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Zorluk: OrtaChildhood and Neurodevelopmental Disorders

During a routine health maintenance visit, the parents of a 24-month-old boy express deep concern that their son might have a neurodevelopmental disorder. They report reading online that toddlers should speak in complete sentences by age 2 and are worried because he only uses two-word phrases, such as "want juice" or "go out". His current vocabulary consists of approximately 60 words. The parents also mention that he occasionally has temper tantrums when transitioning from playtime to bedtime, during which he cries and drops to the floor. These episodes typically resolve within five minutes after redirection. On examination, the child makes appropriate eye contact, points to pictures in a book when named, and engages in pretend play with a toy telephone. He can run, kick a ball, and build a tower of six blocks. Which of the following is the most appropriate next step in management?

  1. A
    Referral for formal autism diagnostic assessment
  2. B
    Audiologic evaluation
  3. Reassurance and routine follow-upCevap
  4. D
    Initiation of speech and language therapy
  5. E
    Chromosomal microarray analysis

Cevap

Reassurance and routine follow-up
The correct answer is reassurance and routine follow-up because this child is exhibiting perfectly normal development for a 24-month-old.

Normal milestones at age 2 include:
DomainExpected Milestones at 24 Months
LanguageVocabulary of ≥50 words, uses 2-word phrases (noun + verb), speech is ~50% intelligible to strangers
SocialParallel play, pretend play, joint attention (pointing to share interest)
MotorRuns well, kicks a ball, walks up/down stairs (two feet per step)
Fine MotorBuilds a tower of up to 6 blocks, turns book pages
Joint attention and normal eye contact make autism spectrum disorder highly unlikely. Occasional, easily redirectable temper tantrums are a normal part of toddlerhood as children begin to assert their independence. Therefore, no further diagnostic workup is required.

Adım Adım Çözüm

1
Evaluate the patient's language milestones against developmental norms.
The child has a 60-word vocabulary and uses 2-word phrases, which meets and slightly exceeds the 24-month milestone expectations.
To determine if there is an objective language delay justifying the parents' concerns.
2
Assess the patient's social and behavioral presentation.
The child exhibits joint attention (pointing), pretend play, and brief, easily redirectable temper tantrums.
To screen for core features of autism spectrum disorder (which would present with social deficits) or significant behavioral pathologies.
3
Synthesize findings to determine the next management step.
All language, motor, and social milestones are normal for a 2-year-old.
Because development is entirely normal, medical interventions or specialist referrals are contraindicated, making reassurance the appropriate action.

Anahtar Kavram

Normal pediatric development at 24 months includes a vocabulary of ≥50 words, 2-word phrases, parallel or pretend play, joint attention, and transient temper tantrums.
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Konular

Childhood and Neurodevelopmental Disorders

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