Symptom type Coventry Criteria Evidence for Evidence against

1. Lack of flexibility of Repetitive questions related to own intense interests After establishing therapeutic goal to
thought and behaviour connect with sister, Warne began
talking/asking about video games
1.1 Preference for Repetitive questioning re: changes in routines and new
predictability in daily experiences
life Ritualised greetings
Becomes anxious if routine is removed and may seek to
impose usual routine (e.g., wants same bedtime routine
when away on holidays, won’t accept other teachers)
Inclined to try to repeat experiences and to interpret any
repetition as routine (e.g., asks/demands repetition of
following the same route to school; cannot cope with a
change to appointments)
Distressed when a routine or ritual cannot be completed
(e.g., when cannot follow the usual route because of
road works)
1. Lack of flexibility of May limit foods eaten according to unusual criteria such
thought and behaviour as texture, shape, colour, make, situation, rather than
what the food is (e.g., will eat chicken nuggets but no
1.2 Difficulties with other chicken)
eating May adjust eating because of literal understanding of
healthy eating messages (e.g., sell-by dates, avoidance
of fat)
Restricted diet seems to be about maintaining sameness
and the child is not easily encouraged by people the
child is attached to
Connection between high functioning ASD and eating
disorders during adolescence
1. Lack of flexibility of Echolalia None No echolalia in session or reported.
thought and behaviour Repetition of “favoured” words which are chosen for
their sound or shape, rather than for their use in
1.3 Repetitive use of communication or emotional content
language Children’s repetitiveness is out of synch with their
developmental stage
May use formal or inappropriate language which they
don’t understand (incorrect use of words/phrases)
1. Lack of flexibility of Often uses possessions as ornaments, especially making
thought and behaviour collections of objects, but does not seek approval for the
collection or for its care
1.4 Unusual relationship Will often be able to say where most treasured
with treasured possessions are and recognise if they are moved
possessions May be unable to dispose of old toys/papers/books even
though they are not used
Shows a preference for old, familiar items (or toys/items
which are part of a series) rather than new and different
toys
Can be a mismatch between the amount of theoretical Warne openly talks about the
knowledge they have and their social use of that characters, strategies etc. that he uses
knowledge e.g., aware of football facts but doesn’t share in the game he plays
it socially
2. Play May try to impose own rules on games
May see eventually losing a game as unfair if was
2.1 Poor turn-taking winning earlier in the game
and poor losing Preference for playing alone or in parallel with others
Interests may not be age appropriate, and narrow Narrow and excessive interest in video Age appropriate, yes
games
2. Play Plays with toys as objects rather than personifying them
May spend all time organising toys and arranging in
2.2 Poor play with toys patterns (e.g., ordering by size, colour)
May ‘play’ with unusual things (e.g., reading the
telephone book, watching water run down the drain) for
long periods from a young age
2. Play Dislike and avoidance of others joining in play
2.3 Poor social play Lacks interest in social play with parents/carers
2. Play Lack of interest in developing a range of play
2.4 Poor imaginative Strong preference for the familiar and tendency to play
play alone for long periods
2. Play Difficulty playing a variety of roles within games
Difficulty incorporating a range of toys into the same
2.5 Poor imaginative game (e.g., using both Dr Who and Spiderman toys in a
play game)
Preference for toys which have a mechanical rather than
emotional nature (e.g., cars, trains, Lego) or which
require logic and order (e.g., reviewing and organising
collections of objects) or examining objects (e.g.,
 watching spinning objects)
3. Poor social Interaction is usually one-sided and egocentric with little Yes, Warne often speaks to you rather Warne will answer questions that do
interaction regard for the response of the audience than with you; Warne has initiated a not interest him.
3.1 Difficulties with question before but not out of interest
social interaction Does not often manipulate others emotionally except for the responder but to stimulate is
through angry outbursts (i.e., would rarely ingratiate self own curiosity and knowledge.
3.2 More successful in with audience)
interactions with adults Warne has a tendency for blaming
than peers May perform better in less emotional situations others or calling things stupid/dumb if
things do not turn out his way. Does not
3.3 Own needs drive Poor awareness of own role in interactions seem to take responsibility for his role
interactions in the situation (unclear whether this is
Lack of social imagination – can’t imagine what risks due to lack of understanding or
3.4 Lacks awareness of might be associated with certain peer/adult “maintaining integrity”)
risk and personal relationships (it can look similar to attachment in need
danger in interactions to make friends)
with adults
3. Poor social Lacks awareness of the social expectation that the child
interaction will share (because the child does not understand or
need the social approval of others)
3.5 Difficulty sharing May not realise the needs of others waiting for their
and working in a group turn
4. Mind reading Rarely refers to the views of others

4.1 Difficulty
appreciating others’
views and thoughts
4. Mind reading Lacks awareness of others’ views of self-including lack of
awareness of ‘visibility’ of own difficulties (e.g., may
4.2 Lack of appreciation volunteer to perform gym sequence even though child is
of how others may see very poor at gym)
them Does not appreciate the information parents would like
to hear about successes and enjoyment
4. Mind reading Rarely refers to the emotional states of self and others

4.3 Limited use of

emotional language
4. Mind reading May not realise that cartoons, toys, animations and
 science fiction are not real
4.4 Problems May not realise that fantasy play is a temporary role
distinguishing between May be easily influenced by fantastic claims and
fact and fiction advertising
Lies are often easily discovered and ‘immature’ in style
5. Communication Poor awareness of the purpose of communication
Lacks awareness of needs of audience
5.1 Pragmatic language Does not repair communication break down
problems Poor eye contact (may be fleeting, staring, is not
synchronised with verbal communication)
Proximity does not signal intimacy or desire for contact
Often does not start conversation by addressing the
person
Conversation is stilted
The burden of communication lies with the
listener/adult
Assumes prior knowledge of listener
5. Communication Poor understanding of idiomatic language
5.2 Poor understanding
of inferred meaning,
jokes, sarcasm and
gentle teasing
5. Communication Makes noises for personal pleasure (as with favourite
5.3 Use of noise instead words) e.g., barking
of speech
5. Communication May have word-finding problems
Often have unusually good vocabulary (for age, or
5.4 Vocabulary cognitive ability, or within specific interest areas)
Less use of vocabulary related to emotions
5. Communication Provides detail in pedantic fashion and gives excessive
5.5 Commenting information
6. Emotional regulation Extremes of emotion may provoke anxiety and repetitive
questioning and behaviour
6.1 Difficulties Does not easily learn management of emotions from
managing own modelling (also likely to need an explanation)
emotions and Poor recognition of emotions
appreciating how other Emotions take over from logic/knowledge of what one
people manage theirs should do (e.g., when losing a game)
 Does not show displays of emotion to everyone –
discriminating between people and places (e.g., never
has a temper tantrum in school)
Difficulties showing empathy even for significant others
in life
Cognitive empathy is poor
6. Emotional regulation Sudden mood changes in response to perceived injustice
6.2 Unusual mood
patterns
6. Emotional regulation Panics about change in routines and rituals and about
6.3 Inclined to panic unexpected and novel experiences
7. Problems with Poor short term memory unless well-motivated
executive function Very good long-term memory with recall of excessive
7.1 Unusual memory detail for areas of particular interest to the child
7. Problems with Rigid reliance of the using previse times (e.g., uses watch
executive function and unable to guess the time)
7.2 Difficulty with Waiting irritates child because it affects routine
concept of time –
limited intuitive sense of
time
7. Problems with Inclined to consider the immediate context (not talking
executive function into account past experiences and emotional factors)
7.3 Poor central
coherence
8. Problems with May be passive and quiet in acceptance of discomfort or
sensory processing may be distressed but does not communicate the source
8.1 Difficulty integrating of distress
information from senses
(e.g., lack of awareness May be hypersensitive to some light sensations even
of heat, cold, pain, when pain threshold is high (e.g., labels in clothes
thirst, hunger, need to irritate but a bitten arm does not)
urinate/defecate) and
lack of physical problem
solving skills (e.g.,
removing coat when
hot)
8. Problems with Physical distance is unrelated to intimacy (e.g., they
sensory processing stand too close because they are unaware of social
8.2 Unusual physical proximity rules)
proximity
8. Problems with Self-stimulation is likely to be related to own sensory
sensory processing needs
8.3 Self-stimulation
 Autism Spectrum Disorder

Autism Spectrum Disorder

Diagnostic Criteria
299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of 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).
B. 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 of verbal or nonverbal behavior (e.g., extreme distress at small
changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same 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 interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest 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).
C. 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).
D.Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. 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(Coding note: Use additional code to identify the associated medical or
genetic condition.)
 Associated with another neurodevelopmental, mental, or behavioral disorder(Coding note: Use additional code[s] to identify the associated
neurodevelopmental, mental, or behavioral disorder[s].)
 With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119–120, for definition) (Coding note: Use additional code 293.89
[F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)