Which of the following is NOT a cluster A symptom of DSM-5 Autism Spectrum Disorder?

• A. Social-emotional reciprocity
• B. Nonverbal communicative behaviors used for social interaction
• C. Difficulty developing, understanding, and maintaining relationships
• D. Insistence on sameness

Answer: (D)

The key idea is separating the two symptom domains used for autism spectrum disorder in DSM-5: deficits in social communication and interaction (cluster A) versus restricted and repetitive behaviors (cluster B). The three items that describe social-emotional reciprocity, nonverbal communicative behaviors for social interaction, and developing, maintaining, and understanding relationships are classic examples of cluster A deficits. The item about insisting on sameness reflects rigidity in routines and repetitive patterns, which belongs to the restricted and repetitive behaviors domain (cluster B). So, while rigid

routines and insistence on sameness are relevant to autism, they are not cluster A symptoms.