# A nurse is conducting an assessment of a 3-year-old child suspected of having autism spectrum disorder (ASD). Which assessment finding would be most indicative of ASD in this child?

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## 문제

A nurse is conducting an assessment of a 3-year-old child suspected of having autism spectrum disorder (ASD). Which assessment finding would be most indicative of ASD in this child?

## 보기

1. The child demonstrates age-appropriate gross motor skills and can run and climb stairs independently
2. The child shows separation anxiety when the parent leaves the room and seeks comfort from familiar caregivers
3. The child avoids eye contact, does not respond to their name being called, and engages in repetitive hand-flapping behaviors **✔ 정답**
4. The child exhibits occasional temper tantrums when frustrated and has difficulty sharing toys with other children

**정답: 3**

## 해설

Core symptoms of ASD include deficits in social communication and interaction, and restricted/repetitive behaviors. Avoiding eye contact, not responding to name, and repetitive hand-flapping are classic early indicators. Other options describe typical developmental behaviors not specific to ASD.

## 심화 해설

Core Deficit in Autism Spectrum Disorder

The most indicative finding for ASD in a 3-year-old child is a cluster of impairments in social communication and the presence of restricted, repetitive patterns of behavior. The behavior described in option 3—avoiding eye contact, not responding to one's name, and engaging in repetitive hand-flapping—directly reflects these two core diagnostic domains. The practice parameter emphasizes that early identification hinges on recognizing these specific developmental deviations, as they are often present during the toddler years but may go unrecognized without appropriate screening [1].

Why Other Options Are Less Indicative

The other options describe behaviors that are either developmentally typical or non-specific in a 3-year-old.

| Option | Clinical Reasoning |
| --- | --- |
| 1. Age-appropriate gross motor skills | Motor skills are often a relative strength in children with ASD. The diagnostic criteria and screening recommendations focus on social and communicative deficits, not motor milestones, making this a non-specific finding that does not rule out or support an ASD diagnosis [1]. |
| 2. Separation anxiety and seeking comfort | This is a developmentally appropriate attachment behavior for a 3-year-old. While children with ASD can show atypical attachment behaviors, the presence of typical separation anxiety and comfort-seeking is not a defining feature of the disorder and is common in typically developing children [1]. |
| 4. Temper tantrums and difficulty sharing | These behaviors reflect typical toddler frustration and emerging autonomy. They are not specific to ASD. The key distinction is that the challenging behaviors in ASD are often driven by an inability to communicate needs or a disruption in rigid routines, not simply frustration over sharing [1]. |

Connecting to Early Intervention

The practice parameter strongly links early identification with improved outcomes through intensive early intervention during the toddler and preschool years. Recognizing a pattern of joint attention deficits, such as a failure to respond to one's name being called, and unusual motor mannerisms like hand-flapping is the critical first step. This knowledge allows the nurse to advocate for a comprehensive diagnostic evaluation, as routine developmental screening tools may not be sufficient to detect these specific autism-related impairments [1].

References (research sources)

- [1]Practice parameter: Screening and diagnosis of autismResearch articlePauline A. Filipek, Pasquale Accardo, Stephen Ashwal, Grace T. Baranek, Edwin H. Cook, Géraldine Dawson (2000) · DOI: 10.1212/wnl.55.4.468

## 임상 시나리오

ASD Red Flags in ToddlersCore social-communication and behavioral indicators
The hallmark of Autism Spectrum Disorder is a combination of impaired social communication and restricted/repetitive behaviors. Key findings include avoidance of eye contact, failure to respond to name by 12 months, and stereotyped movements like hand-flapping.

Motor skills are often a relative strength and are not part of the core diagnostic criteria. Typical separation anxiety is developmentally appropriate at age 3 and does not differentiate ASD from typical development.

CautionDo not rule out ASD based on the presence of motor skills or attachment behaviors. Rely on validated screening tools (e.g., M-CHAT-R/F) when these social-communication red flags are observed.

## 핵심 개념

- **Autism Spectrum Disorder (ASD)** — A neurodevelopmental disorder characterized by persistent deficits in social communication/interaction and restricted, repetitive patterns of behavior.
- **Stereotyped/Repetitive Motor Movements** — Simple motor stereotypies such as hand-flapping or finger-flicking, a core diagnostic feature of ASD under restricted/repetitive behaviors.
- **Joint Attention** — The shared focus of two individuals on an object, typically impaired in ASD, often manifesting as failure to respond to one's name or follow a point.

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