Question 15  <br/>Adam is a 26-month-old boy referred by his pediatrician

for evaluation of speech delay. He has not spoken any intelligible words. Adam is an only child, and the parents deny any contributory medical history. Adam was delivered at 38 weeks 5 days’ gestation without complication. At 5 weeks of age he developed respiratory failure due to respiratory syncytial virus (RSV) and was hospitalized on a ventilator for several days; since then, the parents report only the occasional upper respiratory virus. They report that Adam is a ―really good‖ child and will often entertain himself for periods of time with his building blocks; rarely he will have a ―temper tantrum.‖ The parents confirm that Adam does not speak any recognizable words. While he does make sounds, his parents admit that he does not appear to be trying to communicate with them. When considering a diagnosis of autism spectrum disorder (ASD), the PMNHP would expect further history and examination to reveal:

A. The presence of imaginary play
B. A failed hearing test
C. Exaggerated response to minor injury
D. Notable decrease in attachment behaviors