Name/ID: _______________________ Informant[s]: Self / Parent / Spouse / Other ______________
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DSM-5 Symptom Checklist for Adult Autism Diagnosis
Instructions: This checklist operationalizes the DSM-5 diagnostic criteria for autism spectrum disorder [autism]. It is meant to support a diagnostic
evaluation by organizing information gathered from clinical interviews and/or behavioral observations. It is highly recommended that diagnostic
evaluations include an interview with a parent/caregiver or another individual who can report on autism features present in early childhood.
Rate each behavior as present [+], subthreshold [±] or absent [–] in childhood, adolescence, and adulthood.
A. Persistent deficits in social communication and social interaction
[Lifetime history of all A criteria [A1 + A2 + A3] needed for diagnosis]
A1 – Deficits in social-emotional reciprocity
Abnormal social approach [consistently awkward, one-sided, absent, or inappropriate initiations, e.g., odd or
stilted greetings, frequently used phrases [scripting], intrusive or out of context touching, diminished social smile]
Difficulty in initiating or in sustaining a conversation [especially on non-preferred topics]. Includes difficulty
with four-round conversation [A opens → B comments → A responds → B responds to response] or longer.
Atypical conversational style [e.g., overly passive, takes over, shifts topic to preferred interests, circumstantial]
Poor pragmatic/social use of language [e.g., does not provide or appreciate necessary context or clarifications]
Does not usually talk to be friendly or social [limited ability to make small talk, rarely asks about others]
Reduced spontaneous sharing of objects, possessions, or food [e.g., requires prompting to share with others]
Reduced spontaneous sharing of own interests [e.g., sharing new information, inviting others to join activities]
Reduced spontaneous sharing of emotions or affect [e.g., sharing enjoyment, excitement, or achievement with
others; seeking support, comfort, or validation from others when distressed]
Does not usually respond appropriately to others’ emotions [e.g., not sharing in someone’s excitement, not
comforting someone in distress, indifference/aversion to affection from others or displays of emotion]
Abnormal response to others’ social bids [e.g., does not respond when spoken to directly]
Reduced or absent imitation of others’ behavior [e.g., a child not pretending to cook, fix things, talk on the
phone, etc.; in older individuals, does not “pick up” behaviors from others unless explicitly taught]
A2 – Deficits in nonverbal communicative behaviors
Poor/abnormal eye contact [e.g., eye-contact is limited, inconsistent, poorly modulated, or overly intense/staring]
Abnormal use of facial expressions and body language [nonverbal emotional expression may be attenuated,
absent, exaggerated/inappropriate, or limited to “simple” emotions [happiness, sadness, anger, fear]]
Limited/abnormal use of gestures [e.g., few or no descriptive or emphatic gestures, frequent use of
stilted/abnormal gestures, lack of conventional gestures [e.g., nodding, waving good-bye] in childhood]
Limited/abnormal declarative gestures [i.e., limited/abnormal use of gaze/pointing to direct others’ attention]
Poor integration of eye-gaze, facial expressions, and gestures [e.g. eye contact or facial expressions which do
not align with current conversation or social interaction]
Poor integration of verbal and nonverbal communication [e.g., does not nod to maintain flow of conversation]
Abnormal body positions during social interaction [e.g., faces away from conversation partner, maintains
inappropriate amount of interpersonal space [either too little or too much], spins in chair while being talked to]
Difficulty interpreting/understanding nonverbal cues from others [e.g., does not notice that others are
inattentive, [un]interested, uncomfortable, etc. based on their facial expressions or body language]
Speech abnormalities [e.g., abnormal volume, pitch, intonation, rate, rhythm, syllable stress, or prosody]
Limited understanding of tone of voice [i.e., difficulty inferring emotional states or sarcasm from tone of voice]
A3 – Deficits in developing, maintaining, and understanding relationships
Limited interest in socializing with same-aged peers [e.g., has limited desire in peer interactions; strongly
prefers interacting with much older/younger people; in childhood, does not approach peers on playground]
Difficulty making friends or maintaining existing friendships [e.g., limited social contact outside of “required”
relationships; puts little effort into friendships; relies on others to plan most social gatherings or activities]
Poor understanding of social relationships [e.g., unrealistic/transactional view of friendships]
Limited ability to work or play collaboratively with others [e.g., overly passive, controlling, or conflict-prone]
Unaware of social conventions/appropriate behavior [e.g., unintentional rudeness, misses “unwritten rules”]
Difficulty adapting behavior to different social contexts [e.g., contextually inappropriate behavior, oversharing]
Social naïveté [i.e., difficulty spotting insincerity, overly trusting/gullible, easily taken advantage of by others]
Lack of imaginative play with peers [includes social role playing]
Mentalizing difficulties [i.e., difficulty inferring others’ intentions, attitudes, or emotions unless obvious]
Difficulty with nonliteral speech [e.g., irony, sarcasm, metaphor, inuendo, implied meaning, humor]
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