Table 1 ASD symptoms for the structured interview, DSM-III-R and DSM-IV

A. THESE ARE SOME QUESTIONS ABOUT HOW YOUR SON/DAUGHTER RELATES TO OTHERS.

A. QUALITATIVE IMPAIRMENT IN RECIPROCAL SOCIAL INTERACTION

(1). QUALITATIVE IMPAIRMENT IN SOCIAL INTERACTION

1. Did s/he seem unusually unaware of the existence or feelings of others?

1. Marked lack of awareness of the existence of or feelings of others

(d) Lack of social or emotional reciprocity

2. Did s/he not come for comfort even when hurt, or did s/he seek comfort in an odd way

2. No or abnormal seeking of comfort at times of distress

3. Was s/he unable to imitate others when appropriate?

3. No or impaired imitation

4. Does s/he have difficulty playing cooperatively with other children?

4. No or abnormal social play

(c) A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people

5. Is s/he uninterested in making peer friendships? Or if s/he is interested, does s/he seem to understand the conventions of social interaction?

5. Gross impairment in ability to make peer friendships

(b) Failure to develop peer relationships appropriate to developmental level

B. THESE ARE SOME QUESTIONS ABOUT HOW YOUR SON/DAUGHTER COMMUNICATES OR PLAYS WITH OTHERS.

B. QUALITATIVE IMPAIRMENT IN VERBAL AND NONVERBAL COMMUNICATION, AND IN IMAGINATIVE ACTIVITY

(2). QUALITATIVE IMPAIRMENTS IN COMMUNICATION

1. Is s/he unable to communicate?

1. No mode of communication, such as communicative babbling, facial expression, gesture, mime, or spoken language

(a) Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

2. Does s/he avoid looking at people or avoid greeting people? If no, ask: Does s/he ignore people around her/him, dislike being held?

2. Markedly abnormal nonverbal communication, as in the use of eye-to-eye gaze, facial expression, body posture, or gestures to initiate or modulate social interaction

(1) (a) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

3. Is s/he uninterested in imaginative activities or stories?

3. Absence of imaginative activity, such as playacting of adult roles, fantasy characters, or animals; lack of interest in stories about imaginary events

(d) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

4. When s/he speaks does her/his tone seem odd?

4, Marked abnormalities in the production of speech, including volume, pitch, stress, rate, rhythm, and intonation

5. Did s/he repeat words or phrases s/he has just heard, in place of responding to what was said? Did s/he often use the wrong pronouns to refer to her/himself or others, or refer to him/herself in the third person, as "he wants a remarks cracker?"

5. Marked abnormalities in the form or content of speech, including stereotyped and repetitive use of speech; use of "you" when "I" is meant; idiosyncratic use of words or phrases; or frequent irrelevant remarks

(c) Stereotyped and repetitive use of language or idiosyncratic language

6. Did s/he seldom, if ever, start a conversation with someone else, even if s/he might talk to her/himself?

6. Marked impairment in the ability to initiate or sustain a conversation with others, despite adequate speech

(b) In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

C. THESE ARE QUESTIONS ABOUT SON/DAUGHTER' S ACTIVITIES OR INTERESTS

C. MARKEDLY RESTRICTED REPERTOIRE OF ACTIVITIES AND INTERESTS

(3) R ESTRICTED REPETITIVE AND STEREOTYPED PATTERNS OF BEHAVIOR, INTERESTS, AND ACTIVITIES

1. Did s/he ever have any repetitive patterns of behavior such as hand movements, clapping or twirling?

1. Stereotyped body movements, e.g., hand-flicking or -twisting, spinning, head-banging, complex whole-body movements

(c) Stereotyped and repetitive motor mannerisms

2. Did s/he ever have any prolonged attachments to certain objects, either holding them or staring at them, or lining them up in a repetitive pattern?

2. Persistent preoccupation with parts of objects or attachment to unusual objects

(d) Persistent preoccupation with parts of objects

3. Did s/he ever get unusually upset if there were even small changes in where things were placed in the house?

3. Marked distress over changes in trivial aspects of environment

4. Or get upset when there are changes in daily routine?

4. Unreasonable insistence on following routines in precise detail

(b) Apparently inflexible adherence to specific, nonfunctional routines or rituals

5. Does s/he have an extremely restricted range of interests, or a preoccupation with one very narrow interest

5. Markedly restricted range of interests and a preoccupation with one narrow interest

(a) Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus