In DSM-5, Autism Spectrum Disorder (ASD) requires deficits in social communication/interaction AND restricted repetitive behaviors. Which of the following is included in the restricted/repetitive behaviors domain?

• A Reduced back-and-forth conversation
• B Failure to initiate or respond to social interactions
• C Highly restricted, fixated interests with abnormal intensity or focus ✓
• D Deficit in understanding metaphors and sarcasm

Explanation

DSM-5 ASD Criterion B (restricted, repetitive behaviors) includes: stereotyped or repetitive motor movements/speech/object use; insistence on sameness and inflexible adherence to routines; highly restricted, fixated interests; and hyper- or hyporeactivity to sensory input. Reduced reciprocal conversation, failure to respond to social interaction, and difficulties with non-literal language fall under Criterion A (social communication/interaction deficits). DSM-5 collapsed the previous separate categories (Asperger's, PDD-NOS, Autistic Disorder) into a single ASD diagnosis with severity specifiers.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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