Which anecdotal observation regarding developmental milestones is most suggestive of autism spectrum disorder in a child being evaluated for FIIE?

• A. He learns to walk earlier than peers
• B. He engages in typical group play with peers
• C. He lines up all his toys every morning and becomes very upset if anyone touches them
• D. He speaks in complete sentences by 2 years old

Answer: (C)

The key idea is recognizing restricted, repetitive behaviors as a sign of autism spectrum disorder during a developmental evaluation. When a child lines up all of their toys every morning and becomes very upset if anyone touches them, that shows an insistence on sameness and ritualized activity. This social-communication difficulty often accompanies such repetitive patterns, and it tends to be more distinctive of autism than early motor milestones or typical social play alone.

In contrast, walking earlier than peers isn’t a diagnostic clue for autism, typical group play suggests better social engagement, and speaking in complete sentences by age two would be unusually advanced and not characteristic of the broader ASD pattern. So the observed ritualistic toy organization is the observation most consistent with autism in this context.