## Distinguishing ASD from Intellectual Disability ### Key Differentiating Feature **Key Point:** Restricted, repetitive behaviors and interests (RRBIs) are the hallmark feature that distinguishes ASD from ID. While both conditions involve developmental delay, ASD is uniquely characterized by qualitative deficits in social communication and the presence of stereotyped, repetitive patterns of behavior. ### Comparison Table | Feature | ASD | Intellectual Disability | | --- | --- | --- | | **Social-communication deficit** | Qualitative (pragmatic, theory of mind) | Quantitative (global delay) | | **Restricted, repetitive behaviors** | **Present (core diagnostic feature)** | Absent | | **Adaptive functioning** | Uneven profile (may be spared in some areas) | Uniformly delayed across domains | | **Language pattern** | Echolalia, pronoun reversal, pedantic speech | Simple delay without qualitative features | | **Onset** | Early infancy (12–24 months) | Present from birth | | **IQ profile** | May have uneven cognitive strengths | Uniformly low across subtests | ### Why This Matters Clinically **Clinical Pearl:** A child with ASD may have average or above-average intelligence in specific domains (e.g., visual-spatial, rote memory) while showing profound social deficits. A child with ID shows uniform delay across all cognitive and adaptive domains without the stereotyped behaviors characteristic of ASD. **High-Yield:** The DSM-5 diagnostic criteria for ASD require BOTH persistent deficits in social communication AND restricted, repetitive patterns of behavior. ID requires only significantly subaverage intellectual functioning and adaptive behavior deficits — no behavioral stereotypies are required. ### Mnemonic **RRBI = ASD:** Restricted, Repetitive Behaviors and Interests are the **discriminator** that separates ASD from ID. [cite:DSM-5 Diagnostic and Statistical Manual of Mental Disorders]
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