The nurse is assessing a 30-month-old child during a well-baby checkup. Which behaviors by the child would lead the nurse to suspect that the child has autism spectrum disorder? Select all that apply.

Autism spectrum disorder is a neurodevelopmental condition characterized by impaired social interaction, restricted behaviors, communication deficits, and sensory abnormalities. Early signs include limited eye contact, reduced affective reciprocity, repetitive behaviors, and resistance to environmental or routine variability. Rationale: A. Thriving on changes in routine is inconsistent with autism spectrum disorder. Children typically exhibit rigidity and distress with environmental variation. Preference for sameness and predictable patterns is characteristic, making adaptability to frequent routine changes unlikely in affected individuals. B. Avoidance of spontaneous play reflects impaired social and imaginative development. Restricted play patterns are common, with preference for repetitive or solitary activities. Lack of flexible, creative interaction indicates deficits in symbolic play and social engagement typical of autism spectrum disorder. C. Limited facial expressions toward others indicate reduced social reciprocity. Affective blunting manifests as diminished emotional expression and poor responsiveness to social cues. This deficit interferes with interpersonal communication and is a core feature of autism spectrum disorder. D. Rare eye contact is a hallmark early sign of autism. Eye gaze avoidance reflects impaired social attention and difficulty interpreting nonverbal cues. This behavior significantly affects bonding, communication development, and social interaction in young children. E. Answering questions verbally suggests preserved communication ability. Language delay may occur, but verbal responsiveness generally indicates more typical social communication skills and does not strongly support suspicion of autism spectrum disorder.