Six or more criteria from three lists
1) Qualitative impairment in social interaction, manifested by at least two of the following:
• marked impairment in use of multiple nonverbal behaviors (eye-to-eye gaze, facial expression, body postures, gestures)
• failure to develop peer relationships appropriate to developmental level
• lack of spontaneous seeking to share enjoyment, interests, or achievements with others
• lack of social or emotional reciprocity
2) Qualitative impairments in communication, manifested by at least one of the following:
• delay in, or total lack of, development of spoken language, not accompanied by attempts to compensate through alternative modes of communication such as gesture or mime
• in individuals with adequate speech, marked impairment in ability to initiate or sustain conversation
• stereotyped and repetitive use of language or idiosyncratic language
• lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
3) Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, manifested by at least one of the following:
• preoccupation with one or more stereotyped and restricted patterns of interest abnormal in either intensity or focus
• apparently inflexible adherence to specific, nonfunctional routines or rituals
• stereotyped and repetitive motor mannerisms (hand or finger flapping, complex whole-body movements)
• persistent preoccupation with parts of objects
Delays or abnormal functioning in at least one of the following areas, with onset prior to age three:
• social interaction
• language as used in social communication
• symbolic or imaginative play
Symptoms not better explained by Rett's Disorder or Childhood Disinte-grative Disorder speech pathology in autism is either immediate or delayed repetition of something heard but simply parroted back (such as a television commercial), phenomena called immediate and delayed echolalia, respectively. Yet another problem seen is lack of true language comprehension, shown by the fact that an autistic child's ability to follow instructions is often dependent on situational cues. For example, such a child may understand the request to come and eat dinner only when a parent is eating or sitting at the dinner table.
Behavior denoting resistance to change is often best exemplified by rigid and repetitive play patterns, the interruption of which results in tantrums and even self-injury. Some autistic children also develop very ritualistic preoccupations with an object or a schedule. For example, they may become extremely distressed with events as minor as the rearrangement of furniture in a particular room at home.
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