Triad of Impairments

The triad of impairments concept originated in the late 1970s to understand challenges facing those with autism, but has undergone revision. In DSM-5, the triad changed to a dyad of impairments: social and communication deficits are now seen as inseparable (two into one). The dyad is impaired social interaction and repetitive behavior. In this newer thinking, there’s a shift from behaviors to underlying cognition, making further revisions likely. The original triad describes the following areas of difficulty: 

• Social interaction, in understanding social rules, behavior, and relationships, taking turns or engaging in reciprocal conversation, maintaining eye contact
• Social communication, spectrum from delayed/limited speech to nonverbal. If verbal, may struggle with pragmatic language skills (understanding sarcasm, using appropriate tone of voice). May also not fully understand nonverbal gestures/facial expressions.
• Restricted and repetitive behaviors (RRBs), repetitive movement, intense interest in narrow topics, obsessively strict routines, severe sensory sensitivities, limited interpersonal play/imagination