| Impairments in social communication and interaction |
- Lack of, delay, or regression in spoken language.
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- If present, spoken language may be atypical, for example:
- Unusual intonations (monotone, sing-song)
- Echolalia
- Incorrect pronoun use (referring to self by name or as "you," "he," or "she" after age 3 years)
- Non-speech-like vocalizations (eg, grunting, squealing)
- Limited to specific topics of interest
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- Limited use of language for communication (eg, using only single words even though capable of speaking in sentences).
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- Reduced or absent nonverbal communication (gestures, facial expression).
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- Little or no response to others' gestures or facial expression.
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- Lack of response or slow to respond when called by name (despite normal hearing).
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- Reduced or absent interest in or attempts to share interest with another person (eg, by pointing or monitoring the other's gaze), for example:
- Lack of social smile or eye contact
- Lack of imitation (eg, clapping)
- Limited or absent social bids
- Lack of ability of interest in sustaining a social interaction
- Resistance to being be cuddled
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- Lack of awareness of other people; appearing to be in their own world.
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- Preference for solitary play (lack of initiation or participation in social play with others).
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- Lack of interest in other children or odd social approaches to other children (eg, disruptive, aggressive).
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- Lack of awareness of common social conventions (eg, taking turns in a conversation, awareness of personal space).
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- Lack of or minimal recognition or responsiveness to another's feelings (eg, happiness, distress).
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- Abnormal interactions with peers or adults (eg, too friendly or too distant).
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- Normal or even exaggerated level of motivation to socialize, with limited ability to infer the intentions or behaviors of others.
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- Motivated to socialize but not able to sustain a social interaction that is mutually enjoyable due to not respecting social conventions, due to an inability to anticipate the knowledge and interests of others, etc. For example, does not respect personal boundaries; may talk only about preferred interests and not engage in the social partner's interests.
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| Restricted, repetitive behaviors, interests, and activities |
- Repetitive motor mannerisms (eg, hand flapping).
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- Resistance to change, insistence on following same routines.
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- Re-enacting scenes from videos or cartoons.
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- Atypical play:
- Repetitive (eg, lines up objects, opens and closes doors, turns lights on and off)
- Lacking imaginative/creative play
- No pretend play (eg, feeding doll)
- Over-attention to parts of objects (eg, spinning wheels)
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- Lack of or unusual reaction to sensory stimuli (noise, texture, smells).
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