent communication and social interaction, but in other cases they do.

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Issues occur when sensory issues interfere with hearing and understanding what is said. Such as sound discrimination issues and synaesthesia (eg seeing colours for sound can be very distracting and prevent understanding of what is said), Some autistic people struggle to tolerate being around other people because of sensory issues. Smell can be a factor in this as can the pitch of someone's voice. Being oversensitive to emotion, can also be a factor.

If you are not able to hear properly or to be in the same place as people or be with certain people due to smells, noise, or emotion you will struggle to make friends. If you do make friends if will be difficult to maintain the relationship as you can not enjoy the things they do or go to they places they want to go due to sensory issues, you may then feel very left out or even disregarded. If you are left out, there will be much less opportunity to learn social skills.

Routines or ritualised patterns of behaviour

Avery regimented life (ie difficulty with change) means that you thrive on routines and being organised in order to create structure and avoid anxiety. When this is the case, there is insufficient flexibility to be able to meet new people and get to know them. New people are too unpredictable, having to get to know a new person will be extremely difficult and stressful. Under these circumstances, there is no opportunity to learn social skills, never mind put them into practice.

Highly restricted, fixated interests

In order to dosocial interaction you need to show an interest in the lives of others or at least have a passing interest in what others are interested in. Some autistic people have their own specific interests that don't always match the interests of the general population. Some autistic people like to speak only about their own interests and do not pay any attention or are very disinterested when others are describing theirs.

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A very narrow range of interests results in huge gaps in your understanding of the world around you. The world of people will not make any sense. Any friendship has to be built on shared interests and conversation will be mainly about that interest.

Consider the 'why' not the 'what'

Ifyou accept that Part B of the diagnostic criteria causes Part A, then you are starting to understanding the 'WHY' and not just the the 'WHAT' (or symptoms). You are starting to understand the root of the symptoms and thus be able to think of strategies. The next step is to go deeper and to recognise that difficulty with change can be because of processing issues or because of visual issues, for example. Restricted interests can have processing issues as an underlying issue, or it could be a reflection of how an individual thinks and/or learns.

Of course, combinations of Part B criteria interact with each other and compound the issues, making part A symptoms more severe.

Understanding the WHY of an individual's autism is much more valuable than a tick box exercise to determine a diagnosis. This is particularlypertinentfor autism as there are essentially and infinite number of ways of being autistic. Without a thorough understanding of WHY, you are reduced to a trial and error approach to find appropriate interventions.

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Aspiedent can Help

Aspiedent has a service that helps gets to the root of the issues around Autism with suggested interventions of what may help in school and at home. This is anautism profileor aworkplace assessment. Example autism profiles can be found on ourwebsite. Autism Profiles are potentiallylife changingfor the better because they help the both the person and those around them to understand their individual autistic difficulties.

If you are interested in having an autism profile or a workplace assessment, please do get in touch by emailing us

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What is diagnostic criteria? ›

Diagnostic criteria are a set of signs, symptoms, and tests developed for use in routine clinical care to guide the care of individual patients.

What is the diagnosis criteria for Aspergers? ›

The DSM-IV criteria for Asperger's specified that the individual must have “severe and sustained impairment in social interaction, and the development of restricted, repetitive patterns of behavior, interests and activities that must cause clinically significant impairment in social, occupational or other important ...

What are the DSM-5 levels of autism? ›

Proposed DSM-5 autism spectrum criteria includes three severity classifications: Level 1 (“Requiring support”), Level 2 (“Requiring substantial support”), and Level 3 (“Requiring very substantial support”) (American Psychiatric Association 2012).

What are the three main symptoms of ASD? ›

Signs and Symptoms of ASD. People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors.

What are the 3 types of diagnosis? ›

Sub-types of diagnoses include: Clinical diagnosis. A diagnosis made on the basis of medical signs and reported symptoms, rather than diagnostic tests. Laboratory diagnosis.

What are the markers for Aspergers? ›

Social Symptoms

Common symptoms of Asperger's that may impact social interaction or communication include: Problems making or maintaining friendships. Isolation or minimal interaction in social situations. Poor eye contact or the tendency to stare at others.

What is the criteria for diagnosing autism? ›

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 ...

What level of autism is Aspergers? ›

Level 1 Autism Spectrum Disorder (formerly known as Asperger's Syndrome)

What is the difference between Level 1 and Level 2 autism? ›

Level 1: The person may be able to live a relatively independent life with minimal support. Level 2: Substantial support is necessary to help the person communicate and deal with change.

What are the four diagnoses of autism? ›

Using DSM-IV, patients could be diagnosed with four separate disorders: autistic disorder, Asperger's disorder, childhood disintegrative disorder, or the catch-all diagnosis of pervasive developmental dis- order not otherwise specified.

What are early red flags of ASD? ›

The early warning signs for an ASD include concerns about a child's social skills, communication, and restricted or repetitive patterns of behaviors, interests, activities, and emotional regulation.

What are signs of mild autism? ›

Restricted or Repetitive Behaviors or Interests
  • Lines up toys or other objects and gets upset when order is changed.
  • Repeats words or phrases over and over (called echolalia)
  • Plays with toys the same way every time.
  • Is focused on parts of objects (for example, wheels)
  • Gets upset by minor changes.
  • Has obsessive interests.

What is ASD commonly misdiagnosed as? ›

ASD often presents early but can be difficult to diagnose in some cases. There are other brain disorders that mimic autism symptoms, like ADHD and anxiety disorders, including selective mutism. Autism can be misdiagnosed as another disorder with some shared symptoms.

What are the 3 steps in diagnosis? ›

The diagnostic process involves multiple steps: Take a medical history. Perform a physical exam. Order diagnostic testing.

What types of codes are used for diagnosis? ›

Diagnosis Codes

Diagnoses are to be coded using valid international classification of diseases (ICD)-9/10 CM codes. States should report the diagnosis in T-MSIS as coded and identified by the medical service provider and should be full valid ICD 9/10 CM codes without a decimal point.

What are the stages of diagnosis? ›

Steps to diagnosis
  • taking an appropriate history of symptoms and collecting relevant data.
  • physical examination.
  • generating a provisional and differential diagnosis.
  • testing (ordering, reviewing, and acting on test results)
  • reaching a final diagnosis.
  • consultation (referral to seek clarification if indicated)

What are the 3 types of nursing diagnosis? ›

A nursing diagnosis has basically three components; the Problem statement or diagnostic label, the Etiology and the Signs and symptoms. PROBLEM STATEMENT: The problem statement or diagnostic label indicates the client's problem or response for which requires nursing intervention.

What are the 3 parts of the nursing diagnosis PES? ›

Nursing diagnoses are made up of three components: problem statement, the etiology/related factors, risk factors, and defining characteristics. The etiology, or related factors, identifies probable causes of the health problem, and/or the conditions involved in the development of the problem.

Is Aspergers mild autism? ›

Many professionals believed Asperger's was a more mild form of autism, leading to the origin of the phrase “high-functioning”. Now, children with Asperger's symptoms are diagnosed with autism spectrum disorder (ASD). Their symptoms are typically on the milder side, but every child experiences symptoms differently.

What is the difference between high-functioning autism and Aspergers? ›

Asperger's syndrome is closely related. Identified for the first time in 1944 by Viennese psychologist Hans Asperger, it wasn't officially classified as a unique disorder until 1994. It shares all the features of high-functioning autism except that people with Asperger's don't have early delays in developing language.

What is mild Asperger's? ›

Asperger Syndrome (ASD) is a pervasive developmental disorder that is widely described as a mild form of autism. People with ASD tend to have many of the social and sensory issues of those with more severe forms of autistic disorder but have average to above average IQs and vocabularies.

What is criteria B 4 autism? ›

B4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

How do you test positive for autism? ›

Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child's developmental history and behavior to make a diagnosis. ASD can sometimes be detected at 18 months of age or younger.

What is level 3 autism spectrum? ›

ASD Level 3: Requiring Very Substantial Support

ASD level 3 is characterized by severe challenges in social communication as well as extremely inflexible behavior. Children with level 3 autism will be nonverbal or have the use of only a few words of intelligible speech.

What is Aspergers called now? ›

The name for Asperger's Syndrome has officially changed, but many still use the term Asperger's Syndrome when talking about their condition. The symptoms of Asperger's Syndrome are now included in a condition called Autism Spectrum Disorder (ASD). ASD is now the name used for a wide range of autism-like disorders.

What are high-functioning autistic traits? ›

High-functioning autism means that a person is able to read, write, speak, and handle daily tasks, such as eating and getting dressed independently. Despite having symptoms of autism, their behavior doesn't interfere too much with their work, school, or, relationships.

At what age is Aspergers usually diagnosed? ›

Problems are usually obvious by the age of 3, but children are often not diagnosed with Asperger syndrome until they are 7 years old. Your child's doctor will look for a group of behaviors.

What is highest functioning autism? ›

High-functioning autism (HFA) is an autism classification where a person exhibits no intellectual disability, but may exhibit deficits in communication, emotion recognition and expression, and social interaction.

Can a child with level 3 autism improve? ›

However, it is also possible for children with level 3 autism to improve over time. If they get an accurate diagnosis, impactful therapy plans, and early interventions, they have a better chance of overcoming any growth delays.

What do the scores mean on an autism test? ›

Total scores can range from a low of 15 to a high of 60; scores below 30 indicate that the individual is in the non-autistic range, scores between 30 and 36.5 indicate mild to moderate autism, and scores from 37 to 60 indicate severe autism (Schopler et al. 1988).

What is the lowest form of autism? ›

ASD Level 1 – Level 1 ASD is currently the lowest classification. Those on this level will require some support to help with issues like inhibited social interaction and lack of organization and planning skills.

Is autism is Hereditary? ›

If someone in your family has autism spectrum disorder (ASD), you may be more likely to have a child with ASD. ASD can look very different from person to person, so taking a careful family health history can be important for early diagnosis.

What are the 5 types of autism? ›

There are five major types of autism which include Asperger's syndrome, Rett syndrome, childhood disintegrative disorder, Kanner's syndrome, and pervasive developmental disorder – not otherwise specified.

What are the 2 categories to consider when diagnosing autism? ›

into two categories of symptoms
  • Persistent deficits in social communication/interaction and.
  • Restricted, repetitive patterns of behavior.

What is autism A1 criteria examples? ›

A1. 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.

What are 2 main symptoms of autism? ›

The core symptoms of autism are:
  • social communication challenges and.
  • restricted, repetitive behaviors.

What is a diagnostic example? ›

Examples are taking a blood sample, biopsies, and colonoscopies. Non-invasive diagnostic testing does not involve making a break in the skin. Diagnostic imaging procedures are prime examples of non-invasive diagnostic testing procedures.

What is diagnostic criteria and classification criteria? ›

Christian Dejaco, MD, PhD: The difference between classification and diagnostic criteria is that classification criteria have been developed for the classification of patients for the purpose of clinical studies, whereas diagnostic criteria are used to diagnose patients in clinical practice.

What is a DSM-5 diagnostic criteria? ›

For each disorder included in DSM, a set of diagnostic criteria indicates symptoms that must be present (and for how long) as well as a list of other symptoms, disorders, and conditions that must first be ruled out to qualify for a particular diagnosis.

What does DSM-5 diagnostic criteria mean? ›

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms and other criteria for diagnosing mental disorders.

What is the most common diagnostic test? ›

Chest x-rays are one of the most commonly performed diagnostic medical tests. This test provides a black-and-white image of your lungs, heart, and chest wall.

What are types of diagnostics? ›

Diagnostic Tests
  • A1C.
  • Amniocentesis see Prenatal Testing.
  • Biopsy.
  • Blood Pressure see Vital Signs.
  • Blood Tests see Laboratory Tests.
  • Breathing Rate see Vital Signs.
  • CAT Scans see CT Scans.
  • Chorionic Villi Sampling see Prenatal Testing.

How many diagnostic categories are there? ›

The Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnoses (from ICD-9) into 25 mutually exclusive diagnosis areas.

What is criterion A in PTSD? ›

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct exposure. Witnessing the trauma. Learning that a relative or close friend was exposed to a trauma.

Which four types of criteria are used to classify terms? ›

In other words, the boundaries are "fuzzy", so different grammars draw them in different places.
Criteria for Word Classes
  • The meaning of the word.
  • The form or `shape' of the word.
  • The position or `environment' of the word in a sentence.

What is the basic criteria of classification? ›

Classification is the arrangement of organisms in groups. The arrangement is based on their morphology, cellular organization, and evolutionary relationship. R. H. Whittaker postulated five kingdoms, and classifications include Monera, Protista, Fungi, Plantae, and Animalia.

What is the most common DSM-5 diagnosis? ›

Below are the five most common mental health disorders in America and their related symptoms:
  • Anxiety Disorders. The most common category of mental health disorders in America impacts approximately 40 million adults 18 and older. ...
  • Mood Disorders. ...
  • Psychotic Disorders. ...
  • Dementia. ...
  • Eating disorders.
Jan 30, 2020

How many DSM-5 criteria are there? ›

The DSM, fifth edition, text revision (DSM-5-TR) contains revised criteria for more than 70 disorders. The DSM-5-TR also includes the addition of a new diagnosis called prolonged grief disorder.

What are the 3 sections of the DSM-5? ›

The DSM-5 is divided into three sections, using Roman numerals to designate each section.
  • Section I.
  • Section II: diagnostic criteria and codes.
  • Section III: emerging measures and models.

What is the third DSM-5 diagnostic criterion that must be met for a diagnosis of intellectual disability to be made? ›

In DSM-5, intellectual disability is seen as being at least about two standard deviations or greater below the population, which is approximately an IQ score of 70 or less. Again the emphasis is not specifically on meeting any cutoff score, but rather on how the particular individual presents.

What are the major classes of DSM-5 disorders? ›

The DSM-5 organizes mental disorders into the following chapters: Neurodevelopmental Disorders, Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive and Related Disorders, Trauma- and Stressor-Related Disorders, Dissociative ...


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