# A nurse is assessing a 4-year-old child who has been referred for evaluation of possible autism spectrum disorder (ASD). Which assessment finding would be most characteristic of ASD?

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## 문제

A nurse is assessing a 4-year-old child who has been referred for evaluation of possible autism spectrum disorder (ASD). Which assessment finding would be most characteristic of ASD?

## 보기

1. Difficulty making eye contact and engaging in reciprocal conversation **✔ 정답**
2. Hyperactivity and difficulty sitting still during the assessment
3. Frequent temper tantrums when requests are denied
4. Difficulty following multi-step instructions

**정답: 1**

## 해설

Difficulty with eye contact and reciprocal conversation are core social communication deficits characteristic of ASD. Other options are common in various childhood disorders but not specific to ASD.

## 심화 해설

Core Deficit in Autism Spectrum Disorder

The question asks for the most characteristic finding of autism spectrum disorder (ASD) during an assessment of a 4-year-old child. The correct answer is 1. Difficulty making eye contact and engaging in reciprocal conversation. This choice directly reflects the primary diagnostic criteria for ASD, which center on persistent deficits in social communication and social interaction.

The foundational features of ASD are explicitly defined in the provided literature as "deficits in social interactions, reciprocal communication, and pragmatic language" [1] and "deficits in social communication and interactions as well as restricted, repetitive behaviors" [3]. Difficulty with eye contact is a classic nonverbal communicative behavior used for social interaction, and the inability to engage in reciprocal conversation is a direct manifestation of a social-emotional reciprocity deficit. These are not simply signs of shyness or a developmental phase; they represent a core neurological divergence in understanding and applying the unspoken rules of social engagement. For instance, research on conversational dynamics reveals that autistic speaker pairs exhibit "consistently longer silent gaps" during turn-taking [4], a subtle but measurable breakdown in the fluid, reciprocal timing that characterizes typical conversation. This provides a mechanistic insight into why a child with ASD might not engage in the expected back-and-forth flow of a conversation, even if they have developed some verbal language.

The other options describe behaviors that, while potentially present in a child with ASD, are not the most defining or characteristic features. Hyperactivity and difficulty sitting still (Option 2) are hallmark symptoms of attention-deficit/hyperactivity disorder (ADHD), which is a distinct neurodevelopmental condition. A published case report highlights a child whose initial ASD diagnosis was later deemed no longer applicable after his underlying ADHD and severe mood dysregulation were treated, demonstrating that these symptom profiles can overlap and be mistaken for one another [3]. Frequent temper tantrums when requests are denied (Option 3) point more toward oppositional defiant disorder or a general difficulty with emotional regulation, which can be a feature of mood disorders. Difficulty following multi-step instructions (Option 4) is often associated with a receptive language disorder or the inattention seen in ADHD, rather than being a primary social-communication deficit. The NCLEX-RN examination will frequently test your ability to differentiate the core symptoms of ASD from those of other common pediatric conditions like ADHD, language disorders, and behavioral disorders, making this a critical distinction to master.References (research sources)

- [1]AVATA Cure Digital Therapeutics for Social Communication in Children With Autism Spectrum Disorder: A Pilot Clinical Trial.RCT/clinical trialKim M, Lee J, Kim M, Kim J, Park H, Yang S, Yoon H, Chang J, Chung M, Jung YK, Hong SH, Kim HJ, Choi TK. (2026) · DOI: 10.30773/pi.2025.0354

- [3]Autism and Its Lookalikes: A Case Report of a Child Whose Autism Diagnosis No Longer Fit Years Later.Case reportKim E, Hong JS. (2026) · DOI: 10.1155/crps/8279416

- [4]Consistently longer silent gaps in autistic speaker pairs across three conversational contexts.Research articleWehrle S, Spaniol M, Vogeley K, Grice M. (2026) · DOI: 10.1038/s41598-026-53132-z

## 임상 시나리오

Recognizing Core Social Deficits in ASDKey assessment findings for early identification
The hallmark of autism spectrum disorder is persistent deficits in social communication and social interaction. In a young child, this manifests as reduced sharing of interests, difficulty with back-and-forth conversation, and abnormal nonverbal communication.

Assess for a lack of eye contact and deficits in social-emotional reciprocity. The child may not initiate or respond to social interactions, and conversational turn-taking may feature consistently longer silent gaps.

CautionDo not mistake core social deficits for simple shyness or a language delay. Isolated hyperactivity or tantrums are not specific to ASD; focus on the quality of reciprocal engagement.

## 핵심 개념

- **Reciprocal Conversation** — A back-and-forth, two-way exchange of communication involving shared topics, turn-taking, and appropriate responses, which is often impaired in ASD.
- **Social-Emotional Reciprocity** — The ability to engage in shared social interactions, including initiating or responding to social overtures, a core deficit area in ASD.
- **Pragmatic Language** — The social use of language, including understanding context, non-literal meanings, and conversational rules, often challenging for individuals with ASD.
- **Restricted/Repetitive Behaviors** — A diagnostic criterion for ASD encompassing stereotyped movements, insistence on sameness, fixated interests, and sensory sensitivities.
- **Neurodevelopmental Disorder** — A group of conditions with onset in the developmental period, characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.

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