A 5-year-old girl is brought to the office by her parents due to problems at school. The patient's teachers report that she is very quiet in class. When she does talk, she frequently uses the wrong verb tense and is occasionally teased by peers. Her parents report that she was slow to speak as a toddler, but they were not overly concerned as they had assumed that she was quiet and shy. The girl has a friend with whom she plays after school. The patient is able to dress herself, skip, tie her shoelaces, and draw a triangle. Physical examination, audiologic testing, and laboratory evaluation are normal. On examination, the girl is initially shy but warms up as the interview progresses. The patient's speech is clear, but her vocabulary is limited and she uses simple sentences. She is able to count to 10 slowly. Which of the following is the most likely diagnosis for this patient?

Question

A 5-year-old girl is brought to the office by her parents due to problems at school.  The patient's teachers report that she is very quiet in class.  When she does talk, she frequently uses the wrong verb tense and is occasionally teased by peers.  Her parents report that she was slow to speak as a toddler, but they were not overly concerned as they had assumed that she was quiet and shy.  The girl has a friend with whom she plays after school.  The patient is able to dress herself, skip, tie her shoelaces, and draw a triangle.  Physical examination, audiologic testing, and laboratory evaluation are normal.  On examination, the girl is initially shy but warms up as the interview progresses.  The patient's speech is clear, but her vocabulary is limited and she uses simple sentences.  She is able to count to 10 slowly.  Which of the following is the most likely diagnosis for this patient?

Quizplus · Accepted Answer

This patient most likely has a language disorder (LD), a common developmental disability of childhood that occurs in 5%-10% of children. LD is characterized by persistent difficulties in comprehension (receptive) and/or production (expression) of spoken and written language. It may involve the rules (grammar, syntax, morphology), content (vocabulary), and/or functional use of language. As in this patient, typical symptoms include a markedly limited vocabulary, errors in tense, and difficulty producing sentences with developmentally appropriate length and complexity. LDs interfere with academic functioning and increase the risk for specific learning disorders (eg, reading and writing disabilities). Early intervention, including structured language therapy and stimulating language development at school and at home, is beneficial and improves outcomes. (Choices A and F) Childhood-onset fluency disorder, also known as stuttering, is an impairment in the fluency of speech production. Speech sound disorder is an impairment in speech articulation. This child's speech is fluent and clear. (Choice C) In selective mutism, patients do not speak in specific settings, typically at school. This girl's speech deficits are apparent in multiple settings. (Choice D) Social (pragmatic) communication disorder is characterized by persistent difficulty in the social use of verbal and nonverbal communication. This girl's ability to interact socially with peers and family makes this diagnosis less likely. (Choice E) As the demands of reading and writing increase, this patient will be at risk for a comorbid learning disorder. At this time, however, there is insufficient evidence to make this diagnosis, as it requires the use of standardized achievement testing. Educational objective: Language disorder is common and characterized by persistent difficulties in the acquisition and use of language due to deficits in comprehension and/or production. Typical signs include limited vocabulary, sentence structure and functional use of language. References: School-readiness profiles of children with language impairment: linkages to home and classroom experiences. (http://www.ncbi.nlm.nih.gov/pubmed/24894359) The pediatrician's role in optimizing school readiness. (http://www.ncbi.nlm.nih.gov/pubmed/27573085) The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. (http://www.ncbi.nlm.nih.gov/pubmed/27184709)

A 5-Year-Old Girl Is Brought to the Office by Her