People with ASD often have difficulties with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things.

The following is the diagnostic criteria of ASD from the Diagnostic Statistical Manual, 5th Edition The criteria below is used by psychologists and psychiatrists to diagnose individuals with ASD.

1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
   2. Deficits in nonverbal communicative behaviors used for social interaction, ranging for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
   3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

2. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
   1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
   2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
   3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
   4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

3. 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).
4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
5. 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.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
With catatonia

Table 2  Severity levels for autism spectrum disorder

Asperger’s Disorder was first described in the 1940s by Viennese pediatrician Hans Asperger, who observed autistic-like behaviors and difficulties with social and communication skills in boys who had normal intelligence and language development. Many professionals felt Asperger’s Disorder was simply a milder form of autism and used the term “high-functioning autism” to describe these individuals.

In 1994, Asperger’s Disorder was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a separate disorder from autism. There are many professionals who consider Asperger’s Disorder to be a less severe form of autism. In 2013, the DSM-5 replaced autism, Asperger’s Disorder and other pervasive developmental disorders with the umbrella diagnosis of autism spectrum disorder or ASD.

Please refer to the diagnostic criteria listed for ASD from the Diagnostic Statistical Manual, 5th Edition.

According to the American Psychiatric Association (APA), social (pragmatic) communication disorder is characterized by a persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. SPD limits effective communication, social relationships, academic achievements, or occupational performance. ASD must be ruled out before SCD can be accurately diagnosed.

In May of 2013, the DSM V was published with a new diagnosis called Social (Pragmatic) Communication Disorder. Below are the diagnostic criteria for SCD according to the DSM-5:

1. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
   1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context.
   2. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
   3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
   4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation.)
2. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
3. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
4. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

Babies and children usually learn important skills such as sitting up, rolling over, crawling, walking, babbling, talking and becoming toilet trained as they develop. These skills are known as developmental milestones that happen in a predictable order and at a fairly predictable age. While all children reach these stages at different times, a child with global developmental delay may not reach one or more of these milestones until much later than expected. A child may be described as having global developmental delay (GDD) if they have not reached two or more milestones in all areas of development such as; motor skills, speech and language, cognitive skills, social and emotional skills.

The criteria below is used by psychologists and psychiatrists to diagnose individuals with GDD using the DSM V:
This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category requires reassessment after a period of time.

Intellectual disability involves impairments of general mental abilities that impact overall adaptive functioning in three domains. These domains assess how well an individual copes with everyday tasks. The conceptual domain consists of the following; skills in language, reading, writing, math, reasoning, knowledge, and memory. The social domain includes empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities. The practical domain includes self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing tasks for work and school.

An individual’s symptoms must begin during the developmental period and are diagnosed based on the severity of deficits in adaptive functioning. The Intellectual Disability often co-occurs with other mental conditions such as; depression, attention-deficit/hyperactivity disorder, and autism spectrum disorder.
In the new DSM V, the diagnosis of Intellectual disability (intellectual developmental disorder) replaced mental retardation used in previous editions of the publication.

Intellectual Disability (Intellectual Intellectual Developmental Disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following criteria must be met:

1. Deficits in Deficits in intellectual functions intellectual functions, such as reasoning such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and intellectual and individualized, standardized  intelligence testing.
2. Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, and across multiple environments, such as home, school work and school, work, and community.
3. Onset of intellectual and adaptive deficits during the developmental period.

The diagnostic criteria for language disorder includes persistent difficulties in the acquisition and use of language across spoken, written, sign language, or other forms due to deficits in comprehension or production. The individual diagnosed with a language disorder has language abilities that are substantially and quantifiably below age expectations.

The criteria below is used by psychologists and psychiatrists to diagnose individuals with GDD using the DSM V:

1. Persistent difficulties in the acquisition and use of language across modalities (i.e., spoken, written, sign language, or other) due to deficits in comprehension or production that include the following:
   1. Reduced vocabulary (word knowledge and use)
   2. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology).
   3. Impairments in discourse (ability to use vocabulary and connect sentences to explain or describe a topic or series of events or have a conversation).
2. Language abilities are substantially and quantifiably below those expected for age, resulting in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination.
3. Onset of symptoms is in the early developmental period.
4. The difficulties are not attributable to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

ADHD is characterized by a pattern of behavior, present across multiple settings that can result in performance issues in social, educational, or work settings. Symptoms are divided into two categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations.

Children must have at least six symptoms from either (or both) the inattention group of criteria and the hyperactivity and impulsivity criteria, while older adolescents and adults who are over age 17 years must present with five of the symptoms. While the criteria have not changed from DSM-IV, examples have been included to illustrate the types of behavior children, older adolescents, and adults with ADHD might exhibit.

The criteria below is used by psychologists and psychiatrists to diagnose individuals with ADHD using the DSM V:

1. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):

1. 1. Inattention: Six or more of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental activities:
      Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

1. 1. 1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
      2. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
      3. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere even in the absence of any obvious distraction).
      4. Often does not follow through on instructions and fails to finish schoolwork, chores, or  duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
      5. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; tends to fail to meet deadlines).
      6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
      7. Often loses things needed for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
      8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
      9. Is often forgetful in daily activities (e.g., chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

2. Hyperactivity and Impulsivity: Six or more of the following symptoms of have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.
   Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults
   1. Often fidgets with hands or feet or squirms in seat.
   2. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining place).
   3. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless).
   4. Often unable to play or engage in leisure activities quietly.
   5. Is often “on the go” or often acts as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
   6. Often talks excessively.
   7. Often blurts out an answer before questions have been completed (e.g., completes people’s sentences; cannot wait for next turn in conversation).
   8. Often has trouble waiting his or her turn (e.g., while waiting in line).
   9. Often interrupts or intrudes on others (e.g., butts into conversations, games or activities; may start using other people’s things without asking or receiving permission, for adolescents and adults, may intrude into or take over what others are doing).

2. Several inattentive or hyperactive-impulsive symptoms were present prior to 12 years.
3. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
4. There is clear evidence that the symptoms interfere with, or reduce the quality of social, academic, or occupational functioning.
5. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, substance intoxication or withdrawal).

Specify whether:
Combined Presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
Predominantly Inattentive Presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.
Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

Specify if:
In Partial Remission: When full criteria were not previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.
Specify current severity:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Individuals diagnosed with ODD exhibit a pattern of angry/irritable behavior, or vindictiveness lasting at least 6 months, and is exhibited during interaction with at least one individual that is not a sibling. Individuals must display four symptoms from one of the following categories: angry/irritable mood, argumentative/defiant behavior, or vindictiveness.

The criteria below is used by psychologists and psychiatrists to diagnose individuals with ODD using the DSM V:

1. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced  by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry/Irritable Mood

1. 1. Often loses temper.
   2. Is often touchy or easily annoyed.
   3. Is often angry and resentful.

Argumentative/Defiant Behavior

4. 1. Often argues with authority figures or, for childnren and adolescents, with adults.
   2. Often actively defies or refuses to comply with requests from authority figures or with rules.
   3. Often deliberately annoys others.
   4. Often blames others for his or her mistakes or misbehavior.

Vindictiveness

8. 1. Has been spiteful or vindictive at least twice within the past 6 months.

Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture.

2. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.
3. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Specify current severity:

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
Moderate: Some symptoms are present in at least two settings.
Severe: Some symptoms are present in three or more settings.

Traumatic brain injury (TBI) is a nondegenerative, noncongenital injury to the brain due to an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

The criteria below is used by psychologists and psychiatrists to diagnose individuals with TBI using the DSM V:

1. The criteria are met for major or mild neurocognitive disorder.
2. There is evidence of a traumatic brain injury-that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following:
   1. Loss of consciousness.
   2. Posttraumatic amnesia.
   3. Disorientation and confusion.
   4. Neurological signs (e.g., neuroimaging demonstrating injury; a new onset of seizures; a marked worsening of a preexisting seizure disorder; visual field cuts; anosmia; hemiparesis)
3. The neurocognitive disorder presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.