DSM-V Criteria

Diagnostic Criteria for Autism Spectrum Disorder (DSM-V)

• Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following:

  • Fails to initiate or respond to social interactions during physiotherapy sessions; minimal sharing of affect or interest during play-based gross motor tasks.
  • Poorly integrated verbal and nonverbal communication; fleeting eye contact and lack of communicative gestures (e.g., pointing, waving) when requesting equipment.
  • Engages exclusively in solitary play during group paediatric gym sessions; apparent disinterest in peers and inability to join cooperative games.

• Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at least two of the following:

  • Frequent bilateral hand flapping and persistent toe-walking (equinus gait pattern) when excited or overstimulated; lines up therapy cones repeatedly instead of navigating the obstacle course.
  • Extreme distress and behavioural dysregulation if the sequence of warm-up exercises is altered or if transitioning between clinic rooms without a visual schedule.
  • Perseverative focus on spinning objects (e.g., therapy tricycle wheels, gym fans), difficult to redirect to functional motor tasks.
  • Tactile defensiveness to varied floor textures (refuses barefoot balance tasks on foam pads) and auditory hypersensitivity to clinic noise, yet seeks intense proprioceptive input via crashing into crash mats.

• Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

  • Parents report delayed motor milestones (independent ambulation at 20 months with immediate onset of idiopathic toe-walking) alongside regression of babbling and lack of joint attention noted at 18 months.

• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

  • Unable to participate in mainstream kindergarten physical education due to sensory overload, elopement risk, and motor coordination deficits; requires 1:1 Education Assistant support and ongoing NDIS-funded physiotherapy and occupational therapy.

• These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

  • Developmental Paediatrician (Dr A. Patel, Perth Children's Hospital, 14/02/2025) ruled out Global Developmental Delay (GDD) and Intellectual Disability; non-verbal cognitive testing within normal limits, confirming social communication deficits are primary and coexist with Developmental Coordination Disorder (DCD) traits.