A 30-Month-Old Girl Is Brought to the Office After Her

A 30-month-old girl is brought to the office after her teacher recommended an evaluation for behavioral and speech problems.  Her mother says, "I have gotten several reports from the school that she hits other children."  The teacher's report indicates that the girl does not respond to her name being called, says only 1-word phrases, and prefers to play by herself with her favorite toy bunny.  The mother acknowledges that the girl's language development has been slow but adds, "Her hearing test was normal, and her sister began speaking late and is perfectly fine; I'm hoping it just runs in the family.  She has always been shy, and I can understand why she hits when it's hard for her to communicate."  The patient is able to walk upstairs, draw a circle, and feed herself.  Her height, weight, and head circumference for age are tracking above the 60th percentile.  On examination, the pediatrician notes that she says 1 or 2 unintelligible words.  The patient does not look up and continues to play with her bunny when he tries to engage her.  Which of the following is the most appropriate response by the physician?

A) Although children may reach milestones at different times, I am concerned that your child's difficulties are suggestive of an anxiety disorder.
B) Difficulty communicating can lead to aggressive behavior; play therapy may be helpful to enhance her social skills.
C) We should monitor her speech and behavior closely.  If they don't improve by the time she is in pre-kindergarten, she will need further evaluation.
D) You are correct that children's milestones vary; however, I would like to obtain further evaluation to see if intervention is necessary.
E) You are correct that speech delay frequently runs in families.  Because her other milestones are normal, there is no need for intervention at this stage.