To receive an ASD diagnosis, all three criteria in section A, at least two criteria in section B, and the overall conditions in sections C–E must be met.
A. Persistent deficits in social communication and social interaction
These difficulties must be present across multiple contexts, such as work, relationships, and daily life.
Clinicians look for evidence of all three:
- Deficits in social-emotional reciprocity
- Difficulty initiating or maintaining back-and-forth conversations
- Reduced sharing of emotions, interests, or affect
- Failure to respond or respond appropriately in social interactions
- Deficits in nonverbal communicative behaviors
- Poor or atypical eye contact
- Limited or unusual facial expressions or gestures
- Difficulty understanding or using body language
- Deficits in developing, maintaining, and understanding relationships
- Challenges adjusting behavior to fit different social contexts
- Difficulty sharing imaginative play or making friends
- Preference for solitude or very structured interactions
B. Restricted, repetitive patterns of behavior, interests, or activities
At least two of the following four must be present, currently or by history:
- Stereotyped or repetitive movements, speech, or use of objects
- Hand-flapping, rocking, lining up objects, echolalia (repeating phrases)
- Insistence on sameness and inflexible routines
- Extreme distress at small changes
- Rigid thinking patterns, ritualized eating or dressing routines
- Highly restricted, fixated interests
- Intense focus on specific topics, objects, or hobbies
- Unusual depth or intensity of interest
- Hyper- or hyporeactivity to sensory input
- Over- or under-sensitivity to sounds, textures, lights, or smells
- Unusual interest in sensory aspects (e.g., fascination with lights or spinning objects)
C. Symptoms must be present in early developmental period
- Signs were evident in childhood, even if they became more noticeable later
- Adults may recall being “different” or having social/sensory struggles as children, even if these were masked or misunderstood at the time
D. Symptoms cause clinically significant impairment
- The traits must impact functioning in daily life — socially, occupationally, or in other areas
- In adults, this may mean chronic stress, social burnout, difficulty maintaining employment, or relationship challenges
E. Not better explained by another condition
- The presentation should not be fully explained by intellectual disability, ADHD, personality disorder, anxiety, trauma, or other diagnoses
- However, co-occurring conditions are common, and ASD can exist alongside them
⚖️ Additional Notes for Adult Diagnosis
- Many adults have learned masking or compensatory strategies, which can hide core traits — clinicians must look beneath these.
- Diagnosis often involves a developmental history (from parents, siblings, or school reports) if available.
- Adult assessments use structured interviews and tools, such as:
- ADOS-2 Module 4 (Autism Diagnostic Observation Schedule)
- ADI-R (Autism Diagnostic Interview – Revised)
- RAADS-R, AQ-50, CAT-Q (self-report screening tools)
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