Which observation is most indicative of autism spectrum disorder in a child referred for an FIIE?

• A. Children never line up toys
• B. The child engages in rapid and varied pretend play with peers
• C. He lines up all his toys every morning and becomes very upset if touched
• D. The child has perfect eye contact in every setting

Answer: (C)

Observation of restricted and repetitive behaviors with a strong preference for sameness is a hallmark of autism spectrum disorder. In this case, lining up all the toys every morning shows a rigid routine, and becoming very upset if touched reveals sensory sensitivity and distress with changes to that routine. Children with autism often display insistence on sameness, ritualized patterns, and strong reactions to disruption, which helps clinicians identify autism during evaluation.

The other descriptions don’t fit as well: a child who never lines up toys lacks the clear pattern of ritualized behavior; someone who engages in rapid and varied pretend play with peers suggests flexible play and social interaction skills often not seen in autism; and perfect eye contact in every setting challenges common ASD profiles, where eye contact is frequently reduced or atypical.