A 4-year-old boy with Autism Spectrum Disorder (ASD) is being evaluated for core diagnostic features. Which of the following is NOT a core diagnostic criterion for ASD according to DSM-5?

Explanation

## DSM-5 Diagnostic Criteria for Autism Spectrum Disorder **Key Point:** The DSM-5 defines ASD by two core domains: (1) persistent deficits in social communication and interaction, and (2) restricted, repetitive patterns of behavior, interests, or activities. Intellectual disability is NOT a required criterion. ### Core Diagnostic Domains | Domain | Features | |--------|----------| | **Social Communication & Interaction** | Deficits in social-emotional reciprocity, nonverbal communication, developing/maintaining relationships | | **Restricted, Repetitive Behavior** | Stereotyped/repetitive motor movements, speech, or use of objects; insistence on sameness; restricted interests; sensory sensitivities | ### Onset & Developmental Course **High-Yield:** Symptoms must be present from early childhood, but may not fully manifest until social demands exceed the child's limited capacities. This is why some children are diagnosed later (e.g., in school when peer interaction demands increase). ### Intellectual Disability & ASD **Clinical Pearl:** Intellectual disability and ASD frequently co-occur (approximately 30–50% of individuals with ASD have co-occurring intellectual disability), but intellectual disability is **not** a diagnostic requirement for ASD. ASD exists across the full spectrum of intellectual functioning—from profound intellectual disability to superior intelligence. **Warning:** A common misconception is that all individuals with ASD have intellectual disability or that ASD cannot occur with average or above-average intelligence. This is false; many individuals with ASD have typical or superior cognitive abilities (sometimes called "high-functioning autism" or Asperger syndrome in older nomenclature). ### Specifier Levels ASD severity is coded on three levels based on support needs, independent of IQ: - Level 1: Requiring support - Level 2: Requiring substantial support - Level 3: Requiring very substantial support [cite:DSM-5 Neurodevelopmental Disorders]