A 6-year-old boy has difficulty making friends and problems with initiating and sustaining back-and-forth conversation. He also has trouble reading social cues and sharing his feelings with others. He has a range of affect that generally seems appropriate to the situation, makes good eye contact, displays appropriate facial gestures, and has normal speech intonation. He demonstrates an interest in space ships that seems abnormally excessive in intensity and focus. He engages in little imaginative play. Which of the following diagnostic requirements for autism spectrum disorder are NOT met in this case?

Choice A reason: The boy exhibits difficulties in social interaction and restricted interests that are observable in early childhood, indicating that symptoms with onset in early childhood that cause clinically significant impairment are present. Choice B reason: The child demonstrates clear difficulties with initiating and sustaining reciprocal social interactions, which aligns with deficits in social-emotional reciprocity. Choice C reason: Despite social interaction difficulties, the boy shows appropriate eye contact, facial expressions, and speech intonation. These behaviors indicate that deficits in nonverbal communicative behaviors used for social interaction are not present in this case, which is why this diagnostic requirement is not met. Choice D reason: The child struggles with making friends and sharing feelings, reflecting difficulties in developing and maintaining relationships, which supports that this diagnostic requirement is present.