A 4-year-old boy is evaluated for suspected autism spectrum disorder. His parents report delayed speech, difficulty with social reciprocity, and repetitive hand-flapping movements. Which of the following is NOT a core diagnostic feature of autism spectrum disorder according to DSM-5 criteria?

Explanation

## DSM-5 Diagnostic Criteria for Autism Spectrum Disorder ### Core Domains (Three Required) **Key Point:** Autism spectrum disorder is diagnosed based on two core domains: (1) persistent deficits in social communication and social interaction, and (2) restricted, repetitive patterns of behavior, interests, or activities. Intellectual disability is NOT required for diagnosis. ### Social Communication Deficits Deficits manifest across multiple contexts and include: - Reduced social-emotional reciprocity - Reduced nonverbal communicative behaviors - Deficits in developing, maintaining, and understanding relationships ### Restricted, Repetitive Patterns At least two of the following: - Stereotyped or repetitive motor movements, use of objects, or speech - Insistence on sameness, inflexible adherence to routines - Highly restricted, fixated interests that are abnormal in intensity or focus - Hyper- or hyporeactivity to sensory input ### Onset and Presentation **High-Yield:** Symptoms must be present from early childhood, but may not fully manifest until social demands exceed the individual's capacities. This is critical—milder cases may go undiagnosed until school age or adolescence when social complexity increases. ### Intellectual Disability and ASD **Clinical Pearl:** Autism spectrum disorder and intellectual disability are separate diagnoses. ASD can occur across the full range of intellectual functioning—from gifted to severe intellectual disability. Many individuals with ASD have average or above-average intelligence. The presence or absence of intellectual disability does NOT determine ASD diagnosis. ### Why Option 3 Is Incorrect The statement "Presence of intellectual disability or global developmental delay in all cases" is FALSE. Intellectual disability is neither required nor always present in ASD. This is a common misconception—many children with ASD have normal or superior cognitive abilities. [cite:DSM-5 Diagnostic and Statistical Manual of Mental Disorders]