Examkin

Soru

Zorluk: OrtaNormal Growth and Development

A parent brings their 24-month-old son to the pediatric clinic due to concerns about his language development. The parent states that the child says only five words, including 'mama' and 'dada', and primarily uses pointing to request items. He does not put words together to form phrases. The child is able to walk up and down stairs while holding onto the railing, kick a ball, and stack a tower of six blocks. He frequently brings books to his parent to read and engages in pretend play with a toy kitchen. He responds to his name consistently and follows simple commands. A routine screening for autism spectrum disorder performed today shows a low-risk profile. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?

  1. A
    Reassurance and follow-up at the next well-child visit
  2. B
    Referral for a comprehensive autism diagnostic evaluation
  3. Formal audiological evaluationCevap
  4. D
    Magnetic resonance imaging of the brain
  5. E
    Recommendation to expose the child to only one language at home

Cevap

Formal audiological evaluation
This 24-month-old boy presents with an isolated expressive language delay. By age 2 years, children are expected to have a vocabulary of at least 50 words and be capable of combining words into 2-word phrases. Since this patient only has a 5-word vocabulary, he requires further evaluation. The first and most crucial step in the workup of any childhood speech or language delay is a formal audiological evaluation to rule out hearing loss. This objective testing is required even if the parents believe the child hears well or if the child responds to his name, as mild or high-frequency hearing loss can easily be missed clinically but severely impact language acquisition.

Adım Adım Çözüm

1
Evaluate the child's developmental milestones based on his chronological age (24 months).
The child demonstrates age-appropriate gross motor (kicking a ball, using stairs), fine motor (building a 6-block tower), and social/cognitive (pretend play, joint attention) skills. However, his expressive language (5 words, no phrases) is severely delayed compared to the expected 50+ words and 2-word phrases.
Establishing which developmental domains are normal and which are delayed is essential to narrowing the differential diagnosis.
2
Determine the initial diagnostic algorithm for an isolated language delay in a toddler.
The primary mandatory step is to assess hearing to rule out an underlying sensory deficit.
Hearing loss is a common, reversible cause of speech delay and must be excluded with objective testing before pursuing other neurobehavioral etiologies, even if the child appears to respond to sounds or his name.

Anahtar Kavram

The initial evaluation of any childhood speech or language delay requires a formal audiological evaluation to rule out hearing loss.
Tahmini Süre:1m 15s
Bu soruyu puanla

Konular

Normal Growth and Development

Bu konudan daha fazla soru