A 3-year-old girl is brought by her parents because she does not speak, avoids eye contact, engages in repetitive hand-flapping, lines up toys in precise rows, and becomes extremely distressed when her routine is changed. Hearing is normal. What is the most characteristic diagnostic feature of autism spectrum disorder that differentiates it from language disorder?
- A Persistent deficits in social communication and social interaction across multiple contexts ✓
- B Absence of any vocalisations or babbling
- C Hearing impairment on audiological testing
- D Intellectual disability as a mandatory co-feature
Explanation
Autism spectrum disorder is defined by persistent deficits in social communication and social interaction (not merely language delay) combined with restricted, repetitive patterns of behaviour, interests, or activities. Language disorder involves primary deficits in language acquisition and use without the broader social communicative impairments or repetitive behavioural features. Children with language disorder engage in reciprocal social interaction and do not show the restricted repetitive behaviours or sensory sensitivities of ASD. Intellectual disability may co-occur with ASD but is not a defining criterion.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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