Which of the following exemplifies a symptom of autism spectrum disorder?

The answer

A behavior that exemplifies a symptom of autism spectrum disorder (ASD) falls into one of its two DSM-5 core domains: (1) persistent deficits in social communication and social interaction, and (2) restricted, repetitive patterns of behavior, interests, or activities. On a multiple-choice question, the correct option describes something from one of these two domains — for example, avoiding or having difficulty with eye contact, echolalia (repeating words or phrases), hand-flapping or rocking, or an insistence on the same routine and distress at small changes.

Both domains must be present (per the DSM-5) for a diagnosis, and symptoms appear in the early developmental period, though they may not become fully apparent until social demands exceed the person's capacity.

Why the other options are wrong

Distractors on this kind of question usually describe symptoms of a different condition or normal behavior. Ruling them out:

• Sadness, low mood, loss of interest, or fatigue — these are symptoms of depression, not autism.
• Excessive worry, restlessness, or panic in social situations — this points to an anxiety disorder (or social anxiety), which is about fear of judgment rather than a core deficit in social communication.
• Inattention, hyperactivity, or impulsivity — these are hallmarks of ADHD. ADHD can co-occur with autism, but distractibility itself is not an ASD diagnostic criterion.
• Hallucinations or delusions — these are features of psychotic disorders like schizophrenia, not autism.
• Age-appropriate imaginative play and flexible, reciprocal conversation — these are typical development and the opposite of an ASD symptom.

The distinction between ASD and social anxiety trips many students up. In social anxiety, the person usually has the social skills but avoids interaction out of fear of embarrassment; in autism, the underlying social-communication ability itself is affected (reading cues, back-and-forth conversation, sharing interests), and it is present across settings from early childhood.

The bigger picture: the DSM-5 domains in detail

Domain 1 — Social communication and interaction deficits include: problems with social-emotional reciprocity (one-sided conversation, not sharing interests or emotions); deficits in nonverbal communication (poor eye contact, limited gestures or facial expression); and difficulty developing, maintaining, and understanding relationships (trouble with imaginative play, making friends, adjusting behavior to context).

Domain 2 — Restricted, repetitive behaviors require at least two of: stereotyped or repetitive motor movements, speech, or object use (lining up toys, echolalia, flapping); insistence on sameness and inflexible routines; highly restricted, fixated interests of abnormal intensity; and hyper- or hypo-reactivity to sensory input (indifference to pain, adverse response to sounds or textures).

Because it is a spectrum, presentation ranges widely in severity and support needs. Recognizing that a valid ASD symptom must come from these two domains — and not confusing it with depression, anxiety, ADHD, or psychosis — is exactly what the exam question is testing.