According to DSM-5, autism spectrum disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. Which of the following is NOT a core diagnostic criterion for ASD?

## DSM-5 Diagnostic Criteria for Autism Spectrum Disorder ### Core Domains ASD diagnosis requires persistent deficits across TWO domains: | Domain | Criteria | |--------|----------| | **Social Communication & Interaction** | Deficits in social-emotional reciprocity; Nonverbal communicative behavior abnormalities; Difficulties developing, maintaining, understanding relationships | | **Restricted, Repetitive Behavior** | Stereotyped or repetitive motor movements, use of objects, or speech; Insistence on sameness, inflexible adherence to routines; Highly restricted, fixated interests; Hyper- or hypo-reactivity to sensory input | ### Why Hallucinations/Delusions Are NOT Diagnostic **Key Point:** Hallucinations and delusions are psychotic symptoms associated with schizophrenia, schizoaffective disorder, and other psychotic disorders—NOT autism spectrum disorder. While individuals with ASD may develop comorbid psychotic disorders, the presence of hallucinations or delusions alone does NOT define ASD and is explicitly excluded from core ASD criteria. **Clinical Pearl:** Misinterpretation of literal language, unusual sensory perceptions, or intense preoccupations in ASD may superficially resemble psychotic symptoms but lack the ego-dystonic quality and loss of reality testing characteristic of true hallucinations or delusions. **High-Yield:** DSM-5 emphasizes that ASD symptoms must be present from early childhood (though may not fully manifest until social demands exceed capacity), whereas psychotic symptoms typically emerge in late adolescence or early adulthood. [cite:DSM-5 pp. 50–52]