ASD EXAM QUESTIONS 2026/2027 | 100% Correct Answers
with Complete Solutions | Autism Spectrum Disorder
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Domain 1: DSM-5-TR Diagnostic Criteria (12 Questions)
Q1: A 5-year-old child demonstrates persistent deficits in social-emotional reciprocity
(rarely initiates social interactions, shows minimal interest in peers), nonverbal
communicative behaviors (limited eye contact, minimal use of gestures), and
developing, maintaining, and understanding relationships (difficulty adjusting behavior to
social contexts). The child also displays restricted interests in train schedules, repetitive
lining up of toys, and hyperreactivity to certain sounds. Which DSM-5-TR diagnostic
criterion is NOT explicitly required for an ASD diagnosis?
A. Symptoms must be present in the early developmental period
B. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning
C. The restricted and repetitive behaviors must include at least one motor stereotypy
D. The disturbances are not better explained by intellectual disability or global
developmental delay
Correct Answer: C
Rationale: The DSM-5-TR (2022) diagnostic criteria for ASD (299.00) require persistent
deficits in all three areas of social communication and interaction (Criterion A) AND at
least two of four manifestations of restricted, repetitive patterns of behavior, interests, or
activities (Criterion B). Criterion B includes: (1) stereotyped or repetitive motor
movements, use of objects, or speech; (2) insistence on sameness, inflexible
adherence to routines; (3) highly restricted, fixated interests; and (4) hyper- or
hyporeactivity to sensory input. A motor stereotypy is NOT required—any two of the four
manifestations suffice. Option A is required (Criterion C), Option B is required (Criterion
,D), and Option D is required (Criterion E for differential diagnosis). The child described
meets Criterion A and shows restricted interests (B3) and sensory hyperreactivity (B4),
satisfying diagnostic requirements without motor stereotypies.
Q2: According to DSM-5-TR, which specifier must be included in every ASD diagnosis
to indicate current symptom severity?
A. With or without accompanying intellectual impairment
B. With or without accompanying language impairment
C. Level 1, Level 2, or Level 3 severity for social communication and restricted repetitive
behaviors
D. Associated with a known genetic or medical condition
Correct Answer: C
Rationale: DSM-5-TR requires clinicians to specify current severity using three levels for
both "Social communication" and "Restricted, repetitive behaviors" domains: Level 1
(Requiring support), Level 2 (Requiring substantial support), and Level 3 (Requiring
very substantial support). This is mandatory for every diagnosis. While specifiers A, B,
and D are important clinical descriptors, they are not required in every case. The
severity levels help guide intervention intensity and educational planning. The separate
severity ratings acknowledge that social communication deficits and RRBs may not
align—an individual could be Level 2 in social communication but Level 1 in RRBs.
Q3: A 16-year-old with average intelligence has struggled with friendships throughout
school. He can engage in one-sided conversations about his special interest (computer
programming) but fails to recognize when others are bored. He interprets language
literally, misses sarcasm, and recently experienced severe anxiety when his class
schedule changed unexpectedly. He had early language delays but now speaks fluently.
What is the most appropriate DSM-5-TR diagnosis?
A. Social (Pragmatic) Communication Disorder
B. Autism Spectrum Disorder, Level 1
C. Autism Spectrum Disorder with catatonia
,D. Intellectual disability with social deficits
Correct Answer: B
Rationale: This presentation meets DSM-5-TR criteria for ASD: persistent deficits in
social-emotional reciprocity (one-sided conversations, failure to recognize social cues),
nonverbal communication (literal interpretation, missing sarcasm), and developing
relationships (lifelong friendship struggles). The insistence on sameness (anxiety about
schedule change) represents restricted/repetitive behaviors. The early language delay
with current fluent speech is consistent with ASD without accompanying language
impairment. Social (Pragmatic) Communication Disorder (A) is incorrect because it
cannot be diagnosed if restricted/repetitive behaviors are present—the schedule change
anxiety and potential circumscribed interests disqualify SCD. Catatonia (C) requires
specific motor symptoms (stupor, catalepsy, waxy flexibility) not described. Intellectual
disability (D) is ruled out by average intelligence. The Level 1 severity reflects that he
requires support but can function independently in some contexts.
Q4: Which statement accurately reflects DSM-5-TR changes regarding the diagnostic
criteria for Autism Spectrum Disorder compared to DSM-5?
A. DSM-5-TR added a new criterion requiring documented sensory processing
difficulties
B. DSM-5-TR clarified that symptoms may not fully manifest until social demands
exceed limited capacities
C. DSM-5-TR eliminated the requirement that symptoms cause clinically significant
impairment
D. DSM-5-TR requires onset of symptoms before age 24 months
Correct Answer: B
Rationale: DSM-5-TR (2022) retained all DSM-5 criteria but added important clarifying
text to Criterion C: "Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited capacities, or may
be masked by learned strategies in later life)." This change acknowledges
camouflaging/masking and delayed diagnosis in individuals with higher cognitive
, abilities or supportive environments. Sensory processing difficulties (A) were already
included in DSM-5 Criterion B4. The impairment requirement (C) remains essential.
While symptoms must be present early, DSM-5-TR explicitly does NOT require
recognition before 24 months (D)—the "early developmental period" is flexible and
recognizes that symptoms may only become apparent later when social complexity
increases.
Q5: A 3-year-old child shows deficits in joint attention, rarely responds to his name, and
engages in repetitive spinning. His pediatrician notes these behaviors but suggests
"watchful waiting" because the child makes occasional eye contact and the parents are
first-time and "anxious." According to DSM-5-TR diagnostic guidelines, what is the
critical error in this approach?
A. The child does not meet criteria because occasional eye contact excludes ASD
B. The child meets criteria but requires assessment of adaptive functioning before
diagnosis
C. The presence of core symptoms warrants comprehensive evaluation regardless of
parent characteristics or intermittent typical behaviors
D. ASD cannot be diagnosed before age 4 due to diagnostic instability
Correct Answer: C
Rationale: DSM-5-TR emphasizes that ASD diagnosis requires comprehensive
evaluation when core symptoms are present, regardless of confounding factors. The
child's joint attention deficits (foundational social communication impairment),
inconsistent response to name, and repetitive spinning represent clear diagnostic red
flags. "Watchful waiting" is contraindicated—early diagnosis enables early intervention
with critical neuroplasticity windows. Occasional eye contact (A) does NOT exclude
ASD; symptom presentation is heterogeneous and context-dependent. Adaptive
functioning assessment (B) informs specifiers but isn't required for diagnosis. ASD can
be reliably diagnosed by age 2 (D), with stability of diagnosis high after age 3. The
physician's attribution to parental anxiety represents diagnostic bias that delays critical
intervention.
with Complete Solutions | Autism Spectrum Disorder
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Domain 1: DSM-5-TR Diagnostic Criteria (12 Questions)
Q1: A 5-year-old child demonstrates persistent deficits in social-emotional reciprocity
(rarely initiates social interactions, shows minimal interest in peers), nonverbal
communicative behaviors (limited eye contact, minimal use of gestures), and
developing, maintaining, and understanding relationships (difficulty adjusting behavior to
social contexts). The child also displays restricted interests in train schedules, repetitive
lining up of toys, and hyperreactivity to certain sounds. Which DSM-5-TR diagnostic
criterion is NOT explicitly required for an ASD diagnosis?
A. Symptoms must be present in the early developmental period
B. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning
C. The restricted and repetitive behaviors must include at least one motor stereotypy
D. The disturbances are not better explained by intellectual disability or global
developmental delay
Correct Answer: C
Rationale: The DSM-5-TR (2022) diagnostic criteria for ASD (299.00) require persistent
deficits in all three areas of social communication and interaction (Criterion A) AND at
least two of four manifestations of restricted, repetitive patterns of behavior, interests, or
activities (Criterion B). Criterion B includes: (1) stereotyped or repetitive motor
movements, use of objects, or speech; (2) insistence on sameness, inflexible
adherence to routines; (3) highly restricted, fixated interests; and (4) hyper- or
hyporeactivity to sensory input. A motor stereotypy is NOT required—any two of the four
manifestations suffice. Option A is required (Criterion C), Option B is required (Criterion
,D), and Option D is required (Criterion E for differential diagnosis). The child described
meets Criterion A and shows restricted interests (B3) and sensory hyperreactivity (B4),
satisfying diagnostic requirements without motor stereotypies.
Q2: According to DSM-5-TR, which specifier must be included in every ASD diagnosis
to indicate current symptom severity?
A. With or without accompanying intellectual impairment
B. With or without accompanying language impairment
C. Level 1, Level 2, or Level 3 severity for social communication and restricted repetitive
behaviors
D. Associated with a known genetic or medical condition
Correct Answer: C
Rationale: DSM-5-TR requires clinicians to specify current severity using three levels for
both "Social communication" and "Restricted, repetitive behaviors" domains: Level 1
(Requiring support), Level 2 (Requiring substantial support), and Level 3 (Requiring
very substantial support). This is mandatory for every diagnosis. While specifiers A, B,
and D are important clinical descriptors, they are not required in every case. The
severity levels help guide intervention intensity and educational planning. The separate
severity ratings acknowledge that social communication deficits and RRBs may not
align—an individual could be Level 2 in social communication but Level 1 in RRBs.
Q3: A 16-year-old with average intelligence has struggled with friendships throughout
school. He can engage in one-sided conversations about his special interest (computer
programming) but fails to recognize when others are bored. He interprets language
literally, misses sarcasm, and recently experienced severe anxiety when his class
schedule changed unexpectedly. He had early language delays but now speaks fluently.
What is the most appropriate DSM-5-TR diagnosis?
A. Social (Pragmatic) Communication Disorder
B. Autism Spectrum Disorder, Level 1
C. Autism Spectrum Disorder with catatonia
,D. Intellectual disability with social deficits
Correct Answer: B
Rationale: This presentation meets DSM-5-TR criteria for ASD: persistent deficits in
social-emotional reciprocity (one-sided conversations, failure to recognize social cues),
nonverbal communication (literal interpretation, missing sarcasm), and developing
relationships (lifelong friendship struggles). The insistence on sameness (anxiety about
schedule change) represents restricted/repetitive behaviors. The early language delay
with current fluent speech is consistent with ASD without accompanying language
impairment. Social (Pragmatic) Communication Disorder (A) is incorrect because it
cannot be diagnosed if restricted/repetitive behaviors are present—the schedule change
anxiety and potential circumscribed interests disqualify SCD. Catatonia (C) requires
specific motor symptoms (stupor, catalepsy, waxy flexibility) not described. Intellectual
disability (D) is ruled out by average intelligence. The Level 1 severity reflects that he
requires support but can function independently in some contexts.
Q4: Which statement accurately reflects DSM-5-TR changes regarding the diagnostic
criteria for Autism Spectrum Disorder compared to DSM-5?
A. DSM-5-TR added a new criterion requiring documented sensory processing
difficulties
B. DSM-5-TR clarified that symptoms may not fully manifest until social demands
exceed limited capacities
C. DSM-5-TR eliminated the requirement that symptoms cause clinically significant
impairment
D. DSM-5-TR requires onset of symptoms before age 24 months
Correct Answer: B
Rationale: DSM-5-TR (2022) retained all DSM-5 criteria but added important clarifying
text to Criterion C: "Symptoms must be present in the early developmental period (but
may not become fully manifest until social demands exceed limited capacities, or may
be masked by learned strategies in later life)." This change acknowledges
camouflaging/masking and delayed diagnosis in individuals with higher cognitive
, abilities or supportive environments. Sensory processing difficulties (A) were already
included in DSM-5 Criterion B4. The impairment requirement (C) remains essential.
While symptoms must be present early, DSM-5-TR explicitly does NOT require
recognition before 24 months (D)—the "early developmental period" is flexible and
recognizes that symptoms may only become apparent later when social complexity
increases.
Q5: A 3-year-old child shows deficits in joint attention, rarely responds to his name, and
engages in repetitive spinning. His pediatrician notes these behaviors but suggests
"watchful waiting" because the child makes occasional eye contact and the parents are
first-time and "anxious." According to DSM-5-TR diagnostic guidelines, what is the
critical error in this approach?
A. The child does not meet criteria because occasional eye contact excludes ASD
B. The child meets criteria but requires assessment of adaptive functioning before
diagnosis
C. The presence of core symptoms warrants comprehensive evaluation regardless of
parent characteristics or intermittent typical behaviors
D. ASD cannot be diagnosed before age 4 due to diagnostic instability
Correct Answer: C
Rationale: DSM-5-TR emphasizes that ASD diagnosis requires comprehensive
evaluation when core symptoms are present, regardless of confounding factors. The
child's joint attention deficits (foundational social communication impairment),
inconsistent response to name, and repetitive spinning represent clear diagnostic red
flags. "Watchful waiting" is contraindicated—early diagnosis enables early intervention
with critical neuroplasticity windows. Occasional eye contact (A) does NOT exclude
ASD; symptom presentation is heterogeneous and context-dependent. Adaptive
functioning assessment (B) informs specifiers but isn't required for diagnosis. ASD can
be reliably diagnosed by age 2 (D), with stability of diagnosis high after age 3. The
physician's attribution to parental anxiety represents diagnostic bias that delays critical
intervention.
