How common is AS?

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I like the DSM-V criteria. The seven criteria create a clear ASD profile: abnormalities in social-emotional reciprocity, non-verbal communication, relationships, stereotypy, routines and rituals, special interests, sensory perception. Five of seven criteria seems reasonable for diagnosis, because the criteria do tend to occur together in a person with ASD. ToM/social cognition deficits tend to contribute to all three social interaction criteria. Then, only two of the other four are required. Stereotypy can be stereotyped motor movements or stereotyped language. Special interests are key in ASD. Sensory issues are common. Many adults try to limit their routines and rituals, but most have a few that are more rigid than normal. Each criteria also allows for a reasonable range of manifestations, not just the most extreme, e.g. total lack of initiation of social interaction. The DSM-IV criteria seems like a bunch of autistic traits thrown together, but the DSM-V criteria creates a clear ASD profile. I don't know how it will affect the numbers of people diagnosed, but it seems that many people diagnosed with ASD will meet all seven criteria.

And my daughter has the motor stereotypy..but still wasn't diagnosed with Aspergers...I guess her points weren't elevated in the social communication category...she does well in groups, playing with other children...but then her eye contact and social reciprocity in conversation is extremely variable. All of this is just very confusing. In her report, the neuropsych wrote...

"The ADOS was used to formally assess her social interaction and communication style and to examine possible symptoms of Asperger's Disorder. Her overall score indicated that she displays some symptoms consistent with someone on the autism spectrum, and her scores fall at the level needed to meet the autism spectrum cut-off. Her communication scores were within normal limits, but her reciprocal interaction skills were in the elevated range She displayed frequent and repetitive hand flapping. Toe walking was also observed at times. Conversation was somewhat one-sided and she pursued conversational topics regardless of others' reactions or interest. she had difficulty with aspects of social communication and typical give and take in conversation. She often followed her own train of thought rather than participate in an interchange. Tone was rather flat. Eye contact was sometimes used to respond to social overturs, but she used poorly modulated eye contact to initiate, terminate, or regulate social interactions. She vocalized and reached for what she wanted but she did not integrate eye contact when requesting. Nevertheless, she reciprocated smiles and showed enjoyment in interaction. She asked many questions and frequently initiated interactions. She responded to her name the first time, engaged in joint attention, imitated appropriately, and adapted well to changing situations. She played with a variety of toys in a coventional manner and she engaged in imaginative play. She was very creative and pretended that a doll family was camping. She used an object as a placeholder (small blanket as a tent). She also participated in a pretend birthday party for a doll in a creative and engaging manner. She pretended it was a surprise birthday party and that everyone was drinking lemondade. Reciprocity was evident in play, but decreased during conversation. Nevertheless, she spontaneously sought to share activities and interests. She consistenly initiated interactions and maintained functional play. Overall she displayed features of someone on the autism spectrum, but not all scores were significantly elevated."

I can see why you are confused, Blueskygirl.

The ADOS report reads like, "ASD! No, not ASD! No, ASD! No, not ASD!"

Her motor stereotypy seems very obvious, so that would meet the RRB criteria for AS. But it seems like the psych thought her social interaction was too normal or borderline for AS. Hence, the watch-and-wait PDD-NOS diagnosis.

Restricted and repetitive behavior. Motor/language stereotypy, routines and rituals, and special interests fall under this category in the DSM.

Examining the ADOS report further, it seems to me that her pretend play and social reciprocity during pretend play were considered to be major factors against ASD. From this forum, my understanding is that many children with ASD do engage in pretend play. Pretend play is a task-positive activity. It is interesting and conducive to focus, so I can see how a child would display more social reciprocity during pretend play, especially if it required the participation of other people. Casual conversation, the dreaded smalltalk, is not a task-positive activity, so social reciprocity would be expected to drop to levels lower than those displayed during pretend play. From this perspective, the ADOS findings actually make some sense. A child with ASD displays reciprocity during a task-positive interesting activity, but less so during unfocused uninteresting interactions. Of course, this could be true for all children, but perhaps the difference would be more striking for a child with ASD.

An adult example of this is me smalltalking vs. me tutoring a student. Blithering idiot in the former case, and pretty smooth in the latter.

BTW, I am experiencing mega deja vu right now, as if I have written this exact post before.