This document is a non-working example of a set of exploratory questions to help identify autistic traits and co-occurring conditions in children of primary school age.

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Human communication is the process by which people exchange mutually-understood information and influence one another. It is made possible through the use of language, the diverse system of sounds, gestures, or symbols acquired through learning.

The different types of language are
  • spoken language, the verbal way of sharing information with others which uses the voice to produce sound patterns and tones, which are the variances in the sound used to express emotion.
  • written language, a nonverbal way of sharing information with others using
    • a visual sequence of symbols to represent spoken language as marks on a medium such as paper or a screen
    • a non-visual touch system of communication for people who are blind, in which blocks of raised dots represent letters of the alphabet, numbers, punctuation marks and special characters.
  • sign language, a visual but nonverbal way of communication for people who are deaf, nonspeaking or nonverbal, in which information is shared using hand gestures, facial expressions, and body language.
Compared to a typical child of similar age how would you describe your child's ability to understand and comprehend the language they hear or read?


Human speech can be described as the use of the voice to create sounds that communicate thoughts as spoken words from within a language in such a way as to convey meaningful messages.

Speech is a complex set of skills that combinesThe essence of a person's speaking involvesAlthough each child will develop their speech and language skills at their own rate, there are typical communication milestonesCompared to a typical child of similar age how would you describe your child's ability to express their thoughts in spoken words in a way that an everyday user of the same language could comfortably understand?


The combined skills associated with the ability to communicate with other people in an appropriate way are the foundation of comfortable social interaction. This includes what we say, how we say it, our facial expressions and body language, and how appropriate our interactions are in a given situation.

Pragmatic language has three major skills associated with itNon-verbal pragmatic skills that are vital for successful social communication includePragmatic skills can be poorly developed or absent in autistic children and can lead to the child unintentionally causing offense when none was meant by being seen as rude, defiant, disrespectful, or insubordinate.

Compared to a typical child of similar age how would you describe your child's ability to adapt their combined use of language and style of speaking to correctly suit the social context?


Autistic children will often think, listen, speak, read and write literally and logically. They may interpret words and phrases exactly as spoken, without realising that the expressions convey a hidden meaning that differs from their literal translation.

Examples includeCognitive ability can be impaired in autistic children and cause them to respond too literally, examples being

You say to your child “pull your socks up”, meaning to make an effort to improve their performance or behaviour, butYou say to your child “Hello, how has your day been?”You say to your child “What did you think you were doing!?”Compared to a typical child of similar age how would you describe your child's ability to recognise non-literal language, successfully interpret its true meaning, and respond in a way that was not oversimplified?

Conversation can be defined as a talk between two or more people in which thoughts, feelings, and ideas are expressed, information is exchanged, or questions are asked and answered.

When autistic and non-autistic people come together, confusion surrounding each others differing needs, expectations and styles of conversation can cause a communication breakdown on both sides.

An autistic child mightCompared to a typical child of similar age how would you describe your child's ability to engage in free-thinking conversation about a broadening range of subjects?

Autistic children may often ask a large number of literal questions, those being direct questions that require straightforward and readily understood answers and have no complex purpose or hidden agenda.

Persistant questions, such asRepetitive questions, where the child seems to become stuck in a thought loop and asks the same question over and over again, and the process can includeHow would you describe your child's ability to engage in conversation that was not dominated by them asking persistant or repetitive questions?

Talking in monotone describes speaking in a flat and unvarying way that sounds repetitive and disinterested from the speaker and dull and uninteresting to the listener.

Key features includeNormal flow of speech should be clear and fluent with the speaker conveying meaning without significant effort. It should be easily understood by a listener who speaks the same language and should not contain noticeable errors in articulation or language structure.

The speaker should be able toCompared to a typical child of similar age how would you describe your child's ability to inject natural rhythm and flow into their speech by using variations in pitch, tone, volume, speed, and pauses to emphasise certain words or ideas and convey meaning?

Echolalia, also known as parrot talk, is the unrequested repetition of vocalisations made by another person.

The speech repetition can be directed towards a particular person or non-person directed.

There are two major typesThe features of speech repetition can beThe purpose for the repetition can beHow would you describe your child's level of impairement from using spoken language that simply involved repeating other people's choices of words and tone?

Dysfluent speech patterns are any of a variety of breaks, irregularities, or nonsensical word variations that occur within the flow of otherwise fluent speech.

Stuttering or stammering, which is when the child knows exactly what they want to say but struggles physically to get the words out, and examples includeCluttering, which is when the child is unsure what they want to say and speaks at a rate that is too fast for them to cope with or for the listener to comfortably understand, and symptoms includeAtypical dysfluencies, for exampleHow would you describe your child's ability to talk in a way that was unimpaired by any aspect of dysfluent speech?

Children with autism may want to interact with others, but often lack the social skills to engage appropriately.

Social and emotional learning can be defined as the interrelated combination ofOther children may respond negatively to an autistic child's differences and subject them toWhen looking specifically at your child's social and emotional personal development, particular areas of focus areCompared to a typical child of similar age how would describe your child's level of social and emotional maturity?

Autistic individuals may have challenges with understanding and using nonverbal cues during social communication. As a result, they may suffer from below average and poorly integrated facial expressions and body language compared to what is seen as typical behaviour.

Examples of unconventional facial expressions during social interaction can includeExamples of unconventional body language during social interaction can includeCompared to a typical child of similar age how would you describe your child's overall ability to use integrated facial expressions and body language when involved in social interaction?

Social hierarchy can be thought of as the structured ranking of individuals based on social status, the position or rank assigned to a person in relation to the other people around them.

The ability to know and understand the concept of social hierarchy is something children are expected to learn as they grow into their environment and experience social interaction.

Autistic children can struggle with a basic understanding of hierarchical rules and see everyone as equal. This can cause particular problems in institutions that are clearly defined by hierarchy, such as schools.

How would you describe your child's ability to correctly identify and respond to any difference between their social status and that of the people they meet within the layered ranking of accepted social hierarchy?

Children with autism can have difficulty understanding the concepts of both physical space and personal boundaries. They can unwittingly approach another person then behave around them in a way that could be misinterpreted as invasive, aggressive or upsetting.

Markers can includeCompared to a typical child of similar age how would you describe your child's combined ability to respect and not invade other people's personal space?

Children with autism may struggle to understand abstract concepts or things they cannot see.

This can manifest itself asCompared to a typical child of similar age how would you describe your child's ability to wait patiently or without pushing in?

Empathy describes the ability to relate to other people on a deeper emotional level and it forms a vital part of social connectedness.

Cognitive empathy requires intellect and a conscious effort to try to understand another person's emotions and guess reasonably accurately what they are thinking or feeling and why.

Emotional empathy describes the ability to share another person's emotional experience and is sometimes described as “feeling what they feel”. It is typically founded on the person's individual experiences of similar emotions or situations, and examples includeCompared to a typical child of similar age how capable would you say your child was of quickly interpreting another person's body language and facial expressions, connecting with them on an emotional level, then responding in an appropriate way?

Social interaction is a dynamic and unpredictable sequence of social actions between individuals or groups. It can be a particularly intense and overstimulating experience for an autistic child.

Social anhedonia describes a significant lack of interest in social contact coupled to an obviously reduced ability to derive pleasure from social situations.

Symptoms includeSocial fatigue can occur after having engaged in full social interaction. The feelings can range from mild fatigue through to exhaustion and last from a few hours to days after the event has finished.

Causes can include

Markers can includeHow would you describe your child's approach to allowing regular social interaction to form a normal part of their everyday life?

Autistic children may not understand the concept of ownership and sharing so can have difficulty advancing from solitary play to partnered or group play. They may also have difficulty coping if their rules of play are not strictly followed by the other participants in the activity.

A child with autism may occasionally be amenable to parallel play, whereby they can engage in a solitary activity whilst being in the same room as others.

Given the choice they may prefer to engage in completely solitary activities that let them keep control and manage their feelings or avoid sensory overload and provide them with self-stimulation.

Compared to a typical child of similar age how would you rate your child for their willingness to engage in the social play and creative ideas of familiar adults and children within their own age group?

A child with autism may struggle to spontaneously create and participate in imaginative play, and symptoms can includeAutistic children may develop intense passions or obsessions with specific topics or activities, often surpassing what is considered typical or expected, and examples might includeConversely, autistic children can excel creatively with originial thought to produce ideas that are new and unique, and examples can include

Autistic children may also have the ability to remember detailed information for long periods of time. This can lead to superior performance in subjects that require memorisation, such as music, history, mathematics or the sciences.

Compared to a typical child of similar age how would you rate your child's creativity?

A child's ability to respond to their name is foundational in the evolution of complex communication skills and in learning to understand simple verbal instructions, such as those linked to recalling them from a dangerous situation.

An autistic child may not respond to their name being called, and reasons can includeHow would you describe your child's ability to respond appropriately when their name was called?

An autistic child may seem to avoid eye contact altogether or make fake eye contact, such as looking just above the other person's eyes or having a downcast gaze.

Any child might avoid eye contact for reasons such asFor an autistic child there can be significant additional complications, examples beingHow would you describe your child's willingness to make and maintain direct eye contact with another person when involved in social situations?

Joint attention is the coordinated act of two people concentrating on the same thing at the same time.

Examples includeHow would you describe your child's ability to pay attention to the same thing as the person they are interacting with at the same time?

Autistic children can struggle with cognitive inflexibility and find change or transition particularly challenging, especially if it is sudden or unplanned. They can be triggered to very high levels of anxiety and stress or shows of aggression if confronted with variation to their routines.

Markers can includeIn sensory-intensive environments the effort of trying to cope with the multiple aspects of change can trigger bolting or a meltdown, or contribute to multi-sensory overload or autistic burnout.

How would you describe the frequency and scale of any heightened emotional reactions by your child in response to changes to their familiar routines, rituals, or surroundings?

In sensory-intensive social environments the effort involved in trying to camouflage themselves can contribute to autistic burnout.

This question explores whether your child tries to avoid drawing attention to themself if they become involved with a group of people through the concealment by social camouflaging.

Example avoidant behaviours includeWhen involved in group social interaction, how often has your child gone to excessive and obvious lengths to avoid drawing attention to themselves?

For this question the point of focus could be a certain person the child comes into regular contact with or a particular character from social media, TV, films etc.

Costume play, also known as “cosplay”, can enable an autistic child to make social connections despite challenges with social interaction. Rather than actively hiding their autistic traits, cosplay can provide a way of camouflaging positively and encouraging self-acceptance.

This question explores whether your child's behaviour takes them excessively beyond cosplay or simple inspiration to consciously or subconsciouslyHow would you rate your child for becoming fixated on another person and excessively copying them?

This question explores whether your child feels a need to hide their special interests or fake enjoyment in the interests of others.

Examples can includeWhen involved in social interaction, how often has your child been known to intentionally hide their personal interests?

This question explores challenges your child might face with communication when trying to navigate social situations.

Difficulties with speech can includeDifficulties with behaviour can includeSocial indicators can includeWhen involved in social interaction, how often has your child been known to change their behaviour in an attempt to make themselves more socially acceptable to other people?

This question explores whether your child tries to supress self-soothing behaviour when presenting themselves for social interaction with other people.

Behavioural distortions can happen in formal situations, such as at school, and in informal situations, such as in the company of family or friends.

Examples can includeWhen involved in social interaction, how often has your child deviated from their natural behaviour in an apparent attempt to reduce or hide a known need to perform repetitive and oversimplified movements that fit a pattern of self-soothing?

This question explores whether your child tries to hide or control heightened or reduced sensory sensitivities when presenting themselves for social interaction with other people.

Examples of sensory suppression includeWhen involved in social interaction, how often has your child tolerated actions that are known to be uncomfortable or unnatural for them in an apparent attempt to reduce or hide their sensory sensitivities?

Physical affection is a commonly recognised way to help build relationships with expressions of love and support.

Affection hyposensitivity describes a reduced responsiveness to sensory stimulation caused by intimate touch and a consequent heightened need for physical affection, such asAffection hypersensitivity describes a heightened responsiveness to sensory stimulation triggered by affectionate intimate touch. Adverse reactions to physical affection can range from mild discomfort to severe distress or meltdowns, and symptoms can includeHyperalgesia causes a child to experience amplified pain from a normally painful stimulus, resulting in a pain response that is far more severe than would typically be expected.

Allodynia describes a condition in which a pain response is triggered by a stimulus that would not normally warrant it. Individuals with chronic pain conditions may experience increased pain and discomfort which can significantly impact sleep, mood, and overall quality of life.

The three types of allodynia areIn crowded sensory-intensive public environments, accidental physical touch or compressed personal space can trigger bolting or a meltdown, or contribute to multi-sensory overload or autistic burnout.

How would you describe your child's approach to participation in simple shows of physical affection?

Clothing hypersensitivity describes a heightened responsiveness to sensory stimulation caused by touch sensation associated with certain types of clothing or textures of cloth.

Examples includeReasons for negative behaviour surrounding clothing could includeHow would you describe your child's level of hostility towards being clothed or their aversion to certain cloth types?

Feeding and eating can present multiple challenges for an autistic child because of the heightened responsiveness to sensory stimulation caused by certain foods.

Examples can includeAdditional challenges can includeIt is also possible for an autistic child to develop avoidant restrictive food intake disorder, also known as ARFID, which can cause them to restrict their diet for reasons includingIn sensory-intensive environments such as busy restaurants or school cafeterias feeding and eating hypersensitivities can trigger a meltdown or contribute to multi-sensory overload or autistic burnout.

How would you describe your child's level of hostility towards foods that irritate or repulse them?

The complex skill of keeping clean combines multiple smaller skills and can overwhelm the senses of a child with autism, leading to below average personal hygiene.

Examples includeFor autistic children the process of developing a toilet routine can take longer than for a typical child and can involve some unique challenges, such asUnderdeveloped personal hygiene and toileting habits can have significant negative social implications as a child ages, and autistic children can also be prone toHow would you describe your child's ability to practice good personal hygiene and toileting habits in their daily life?

Interoception is the conscious and subconscious collection of senses that provide a person with information about the internal condition of their body and enables them to manage their physical and emotional states.

Markers of reduced interoceptive awareness can includeHow would you describe your child's ability to recognise physical or emotional changes within themselves and act on them?

Proprioception is the body's ability to sense its position, movement, and orientation in space and provide the brain with the information it needs to coordinate movements, maintain balance, and navigate the surrounding environment effectively.

Proprioceptive dysfunction can be caused by the heightened sensory processing challenges attached to sensory input related to body position and movement.

Reduced proprioceptive ability can lead to difficulty with motor skills, such asIn some autistic children the vestibular system, located in the inner ear and used to help maintain balance and body position in space, may be oversensitive to movement and balance cues.

Symptoms can includeHow would you describe your child's ability to coordinate and control their movements and maintain balance?

Sensory hypersensitivity describes over-responsiveness to sensory stimulation and this question focuses specifically on sounds or noise and certain light types or colours.

Auditory hypersensitivity can lead toMisophonia, a disproportionate emotional reaction to certain everyday sounds that should be relatively easy to filter out, is often triggered byLigyrophobia is a fear of devices and activities that can suddenly emit loud sounds, such as speakers or fireworks.

Visual hypersensitivity can be triggered by environmental factors such asSymptoms can includeMulti-sensory overload occurs when more than one sense is over-stimulated simultaneously and the brain's capacity to sort through and process the resulting stream of information is exceeded in sensory-intensive environments such asSensory-intensive environments can lead to agoraphobia, a fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless.

How would you describe your child's level of hostility towards uncomfortable experiences that tested their auditory or visual senses?

Sensory hyposensitivity describes under-responsiveness to sensory stimulation and a consequent need to increase sensory input from the environment.

Symptoms can includePatient ratings of pain intensity and pain duration are fundamental to clinical assessments of pain but they can be distorted by atypical pain presentations associated with autism. Suffering can be unintentionally overlooked or underestimated leading to difficulties with appropriate diagnosis and treatment.

How would you describe your child's heightened need for additional sensory stimulation from the world around them?

Autistic children may engage in repetitive self-soothing actions, also known as self-stimulation or “stimming”, to regulate their emotions, cope with overwhelming situations, or stimulate their senses.

The form and frequency varies between individuals, but examples can includeHow would you describe any visible uncontrolled urges your child displayed to perform repetitive and oversimplified movements that fit a pattern of self-soothing?

Elopement by wandering describes a situation where an autistic child sets off unnoticed, without permission, warning or appropriate supervision, on a whim or quest in search of sensory stimulation.

Examples of wandering includeHow would you describe the consequences of your child's attempts to experience sensory stimulation by wandering off?

Emotional dysregulation describes the inability to control the intensity of stress reactions to everyday changes and events, resulting in habitually excessive negative behaviours that are out of proportion to the situation that triggered them.

Symptoms can includeAs a child ages, uninterrupted dysregulated emotions can become increasingly crippling and potentially lead toHow would you describe the intensity of your child's negative emotional reactions, particularly when faced with everyday changes and events?

The emotional bond formed by a child with an inanimate object as they grow and develop, such as a certain blanket, toy, or item of clothing, can provide a sense of comfort, continuity and security. Over time, the child should naturally outgrow the need for them.

Children with autism may exhibit a more intense and enduring attachment to such objects and, particularly in times of distress, assign emotional feelings to those objects as a way of processing and describing their own emotions.

Examples includeWhen faced with explaining how they feel, how often has your child referenced an inanimate object as feeling a certain way instead of themselves?

If a child externalises their emotions, it means they express them outwardly, typically with behavioural excess.

The externalised distress spectrum is highly visible and includes a variety of disinhibited behaviours, such asAn autistic child might also develop a habit of swearing or becoming verbally abusive, and reasons can includeHow would you describe the level of interference on your child's daily functioning and emotional wellbeing of excessive shows externalised of emotion?

Hyperactivity, translated as “above normal activity”, describes the inability to control excess body movement in such a way as is appropriate for the setting, especially in calm or quiet surroundings. When applied to a child, the focus is on behaviour that cannot readily be explained away as youthful high energy, such asNeurodivergent children can be prone toWhen answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, includingHow would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to control their body movements and keep their activity levels within generally-accepted limits?

For this question you are looking at your child's ability to focus, pay attention, or put effort into tasks that similarly-aged neurotypical children should find achievable.

Symptoms of attention deficit can includeADHD paralysis refers to the inability to start, sustain, or complete tasks due to overwhelming feelings of anxiety and stress or mental fatigue.The child may experience difficulty in one or more of the above categories at any time, depending on the situation.

Markers can includeWhen answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, includingHow would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to maintain focus, pay attention, or put effort into tasks when expected to?

Symptoms of impaired organisational abilities can includeWhen answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, includingHow would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to organise their time and activities?

Hyperverbal speech, translated as “above normal word use”, describes the disrupted regulation of speech and thought processes in the brain resulting in a flow of speech that is difficult to follow or engage with in conversation.

Types of hyperverbal speech includeHyperverbal speech can severely impair the use of speech as an effective form of communication and adversely impact social interaction.

When answering this question it is particularly important that you take an interconnected view of your child's behaviour across all of the environments they may have encountered, includingHow would you describe the level of interference on your child's daily functioning and emotional wellbeing of an inability to control excessive verbal output and keep their talking within generally-accepted limits?

Sleep is a critical component of mental and physical health. Sleep-wake disorders can be both a symptom of and a trigger for mood disorders, so creating a cycle of negative impact.

Common symptoms includeSleep apnoea is a disorder which causes breathing to repeatedly stop and start during sleep, and additional symptoms includeCircadian rhythm disorders are conditions that disrupt the body's natural sleep-wake cycle, the circadian rhythm, and affectSleep disturbances can also be linked to additional serious complications such as an increased risk or worsening of certain medical conditions and difficulties with learning and concentration.

How would you rate the impact of disturbed sleep patterns on your child's ability to function?

Anxiety is the internal emotional and physical state that involves persistent worry and a prolonged, internal feeling of apprehension or dread around imminent or imagined future events that can persist even without a clear cause and can interfere with daily life.

Cognition is the umbrella term for how the brain takes in, processes, and makes sense of information to interact with and understand the world and visible symptoms of cognitive anxiety can includeSomatic relates to the body and physiological refers to its normal functions, processes, and mechanisms. Somatic anxiety describes the physiological response to cognitive anxiety and symptoms can be single, multiple or varying and range from mild to severe, and can includeSevere anxiety can also increase the risk ofChildren may self-harm in private and the warning signs may not always be obvious, but more visible ones includeHow would you describe the impact of known episodes of mental anxiety or anxiety-driven physical stress on your child's daily functioning?

Depression differs from occasional sadness through being a prolonged mental state typified by low mood and an aversion to activity that significantly interfere with daily life.

Symptoms can includeIf a child internalises their emotions they suppress their feelings, try to avoid talking about them or deny the way they feel. The internalised distress spectrum can be difficult to observe and children may self-harm in private. The warning signs may not always be obvious, but more visible ones can includeAs a child who is predisposed to depression grows older they may become increasingly drawn toVisible warning signs that a child might be severely depressed or at increased risk of suicide can includeTo what extent has your child's known behaviour been typified by low mood, a loss of pleasure or interest in people or pursuits they used to enjoy, and an aversion to activity?

A phobia is an irrational reaction to a non-existant danger that leads to a fear response.

In autistic children these phobias can go beyond common childhood fears into the unusual, examples beingAlso take into account the level of everyday adaptation required to ensure that your child is protected from their phobias.

How would you describe the visibly heightened pattern of emotional distress that your child has suffered as a result of exposure to any of their phobias?

Situational mutism can cause a child who can speak freely at home and with family to become nonverbal in public settings, particularly around strangers or people in authority, possibly to the point of becoming paralysed with fear or shutting down completely.

Symptoms can include

Situational mutism is indicative of a very high level of anxiety.

How would you describe your child's ability to cope when faced with having to openly verbally communicate in a public setting or with people they are unfamiliar with?

Elopement by bolting describes the sudden act of running off, when an autistic child instinctively tries to escape from situations that they find immediately frightening or overwhelming.

Examples of bolting includeTriggers for bolting can includeHow would you describe the consequences of your child's attempts to escape from overstimulating situations by bolting?

A meltdown is an involuntary and uncontrolled response whereby difficulty with sensory processing triggers a nervous system overload.

There are three main phases to an autism meltdownMeltdowns are distinctly different from temper tantrums, which are brief purpose-driven episodes of largely deliberate extreme behaviour in response to frustration or anger at not getting or being allowed to do something. Whereas a tantrum will typically subside when the child is either rewarded or realises that their behaviour is pointless, after a meltdown individuals cannot usually respond to standard calming techniques and recovery takes an extended period of time.

How would you describe the visible negative impact of meltdowns on your child's ability to function?

Catatonia is a psychomotor disorder that creates a state in a person whereby they are awake but lose responsiveness to environmental stimuli, the things happening around them that should trigger a response, and exhibit a dramatic change in bodily movement from previous behaviour.

Symptoms may come and go and may become more or less intense. A catatonic state can last from a few hours to weeks, months, or years and can reoccur frequently for weeks to years after the initial episode.

Akinetic catatonia causes a person to appear slowed down, and symptoms can includeHyperkinetic catatonia causes a person to appear restless and agitated, with symptoms includingMalignant catatonia disrupts the autonomic nervous system which controls vital body processes such as breathing and heartbeat. It can be potentially fatal without urgent professional medical attention, and symptoms includeHow much of their time has your child spent seemingly trapped within themselves, displaying significant distortion of reactions and responses, bodily movement and speech?

A shutdown is a quietly-expressed involuntary and uncontrolled response whereby difficulty with sensory processing triggers a nervous system overload and the individual is totally emotionally overwhelmed then withdraws mentally and physically.

Example behaviours includeA shutdown will continue until the child feels able to cope again and, once the initial shutdown lessens, they may show signs of exhaustion, confusion, or detachment. A shutdown can follow a meltdown if exhaustion reaches crisis level.

How much of their time would you say your child spent in a state of emotional and physical shutdown?

Neurodivergent fatigue occurs after the body's mental, sensory, and physical resources are overworked for an extended period of time. If the fatigue continues uninterrupted it will lead to burnout, a state of physical, mental, and emotional exhaustion following a chronic episode of severe stress and frustration.

Reasons includeMarkers includeHow much of their time would you say your child spent in a state of emotional and physical exhaustion?

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