politeyeti:

After looking at a lot of the criticisms of the proposed DSM5 criteria, I’ve been thinking about what potential criteria would look like if they were written with the perspective of someone autistic in mind–meaning looking at the underlying differences, not behavioural ones. These are what I’ve come up with so far. I would love to be able to refine and validate these/something built off of these some time in the future to replace the crap being put out in DSM5.

A. Differences in perception (at least 3)

1. Sensory defensiveness (ie, complaints or avoidance of any of the following: loud noises or places, bright lights, textures (food or object/clothing), tastes, smells, touch)
2. Sensory seeking (ie, stims or stimming behaviour such as rocking, flapping, finger flicking, hair twirling, spinning objects, etc or actively desiring any of the following: deep pressure or touch, vestibular sensation [swings, spinning in any context, etc], specific smells, tastes, or textures)
3. Auditory processing difficulties
4. Unusual, awkward, or delayed motor skills, or asymmetry between gross and fine motor skills (ie, clumsy but with strong fine motor skills, good gross motor skills with poor hand-writing or table skills)
5. A reduced or lack of conscious awareness and/or use of allistic (not autistic) nonverbal behaviour and communication such as facial expression, gesture, and posture.
   1. This criterion should not exclude persons who have learnt to read or otherwise comprehend nonverbal behaviour by rote learning, particularly adults. Intentional learning to overcome an inherent difficulty in comprehension is supportive of this criterion. It should also not exclude persons who have been taught to use nonverbals to be less visibly different. In such cases, internal report of difficulty should take precedence over apparent behaviour.

B. Differences in cognition (at least 3, one of which must be 1 or 2)

1. Difficulty in beginning or ending (at least 1):
   1. Perseverative thoughts or behaviours  
   2. Needing prompts (visual, verbal, hand-over-hand, etc) to begin or finish a task
   3. Difficulties planning complex activities
   4. Catatonia
   5. Difficulty switching between activities
   6. Lack of apparent startle response
2. Difficulty in using language (at least 1):
   1. Problems with pronoun use that are developmentally inappropriate
   2. A reduced or lack of awareness of tone in self (ie, speaks in a monotone, childish, or otherwise unusual manner) and/or others (ie, does not perceive sarcasm or follow implied prompts, responds to rhetorical statements and questions in earnest)
   3. A reduced or lack of awareness of volume (ie, speaks too loud or too quietly for the situation)
   4. No functional language use
   5. Echolalia
   6. Mutism in some or all situations
3. At least one special interest in a topic that is unusual for any combination of intensity (ie, does not want to learn/talk about anything else, collects all information about the topic) or subject matter (ie, unusual, obscure, or not considered age appropriate). Topics may be age appropriate and/or common (such as a popular television show or book), but the intensity of interest and/or specific behaviour (such as collecting or organising information as the primary focus) should be taken into account.
4. Asymmetry of cognitive skills
5. Talents in pattern recognition, including music, mathematics, specific language structures, puzzles, and art.
6. A tendency to focus on details instead of the broader picture, across contexts.

C. These differences cause impairment and/or distress in at least one context (ie, school, work, home), which may be variable over time.
D. Symptoms should be present in early childhood, but may not be noticable until social demands outpace compensatory skills, at any age