According to DSM-5, autism spectrum disorder is characterized by persistent deficits in two core domains. Which pair correctly identifies these domains?

Explanation

## DSM-5 Core Domains of Autism Spectrum Disorder **Key Point:** DSM-5 consolidates autism spectrum disorder into two essential diagnostic domains: (1) persistent deficits in social communication and social interaction, and (2) restricted, repetitive patterns of behavior, interests, or activities (RRBs). **High-Yield:** This two-domain structure (social-communication + RRBs) is the foundational diagnostic framework for all severity levels of ASD in DSM-5. Both domains must show persistent deficits for diagnosis. ### Domain 1: Social Communication and Social Interaction Deficits include: - Reduced social-emotional reciprocity (e.g., abnormal social approach, failure to initiate/respond to social interactions) - Deficits in nonverbal communicative behaviors (e.g., poor eye contact, atypical gestures, reduced facial expressions) - Deficits in developing, maintaining, and understanding relationships (e.g., difficulty adjusting behavior to social context, difficulty sharing imaginative play) ### Domain 2: Restricted, Repetitive Patterns of Behavior, Interests, or Activities (RRBs) Deficits include: - Stereotyped or repetitive motor movements, use of objects, or speech (e.g., hand flapping, spinning objects, echolalia) - Insistence on sameness, inflexible adherence to routines, or ritualized patterns of behavior or speech - Highly restricted, fixated interests that are abnormal in intensity or focus - Hyper- or hypo-reactivity to sensory input (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures) **Mnemonic:** **SoCo-RRB** = **So**cial **Co**mmunication + **R**estricted **R**epetitive **B**ehaviors **Clinical Pearl:** Language development per se is NOT a separate diagnostic domain in DSM-5; language deficits are subsumed under the social communication domain. Similarly, motor coordination deficits are not a core diagnostic criterion (though motor clumsiness may co-occur). ### Comparison: DSM-IV vs. DSM-5 | Criterion | DSM-IV | DSM-5 | | --- | --- | --- | | Number of core domains | 3 (social, communication, RRBs) | 2 (social communication, RRBs) | | Communication as separate domain | Yes | No; merged with social interaction | | Severity levels | Not formally specified | Levels 1, 2, 3 (support needed) | | Age of onset | Before 3 years | Early developmental period | | Asperger syndrome | Separate diagnosis | Subsumed under ASD | **Warning:** Do not confuse DSM-5 with DSM-IV. In DSM-IV, there were three separate domains (social, communication, RRBs). DSM-5 merged social and communication into a single "social communication" domain.