Repetitive vocalizations such as repetitive
guttural sounds, intonational noise‐making,
unusual squealing, repetitive humming
• Stereotyped or repetitive motor movements
o Repetitive hand movements (e.g., clapping,
finger flicking, flapping, twisting)
o Stereotyped or complex whole body movements (e.g., foot to foot rocking, dipping, & swaying;
spinning)
o Abnormalities of posture (e.g., toe walking; full body posturing)
o Intense body tensing
o Unusual facial grimacing
o Excessive teeth grinding
o Repetitively puts hands over ears (note: if response to sounds, consider B4)
o Perseverative or repetitive action / play / behavior (note: if 2 or more components, then it is a
routine and should be considered under B2)
o Repetitive picking (unless clear tactile sensory component, then consider B4)
• Stereotyped or repetitive use of objects
o Nonfunctional play with objects (waving sticks; dropping items)
o Lines up toys or objects
o Repetitively opens and closes doors
o Repetitively turns lights on and off
B2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance
to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress
at small changes).
• Adherence to routine
B2 includes rituals and
resistance to change
o Routines: specific, unusual multiple‐step
sequences of behavior
o Insistence on rigidly following specific
routines (note: exclude bedtime routines
unless components or level of adherence is
atypical)
o Unusual routines
• Ritualized Patterns of Verbal and Nonverbal Behavior
o Repetitive questioning about a particular topic (distinguish from saying the same word or phrase
over and over, which goes under B1)
o Verbal rituals ‐ has to say one or more things in a specific way or requires others to say things or
answer questions in a specific way
o Compulsions (e.g. insistence on turning in a circle three times before entering a room) (note:
repetitive use of objects,, including lining up toys, should be considered under B1).
• Excessive resistance to change
o Difficulty with transitions (should be out of the range of what is typical for children of that
developmental level)
o Overreaction to trivial changes (moving items at the dinner table or driving an alternate route)
• Rigid thinking
o Inability to understand humor
o Inability to understand nonliteral aspects of speech such as irony or implied meaning
o Excessively rigid, inflexible, or rule‐bound in behavior or thought