A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

1. )qualitative impairment in social interaction, as manifested by at least two of the following:

   • ) 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

   • ) failure to develop peer relationships appropriate to developmental level

   • ) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (eg, by a lack of showing, bringing, or pointing out objects of interest)

   • ) lack of social or emotional reciprocity

2. ) qualitative impairments in communication as manifested by at least one of the following:

   • ) 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)

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

   • ) stereotyped and repetitive use of language or idiosyncratic language

   • ) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

3. ) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

   • ) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

   • ) apparently inflexible adherence to specific, nonfunctional routines or rituals

   • ) stereotyped and repetitive motor mannerisms (eg, hand or finger flapping or twisting, or complex whole-body movements)

   • ) persistent preoccupation with parts of objects

Delays or abnormal functioning in at least one of the following areas, with onset before 3 years old: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

The disturbance is not better accounted for by Rett's Disorder or childhood disintegrative disorder.