CLINICIAN INTERVIEW VERSION - QUESTIONS TO AID DIAGNOSIS OF ASD USING DSM-5-TR CRITERIA

CLIENT NAME:________________________________________ DOB: ____/____/_____ AGE: _______

CLINICIAN NAME: ____________________________________ COMPLETION DATE: _____/____/_____

Please answer all the questions below, by indicating the strength of severity with which the described trait(s) applies to you.
SEVERITY KEY:
0 = No / Nil / NA – does not apply to me at all 1 = Low, applies to me to a small degree
2 = Medium, applies to me to a moderate/medium degree 3 = High, applies to me to a high degree
A: Persistent deficits in social communication and social interaction across multiple contexts [NEED ALL THREE] as
manifested by the following, currently or by history (e.g.’s are illustrative, not exhaustive, see text):

Specify current severity - based on social communication impairments & restricted repetitive behaviour patterns (Table 2).
Requiring: Level 1 " support”; Level 2 "Substantial support”; Level 3 "Very substantial support”

A1: Difficulties with Social Initiation and Response

Severity
No. Question Comments
(please circle)
1 Do you find it hard to approach others about things you
0 1 2 3
would like or need to discuss with them?
2 Do you have difficulty entering into a social group or
0 1 2 3
conversation?
3 Do you struggle with knowing when it’s your turn to
0 1 2 3
talk?
4 Do you frequently interrupt others in conversations?
0 1 2 3
5 Do you frequently leave unusually long pauses in
0 1 2 3
conversations?
6 Do you find yourself having one-sided conversations in
0 1 2 3
which you are doing most of the talking?
7 Do you get easily bored when someone wants to talk
0 1 2 3
about a subject that does not interest you?
8 Do you find it hard to engage in small talk?
0 1 2 3
9 Do you see conversations primarily as a way to
exchange information rather than to emotionally 0 1 2 3
connect with people?
10 Do you find it hard to explain something in a different
0 1 2 3
way, if someone does not understand you the first time?
11 Do you find it hard to get excited when someone else
shares news of an exciting or enjoyable experience 0 1 2 3
they had?
12 Does praise make you uncomfortable because you’re
0 1 2 3
unsure how to respond and you are feeling judged?
13 Do you find that you don’t enjoy social interactions in
0 1 2 3
the way others seem to enjoy them?
14 Do you have an aversion to physical affection?
0 1 2 3
15 Do you have an aversion to other types of typically
pleasurable physical contact, such as a handshake or 0 1 2 3
hug?
16 Do you find it difficult to ask for help from others?
0 1 2 3

A2: Difficulties with Non-Verbal Communication

Severity
No. Question Comments
(please circle)
1 Do you have trouble coordinating eye contact during
0 1 2 3
conversation?
2 Do you have trouble coordinating gestures or other
0 1 2 3
body language during conversation?

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 3 Have you been told that your facial expressions are
inappropriate for the situation or do not match your 0 1 2 3
feelings?
4 Have others told you that your facial expressions often
look angry, depressed or blank, even though you don’t 0 1 2 3
feel that way?
5 Have you been told that you stare at people
0 1 2 3
inappropriately?
6 Do you have difficulty smiling for photos or otherwise
putting on an appropriate facial expression “on 0 1 2 3
demand”?
7 Do you find making eye contact uncomfortable, difficult
0 1 2 3
or even painful?
8 When talking to others, do you tend to look or face
away from them under certain conditions (such as when
0 1 2 3
you’re thinking, or the conversation becomes
emotionally intense)?
9 Have you been told that you often speak too loudly, too
softly, or too quickly – to be easily understood? (Circle 0 1 2 3
applicable)
10 Do you find yourself imitating the accents or speech
0 1 2 3
patterns of the person you are talking to?
11 Have you been told that your speech is flat or
0 1 2 3
monotonous?
12 Have others described you as cold, detached, or bored,
0 1 2 3
when you weren’t feeling that way? (Circle applicable)
13 Do you have difficulty reading other people’s facial
0 1 2 3
expressions or body language?
14 Do you have difficulty recognising sarcasm?
0 1 2 3

A3: Difficulties with Relationships

Severity
No. Question Comments
(please circle)
1 Do you find it difficult to judge how another person is
0 1 2 3
feeling about you?
2 Do you have trouble judging how another person is
0 1 2 3
reacting to your words and actions?
3 Do you often miss social cues that others seem to
0 1 2 3
easily understand?
4 Do you laugh or smile at the wrong time?
0 1 2 3
5 Have you been told you’re aloof, withdrawn, or in your
0 1 2 3
own world?
6 Do you have a lower than average need for social
0 1 2 3
interaction?
7 Do you often prefer solitary activities or spending time
0 1 2 3
alone?
8 Do you find interacting with people who are much
younger or older than you, easier than interacting with 0 1 2 3
your age peers?
9 Do you find it difficult to make new friends?
0 1 2 3
10 Do you struggle with maintaining friendships?
0 1 2 3
11 Do you prefer to have just one or two friends at a time?
0 1 2 3
12 Do you wish you had more friends but don’t know how
0 1 2 3
to establish relationships?
13 Do you have distant or strained relationships with family
members, especially for reasons you find hard to 0 1 2 3
understand?
14 Do you find it hard to tell if someone is teasing or
0 1 2 3
mocking you?

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15 Do you have trouble figuring out when someone wants
you to do something, if they don’t especially or directly
0 1 2 3
tell you (e.g., saying they’re cold and wanting you to
offer them a blanket or a jumper/sweater)?
16 Do you prefer one-to-one interaction over group
0 1 2 3
interaction?
17 Do you sometimes avoid or ignore people who want to
0 1 2 3
interact with you?
18 Do you find it hard to understand the unwritten rules of
0 1 2 3
social interaction?
19 Do you rely on scripted speech or imitating others in
0 1 2 3
social interactions?
20 Do you have difficulty in reacting in expected ways to
0 1 2 3
another person’s distress?
21 Do you find it hard to judge when it’s ok to join a group
0 1 2 3
activity or a conversation?
22 Do others tell you that you’re insensitive?
0 1 2 3
23 Do others tell you that you don’t seem to notice their
0 1 2 3
feelings?
24 Do others call you selfish because you only seem to be
0 1 2 3
thinking of yourself in certain situations?
25 Are you often surprised when another person tells you
what they were really thinking, after you’ve had a 0 1 2 3
misunderstanding?

B1: Atypical Speech or Movements

Severity
No. Question Comments
(please circle)
1 Do you repeat words, phrases or longer passages of
speech that you’ve heard, such as from a movie or
0 1 2 3
conversational partner (either immediately or along time
after hearing the original speech)?
2 Do you have a large vocabulary?
0 1 2 3
3 Do you have a strong preference for very exact use of
words, regardless of how commonly used those words 0 1 2 3
might be?
4 Do you often use unusually formal words or speech
0 1 2 3
structure?
5 Do you have some phrases that you use frequently,
0 1 2 3
even when they are not exactly appropriate?
6 Do you use a lot of metaphors, especially ones that
0 1 2 3
you’ve made up (that might not make sense to others)?
7 Are there aspects of your speech content or structure
that others find hard to understand until they get to 0 1 2 3
know you?
8 Do you sometimes feel the need to repeatedly talk
about the same subject, even when the other person 0 1 2 3
has asked you to stop, or is no longer listening?
9 Do you perform soothing repetitive hand movements,
like flapping your hands, flicking your fingers, or 0 1 2 3
manipulating an object with your fingers?
10 Do you perform whole body movements like rocking,
bouncing, walking on your toes, skipping, spinning, or 0 1 2 3
swaying in solitude or in company?
11 Do you repeatedly pick at your skin or scalp?
0 1 2 3
12 Do you like to sit, stand or otherwise position yourself in
unusual ways, such as curling up in small places, or 0 1 2 3
lying or sitting with certain body parts under you?
13 Have you been told that you make unusual facial
expressions (e.g. grimaces, flinching) repeatedly, often
0 1 2 3
without realising it?

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14 Do you enjoy using objects in ways other than how they
were intended (e.g., twirling a piece of string, chewing
0 1 2 3
on objects, repeatedly opening and closing things, lining
up or arranging things by colour or category)?

B2: Rituals and Resistance to Change

Severity
No. Question Comments
(please circle)
1 Do you sometimes feel the need to repeatedly ask the
same questions, even after your question has been 0 1 2 3
answered?
2 Do you need to say a particular thing in a certain way at
0 1 2 3
certain times?
3 Do you need to have other people always answer
0 1 2 3
certain questions in specific ways?
4 Do you have compulsive behaviours, like always
touching the door jamb before entering a room, or
0 1 2 3
brushing your hair for (say) exactly 50 strokes before
getting in the shower?
5 Do you find it hard to understand certain types of
0 1 2 3
humour?
6 Do you have difficulty understanding non-literal types of
speech such as irony, sarcasm, symbolism, or 0 1 2 3
allusions?
7 Do you find it hard to end one activity and begin
0 1 2 3
another?
8 Do you struggle to begin or complete self-care tasks,
even when you know that a task is essential or 0 1 2 3
overdue?
9 Do other people tell you that you over-react to small
changes in plans or your environment (even if you don’t 0 1 2 3
consider the changes small)?
10 Do you have a lot of routines that you rely on to get
0 1 2 3
through the day or to navigate certain situations?
11 Do you get upset when someone or something disrupts
0 1 2 3
one of your routines?
12 Do you have routines that other people think are
0 1 2 3
unusual?
13 Do you have routines that no one else seems to do?
0 1 2 3
14 Have you been told that your style of thinking is “black
0 1 2 3
and white” or “all or nothing”?
15 Do you have trouble seeing other people’s point of view
0 1 2 3
in a discussion or an argument?
16 Do you find it hard to apologise or admit that you’re
wrong after you’ve taken a strong stance in a 0 1 2 3
discussion?
17 Do you have a lot of rules that you like to follow?
0 1 2 3
18 Do you expect others to follow your rules?
0 1 2 3
19 Do other people tell you that you’re controlling or
0 1 2 3
bossy?
20 Do you get frustrated by things that are not clearly
defined (e.g., when people say “it depends”) or where 0 1 2 3
there are no clear answers to a problem or question?
21 Do you find open ended questions hard to answer?
0 1 2 3
22 Do you often have trouble changing your mind or
adjusting your plans, if you’re presented with new 0 1 2 3
information, or a situation suddenly changes?

B3: Intense or Unusual Interests

Severity
No. Question Comments
(please circle)
1 Do you tend to get obsessed with certain topics,
0 1 2 3
sometimes for reasons you can’t explain?
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 2 When you interested in a topic, does it seem to take
over many aspects of your life (e.g., you find yourself
0 1 2 3
talking, thinking, or reading about it, or collecting and
making things related to it)?
3 Do you have an object that you like to have with you at
all times – especially something that’s unusual for your 0 1 2 3
age?
4 Do you find that you naturally focus more on details of
0 1 2 3
things, rather than the whole?
5 Do you have interests that are unusually intense
0 1 2 3
compared to your peers?
6 Do you have highly unusual interests?
0 1 2 3
7 Do you have a narrow range of interests?
0 1 2 3
8 Does your leisure time always focus on just one or two
0 1 2 3
activities or topics?
9 Do you have a passion for numbers, letters, words, or
symbols, including specimens/items such as the 0 1 2 3
number 3, or categories? (Circle applicable)
10 Do you consider yourself, or have you been told, that
0 1 2 3
you are a perfectionist?
11 Do you like to collect and/or categorise items?
0 1 2 3
12 Do you have large collections of factual knowledge,
particularly in a specific category likes dates, models, or 0 1 2 3
statistics, or systems?
13 Do you see patterns and systems in things?
0 1 2 3

B4: Atypical Sensory Experiences

Severity
No. Question Comments
(please circle)
1 Do you prefer certain textures?
0 1 2 3
2 Do you find certain textures hard to tolerate?
0 1 2 3
3 Do you find that textures, features or styles of clothing (e.g.
tags, seams, high/tight collars or waists) that don’t seem to 0 1 2 3
bother other people, are irritating or even upsetting to you?
4 Do you find showers, haircuts or other common self-
0 1 2 3
care tasks, physically uncomfortable or painful?
5 Are you unusually sensitive to any light touch on your
0 1 2 3
skin?
6 Do you notice physical sensations that others don’t
0 1 2 3
seem to notice?
7 Are you unusually sensitive to heat or cold?
0 1 2 3
8 Are you easily startled by loud sounds, or do you find
0 1 2 3
certain sounds painful?
9 Do you have unusually sensitive hearing?
0 1 2 3
10 Do you often hear sounds that others don’t notice?
0 1 2 3
11 Do you have difficulty following conversations when
0 1 2 3
there is a lot of background noise?
12 Do you find a certain type of intensity of light painful or
0 1 2 3
otherwise hard to tolerate?
13 Are you unusually sensitive to specific smells, often to
the point that if you can’t escape them, you’ll become 0 1 2 3
physically ill?
14 Do you find it impossible to eat certain types of foods
0 1 2 3
due to their unpleasant taste or texture?
15 Do you sometimes become physically ill (e.g.,
nauseous, dizzy, severe headache) around certain
0 1 2 3
types of sensory input (e.g., fluorescent lights, sirens,
strobes, machinery)? (Circle which one(s)
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16 Do you have an unusually high tolerance for pain?
0 1 2 3
17 Do you enjoy watching moving objects for extended
0 1 2 3
periods of time?
18 Are you strongly drawn to certain smells or visual
0 1 2 3
patterns?
19 Do you seek out certain types of movement like swing,
0 1 2 3
bouncing, speed or flight?
20 Do you seek out deep pressure such as tight hugs,
0 1 2 3
heavy blankets, or tight spaces?

C: Traits Must Be present in Early Childhood

Keep in mind that your traits may have
been different in severity or type when you
Have most of your (above) traits, to which you’ve were younger (e.g. in primary school you
had difficulty maintaining friendships
1 answered 2 or 3, been present since early YES NO because you were “too bossy”, but as an
childhood (8 or younger)?
adult you have difficulty because you
struggle with social rules or prefer to spend
time alone)?
Have most of your (above) traits, to which you’ve
2 answered 2 or 3, been present since early YES NO
adolescence (age 16 or younger)?
If Yes to any questions, please go back
Are there some questions above that you answered 2 through the questionnaire and indicate
3 or 3 to when thinking about your childhood, which were YES NO which question by underlining or circling the
present then, but no longer present in adulthood? appropriate question number in the first
column headed ‘No.’.

Other features that are commonly experienced by children and adults with Autism or Aspergers which are not
included in the criteria are:
DO YOU HAVE:
Severity
No. Question Comments
(please circle)
1 Insomnia or poor sleeping patterns?
0 1 2 3
2 Persistent anxiety?
0 1 2 3
3 Impaired fine motor coordination (tying shoelaces or
0 1 2 3
holding a pencil)?
4 Impaired gross motor coordination (PE and games,
0 1 2 3
bumps into things)
5 Difficulty in recognising your own emotions?
0 1 2 3
6 Difficulty in talking about your own emotions and
0 1 2 3
difficulties?
7 Difficulty in differentiating between physical sensations
0 1 2 3
and emotions?
8 Difficulty in recognising the emotions of others?
0 1 2 3
9 Dyslexia?
0 1 2 3
10 Severe difficulty in making arithmetical calculations (as
0 1 2 3
a result of brain disorder)?
11 Problems in recognising familiar people out of context?
0 1 2 3
12 Meltdowns or shutdowns: periods of intense emotional
upset, physical withdrawal from environment, fit like
0 1 2 3
episodes, reduction in verbal skills followed by intense
fatigue?
13 Auditory processing issues – problems in processing
0 1 2 3
and understanding spoken language?
14 Tics – involuntary movements of face or body?
0 1 2 3
Taken from:
Cynthia Kim (2013): “I Think I Might be Autistic: A Guide to Autism Spectrum Disorder and Self-Discovery for Adults”;
published by Narrow Gauge, USA. Added notes from DSM5 (American Psychiatric Assn 2013) recompiled by A D Cooke.

CLINICIAN VERSION 6 of 7 8/22

 ACTUAL DSM-5-TR CRITERIA SUMMARISED
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.
NO - NOT BETTER explained by intellectual disability YES - BETTER explained by intellectual disability
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 / WITHOUT

With or without accompanying language impairment: WITH / WITHOUT

Associated with a known medical or genetic condition or environmental factor: Y / N

(Coding note: Use additional code to identify the associated medical or genetic condition)

Associated with another neurodevelopmental, mental, or behavioural problem: Y / N

(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioural problem[s])

With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 135, for definition) Y / N
(Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of
the comorbid catatonia)

LEVEL OF SUPPORT ASSESSED AS REQUIRING:

Level 1 "Requiring support”; Level 2 "Requiring substantial support”; Level 3 "Requiring very substantial support”

Table 2 Severity Levels For Autism Spectrum Disorder

Severity
Social communication Restricted, repetitive behaviours
level
Without supports in place, deficits in social communication Inflexibility of behaviour causes
cause noticeable impairments. Difficulty initiating social significant interference with
interactions, and clear examples of atypical or unsuccessful functioning in one or more contexts.
Level 1 response to social overtures of others. May appear to have Difficulty switching between activities.
“Requiring decreased interest in social interactions. For example, a person Problems of organization and
support” who is able to speak in full sentences and engages in planning hamper independence.
communication but whose to-and-fro conversation with others
fails, and whose attempts to make friends are odd and typically
unsuccessful.
Inflexibility of behaviour, difficulty
Marked deficits in verbal and nonverbal social communication
coping with change, or other
skills; social impairments apparent even with supports in place;
Level 2 restricted/repetitive behaviours appear
limited initiation of social interactions; and reduced or abnormal
"Requiring frequently enough to be obvious to the
responses to social overtures from others. For example, a
substantial casual observer and interfere with
person who speaks simple sentences, whose interaction is
support” functioning in a variety of contexts.
limited to narrow special interests, and how has markedly odd
Distress and/or difficulty changing
nonverbal communication.
focus or action.
Severe deficits in verbal and nonverbal social communication Inflexibility of behaviour, extreme
Level 3 skills cause severe impairments in functioning, very limited difficulty coping with change, or other
"Requiring initiation of social interactions, and minimal response to social restricted/repetitive behaviours
very overtures from others. For example, a person with few words of markedly interfere with functioning in
substantial intelligible speech who rarely initiates interaction and, when he all spheres. Great distress/difficulty
support” or she does, makes unusual approaches to meet needs only changing focus or action.
and responds to only very direct social approaches

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