A toddler was recently diagnosed with autism spectrum disorder (ASD). The nurses teaches the family about the disorder. Which of the following behaviors does the nurse teach the family to expect as manifestations of ASD?

Rationale:

• House is older and currently undergoing renovations: Older homes commonly contain lead-based paint, and renovation activities can release hazardous lead dust into the home. A 2-year-old child is at the highest risk for hand-to-mouth ingestion and neurological vulnerability. Lead poisoning can occur even without visible symptoms and can cause irreversible cognitive, behavioral, and developmental impairment.
• Millie is very active and mimics her parents: High activity levels, pretend play, and imitation are expected developmental behaviors for a 2-year-old. These cues do not indicate a safety risk or developmental abnormality and instead reflect age-appropriate gross motor and social development.
• Millie is a picky eater who eats table foods: Picky eating is common at age 2 due to toddler autonomy, slower growth rate, and fluctuating appetite. While nutritional counseling is appropriate, it does not pose an immediate health danger compared to environmental toxin exposure.
• Millie sleeps in a toddler bed and shares a room with her 4-year-old sister: Both room-sharing and sleeping in a toddler bed are typical and safe arrangements for a child of this age when the sleep environment is childproofed. There is no direct safety hazard associated with siblings sharing a room.
• Medications and cleaning products stored in a high, locked cabinet: This storage method reflects appropriate household safety precautions that reduce the risk of accidental ingestion. Although poison control safety is important, the parent’s method shows good preventive practice.

Rationale:

A. A 3-year-old child who was diagnosed with autism spectrum disorder last month: A diagnosis of autism does not increase physiological risk for lead exposure. Risk depends on environmental factors such as housing age, contaminated soil, or parental occupations. Without exposure-related details, this child does not represent the highest likelihood of ingesting or absorbing lead.

B. A 4-year-old child whose parents work in the textile industry making yarn and cloth: Textile work does not typically involve significant lead exposure, unlike industries such as battery manufacturing, construction, or smelting.

C. A 2-year-old child who has a history of eating dirt: Toddlers with pica or frequent soil ingestion are at high risk because soil around older homes or contaminated areas may contain lead. Children at this age also absorb lead more efficiently and often explore the environment orally, greatly increasing their exposure potential through contaminated dust or soil.

D. A 6-year-old child in the 25th percentile for height and weight: Being small for age does not inherently increase risk of lead poisoning. Risk is more closely linked to environmental sources such as old paint, soil, water, and household renovations.