According to DSM-5 criteria, what is the minimum number of restricted or repetitive behaviors required to diagnose Autism Spectrum Disorder?

Explanation

## DSM-5 Diagnostic Criteria for Autism Spectrum Disorder ### Criterion B: Restricted, Repetitive Patterns of Behavior, Interests, or Activities **Key Point:** DSM-5 requires **at least TWO** of the four categories of restricted or repetitive behaviors (RRBs) to meet diagnostic criteria for ASD. ### The Four RRB Categories in DSM-5 | Category | Examples | | --- | --- | | **Stereotyped or repetitive motor movements, use of objects, or speech** | Hand flapping, spinning, echolalia, lining up toys, repetitive vocalizations | | **Insistence on sameness, inflexible adherence to routines, or ritualized patterns** | Distress with minor changes, rigid routines, need for same route/food, resistance to transitions | | **Highly restricted, fixated interests that are abnormal in intensity or focus** | Preoccupation with specific topics (trains, numbers), intense collecting, circumscribed interests | | **Hyper- or hyporeactivity to sensory input** | Apparent indifference to pain/temperature, adverse response to sounds/textures, visual fascination with lights | **High-Yield:** The diagnostic algorithm requires: - **Criterion A:** Persistent deficits in social communication AND social interaction (3 sub-criteria, all must be present) - **Criterion B:** Restricted, repetitive patterns (≥2 of 4 categories) - **Criterion C:** Symptoms present in early childhood (may not fully manifest until social demands exceed capacity) - **Criterion D:** Symptoms cause clinically significant impairment - **Criterion E:** Not better explained by intellectual disability or global developmental delay **Mnemonic:** **SIRS** for the four RRB domains: - **S**tereotyped movements - **I**nsistence on sameness - **R**estrictive interests - **S**ensory sensitivities **Clinical Pearl:** Many children with ASD present with only one prominent RRB (e.g., hand flapping) but meet criteria because they also have sensory sensitivities or insistence on routines—clinicians must probe all four domains. [cite:DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition]