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Zorluk: KolayChildhood and Neurodevelopmental Disorders

A 24-month-old girl is brought to the clinic by her parents due to concerns about her social development. The parents report that when they take her to the local playground, she sits near other children in the sandbox but does not interact or share her toys with them. The parents are worried she might have a neurodevelopmental disorder. The child has a vocabulary of approximately 50 words, puts two words together to form simple phrases, and can follow two-step commands. She consistently makes eye contact, points to birds in the sky to show her parents, and smiles when engaged in play. She has recently begun having temper tantrums when it is time to leave the playground. Her vital signs and physical examination are unremarkable. Which of the following is the most appropriate next step in management?

  1. Reassurance and routine follow-upCevap
  2. B
    Referral for a comprehensive autism evaluation
  3. C
    Referral for formal audiologic testing
  4. D
    Administration of an attention-deficit/hyperactivity disorder rating scale
  5. E
    Initiation of parent-child behavioral therapy

Cevap

Reassurance and routine follow-up
The correct answer provides reassurance and routine follow-up because this 24-month-old girl is meeting all appropriate developmental milestones. At age 2, children typically have a vocabulary of 50-200 words, use 2-word phrases, and follow 2-step commands. Socially, they engage in parallel play (playing alongside, but not directly with, other children) and begin to assert autonomy, often resulting in temper tantrums. Furthermore, she exhibits normal joint attention (pointing to show objects) and good eye contact, which strongly argues against a neurodevelopmental disorder such as autism.

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1
Evaluate the patient's social play behavior
The patient plays alongside but not directly with other children, which is defined as parallel play.
Parallel play is the expected and completely normal social play stage for children between the ages of 2 and 3.
2
Assess communication and language milestones
The patient has 50 words, uses 2-word phrases, points to share interest, and makes good eye contact.
These milestones rule out gross language delay and deficits in social reciprocity (joint attention), which are hallmark signs of autism spectrum disorder.
3
Determine the significance of the temper tantrums
Tantrums when leaving the playground are a classic manifestation of a toddler asserting autonomy.
This is a normal behavioral phase in a 24-month-old and does not signify a disruptive behavioral disorder.
4
Synthesize findings to choose the management plan
All findings point to normal development.
When a child exhibits age-appropriate developmental milestones and normal behavioral variations, the correct management is parental reassurance.

Anahtar Kavram

Normal developmental milestones in a 24-month-old child
Tahmini Süre:45s
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Childhood and Neurodevelopmental Disorders

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