The two‑domain requirement
- Persistent deficits in social communication and reciprocal interaction (social‑emotional reciprocity, non‑verbal communication, developing/maintaining relationships).
- Restricted, repetitive patterns (stereotypies, insistence on sameness, restricted interests, sensory hyper‑/hypo‑reactivity).
Present from early development (may be masked until social demands exceed capacity), impairing, not better explained by intellectual disability alone.
The high‑yield "don't rule out" list 🚩
Do not exclude autism because of: good eye contact, affection, pretend play, or fluent language. Under‑recognised in girls and in able individuals who camouflage. Diagnosis integrates developmental history + multi‑setting observation — not a single tool.
Comorbidity is the rule
ADHD, anxiety, depression, epilepsy, intellectual disability, sleep and feeding disorders. Wide range of intellectual ability. Screen actively — comorbidity drives much of the distress and is treatable.
Discriminators
- ASD vs social anxiety: ASD has a developmental deficit in social understanding; social anxiety is fear of evaluation with intact social cognition.
- ASD vs ADHD: they co‑occur; distinguish social‑communication deficit + restricted interests from inattention/impulsivity.
Pitfalls
- Ruling out autism on the basis of a single reassuring feature.
- Missing comorbid epilepsy/anxiety.
Pearls
- 🎯 Both domains + early onset + impairment define ASD.
- 🩺 Camouflaging and female presentation cause systematic under‑diagnosis — keep a low threshold to assess.
Next → Intellectual and specific learning disorders (Concept 32).