A nurse is interacting with a client. The client repeatedly shrugs and yells out random words. The nurse recognizes that this finding is associated with which of the following disorders?

Choice A reason: Autism spectrum disorder is characterized by deficits in social communication and restricted or repetitive behaviors. Although repetitive movements can occur, involuntary vocalizations and sudden utterance of random words are not typical core features of ASD. Choice B reason: ADHD is associated with inattention, impulsivity, and hyperactivity. While impulsive speech may occur, it does not include involuntary motor and vocal tics such as repeated shrugging and shouting random words. Choice C reason: Expressive language disorder involves difficulty expressing thoughts verbally using appropriate words and sentences. It does not involve involuntary vocal outbursts or motor tics. Choice D reason: Tourette syndrome is a tic disorder characterized by the presence of both multiple motor tics and at least one vocal tic. Repeated shrugging represents a motor tic, and yelling out random words represents a vocal tic, making this the correct association.