Client: Michael Social Worker:


DSM-5-TR diagnosis: F84.0 Autism Spectrum Disorder, requiring very substantial support for social communication and interaction, requiring very substantial support for restricted repetitive behaviors and activities, with accompanying language impairment – lacking nonverbal and verbal communication skills ____________________________________________________________________________________

DSM-5-TR CRITERIA As evidenced by:
A) Persistent deficits in social communication and social interaction across multiple contexts: All 3 areas are met. (Page, 56)

1. Deficits in social-emotional reciprocity

2. Deficits in nonverbal communicative behaviors used for social interaction

3. Deficits in developing, maintaining, and understanding relationships

Michael has difficulties with communicating appropriately and following through with requests: Michael displays no social-emotional communication early on in the movie as seen when Michael gets to the facility (07:29-08:01) He’s introduced to his teacher who is also his communication therapist he demonstrates the lack of ability to communicate back and forth or to initiate a conversation

Michael lacked verbal and nonverbal communication skills when interacting with his parents and other individuals: (02:50-02:53) Michael is seen walking to the park and displaying interest in the sky, is seen walking into the streets, and is almost hit by a car. He shows no emotional response to the driver’s question “Hey kid what are you doing?” and did not make eye contact, and had deficits in imitation and fine motor skills

Michael lacked affection toward either of his parents while interacting with them, once they found him in the park (03.44-04:24) and also showed no eye contact

Michael exhibits excessive tantrums on several different occasions when he decided to grab his therapist by the hair (08:32-08:55) also when started to through tantrums when he became frustrated while working with his therapist (17:57-19:47)

B) Restricted, repetitive patterns of behavior, interests, or activities.

1. Stereotyped or repetitive motor movement, use of objects, or speech

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

3. Highly restricted fixated interests that are abnormal in intensity or focus

4. Hyper or hyperreactivity to sensory input or unusual interest in sensory aspects of the environment

Michael is excessively interested in magazines and a deck of cards exhibits inappropriate toy use such as trying to throw or bounce stationary objects: Michael shows frustration by throwing objects (14:36-14:49)

Michael has a very predictable daily routine: He stays at home with his mother and watches an excessive amount of television, mom states that he usually watches the credits at the end of the show (09:49-09:51) Mom also states that Michael prefers snacks most of the time and is the only way to get his attention. has a fixated interest/ strong attachment to hand cards and magazines for several minutes at a time, (05:49-06:04) demonstrates hand flapping throughout the entire movie it starts in the beginning as he walks out of the door he’s seen looking into the sky and decides to tap on the sofa, television as well as the door including hitting his-self in the face (01:21-01:59)

Michael for several minutes at a time excessive hand flapping (00.38-00:44)

c) Symptoms must be present in the early development


(11:19) Karen Michael’s mom stated that he started showing signs and was diagnosed at 2 y/o with autism. Karen also states (10:41-10:47) that Michael is currently in special education at his local school and finally later on the school admitted that they could no longer do anything more for Michael
D) Symptoms cause clinically significant impairment in social functioning Ruled out Rett syndrome, Selective mutism, language disorders, social communication disorders, IDD without autism spectrum disorder, stereotypic movement disorder, attention-deficit hyporeactive disorder, and schizophrenia.

As evidenced by Michael does not exhibit any appropriate communication skills, shows repetitive behaviors and interests, not excessively hyper, and has limitations in normal development not typical in schizophrenia.

(19:47-19:57) Michael has excessive tantrums, experiences distress when daily routines are changed, and is non-verbal, according to Michael’s therapist she asks that mom comply with the facility rules and stay away from the facility for 6 weeks, Therapist states to mom that every time she shows up Michael’s behavior changes and he becomes belligerent and uncooperative


E) These disturbances are not better explained by intellectual disability or global developmental delay Michael meets all of the criteria for Autism Spectrum Disorder, and he will require intensive and continued care as evidenced throughout the movie
Specify if:

* With or without accompanying intellectual impairment

* With or without accompanying language impairment

* Associated with a known medical or genetic condition or environmental factor

* Associated with another neurodevelopmental, mental, or behavioral disorder

* With catatonia

With accompanying language impairment – nonverbal and verbal communication skills


Omitting the known medical/genetic condition or neurodevelopmental, mental, or behavioral disorder. There was no evidence of any of these factors in this case. Michael may require additional assessments to address these


Specifiers: With accompanying language impairment – nonverbal and verbal communication skills, shows no abilities to engage in verbal or nonverbal communication


Severity: Michael meets Level 3, “Requiring very substantial support” of the severity level for Autism Spectrum Disorder. Michael exhibits inflexibility of behavior, extreme difficulty coping with changes in his daily routine, repetitive behaviors including, hand flapping, tantrums, gazing into the sky for several minutes at a time, lack of eye contact, and difficulties changing focus or action while interacting with his parents