Concerns about diagnostic criteria C for ASD and CD

Some concerns with diagnostic criteria C for Autism Spectrum Disorder and Social (Pragmatic) and other Commutation Disorders

Diagnostic criteria for Autism Spectrum Disorder:

A. Persistent deficits in social communication and social
interaction across multiple contexts, as manifested by all of
the following, currently or by history (examples are illustrative,
not exhaustive; see text):

1. Deficits in social-emotional reciprocity, ranging, for
example, from abnormal social approach and failure of
normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or
respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for
social interaction, ranging, for example, from poorly
integrated verbal and nonverbal communication; to
abnormalities in eye contact and body language or deficits
in understanding and use of gestures; to a total lack of
facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding
relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to
difficulties in sharing imaginative play or in making friends;
to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or
activities, as manifested by at least two of the following,
currently or by history (examples are illustrative, not
exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of
objects, or speech (e.g., simple motor stereotypies, lining
up toys or flipping objects, echolalia, idiosyncratic
phrases).

2. Insistence on sameness, inflexible adherence to routines,
or ritualized patterns of verbal or nonverbal behavior (e.g.,
extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to
take same route or eat same food every day).

3. Highly restricted, fixated interests that are abnormal in
intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).

4. Hyper- or hyporeactivity to sensory input or unusual
interest in sensory aspects of the environment (e.g.,
apparent indifference to pain/temperature, adverse
response to specific sounds or textures, excessive
smelling or touching of objects, visual fascination with
lights or movement).

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).

D. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual
developmental disorder (intellectual disability) or global
developmental delay. Intellectual developmental disorder and
autism spectrum disorder frequently co-occur; to make
comorbid diagnoses of autism spectrum disorder and
intellectual developmental disorder, social communication
should be below that expected for general developmental
level.

Diagnostic criteria for Social (Pragmatic) and other Communication Disorders:

A. Persistent difficulties in the social use of verbal and nonverbal
communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such
as greeting and sharing information, in a manner that is
appropriate for the social context.

2. Impairment of the ability to change communication to
match context or the needs of the listener, such as
speaking differently in a classroom than on a playground,
talking differently to a child than to an adult, and avoiding
use of overly formal language.

3. Difficulties following rules for conversation and storytelling,
such as taking turns in conversation, rephrasing when
misunderstood, and knowing how to use verbal and
nonverbal signals to regulate interaction.

4. Difficulties understanding what is not explicitly stated (e.g.,
making inferences) and nonliteral or ambiguous meanings
of language (e.g., idioms, humor, metaphors, multiple
meanings that depend on the context for interpretation).

B. The deficits result in functional limitations in effective
communication, social participation, social relationships,
academic achievement, or occupational performance,
individually or in combination.

C. The onset of the symptoms is in the early developmental
period (but deficits may not become fully manifest until social
communication demands exceed limited capacities).

D. The symptoms are not attributable to another medical or
neurological condition or to low abilities in the domains of
word structure and grammar, and are not better explained by
autism spectrum disorder, intellectual developmental disorder
(intellectual disability), global developmental delay, or another
mental disorder.

Concerning about diagnostic C for Autism Spectrum Disorder

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).

Although Autism Spectrum Disorder is a neurodevelopmental disorder, but if the symptoms of Autism Spectrum Disorder do not become fully manifested until social demands exceed limited capacity or masked by learned strategies later in life, how are family members and mental health professionals supposed to know about childhood history? What if your family members stopped having good memories about your childhood?

What if you have Autism Spectrum Disorder, but the symptoms did not manifest until older adolescents or adulthood? How are family members and mental health professionals supposed to spot those symptoms behaverly from childhood, if it didn't manifest until later in life?

The problem is that Autism Spectrum Disorder is diagnosed based on behavioral symptoms. The question is if you can have the same brain patterns of Autism Spectrum Disorder without showing obvious symptoms of Autism Spectrum Disorder.

To diagnose Autism Spectrum Disorder that did not manifest until later in life, even if without enough childhood history, is to rule out other neurological disorders that has similar symptoms, and if those neurological disorders are ruled out, then ask a patent what is going on with their mind, the patent without obvious behaviors of Autism Spectrum Disorder will tell you that social rules became too complicated for him or her to follow and that he or she masked diagnostic criteria B for Autism Spectrum Disorder, and that it causes them clinically significant impairment in social, occupational, or other important areas of current functioning.

Concerned about diagnostic criteria C for Social (Pragmatic) and other Commutation Disorders

C. The onset of the symptoms is in the early developmental
period (but deficits may not become fully manifest until social
communication demands exceed limited capacities).

I have similar concerns about diagnostic criteria C for Social (Pragmatic) Communication Disorder. Although Social (Pragmatic) and other Communication Disorders are neurodevelopmental disorders, what if the symptom of Social (Pragmatic) and other Communication Disorders did not fully manifest until social communication exceed limited capacities? How are family members and mental health professionals supposed to know about childhood history? What if the symptoms of Social (Pragmatic) and other Communication Disorders did not manifest until older adolescents or adulthood? How are family members and mental health professionals supposed to know about childhood history?

To know if a person has Social (Pragmatic) and Other Communication Disorders that did not manifest until later in life, even without enough childhood history, is to rule out neurological disorders that causes similar symptoms, and of those neurological disorders are ruled out, the patent can say that thay meet diagnostic criteria for Social (Pragmatic) or other Communication Disorders that did not manifest until later in life and it causes him or her deficits that result in functional limitations in effective
communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.

My other concern is that diagnostic criteria for Autism Spectrum Disorder and Social (Pragmatic) and other Communication Disorders has some gender bias. I did a research from DSM-5-TR that most women are four more times less likely to be diagnosed with Autism Spectrum Disorder than men, and that most woman with Autism Spectrum Disorder have fewer obvious symptoms or mask better and tend to socialize better.