A 2-year-old girl is brought to the office due to concerns about her development. The girl says approximately 40 words and does not string words together. She can jump, walk upstairs slowly, build a 6-block tower, and follow short commands. She feeds and helps to dress herself. The girl's mother says, "My daughter is such a happy child. She loves playing with the other kids at day care. She is affectionate and caring toward us and her dog. I don't know why she won't speak. Her sister was using sentences by age 2. Is there something wrong with her?" Which of the following is the most appropriate response by the physician?

Question

A 2-year-old girl is brought to the office due to concerns about her development.  The girl says approximately 40 words and does not string words together.  She can jump, walk upstairs slowly, build a 6-block tower, and follow short commands.  She feeds and helps to dress herself.  The girl's mother says, "My daughter is such a happy child.  She loves playing with the other kids at day care.  She is affectionate and caring toward us and her dog.  I don't know why she won't speak.  Her sister was using sentences by age 2.  Is there something wrong with her?"  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

At age 2, a child should have a vocabulary of 50-200 words and be able to use 2-word phrases. This patient has an isolated language disorder; her motor and social skills are normal. Language is the most commonly delayed milestone, with an estimated prevalence of 10%-15% at age 2. Many children with isolated language delay will catch up in preschool (prevalence falls to 5% after age 3). However, children with persistent language deficits are at increased risk for writing and/or reading learning disorders in their school years. This child should have a hearing examination as well as a speech and language evaluation, which can help to assess and monitor her language development. (Choice A) Although it is appropriate to reassure the mother that development varies among children, it is incorrect to imply that no further action is required at this time. Children are adaptable; their brains are constantly developing, and they can make great gains with early intervention and close monitoring. (Choice B) Autism spectrum disorder is characterized by impaired social communication/interactions and restricted, repetitive patterns of behavior or interests typically presenting by age 2. This child interacts well with her peers and family, and her mother has described no repetitive behaviors or fixed interests. (Choice C) Global developmental delay is characterized by a failure to meet age-related expectations in multiple areas, including intellectual, communicative, social, and motor functions. This child is functioning below her age in the area of language only. (Choice D) This child's speech development is not within the normal range and requires further assessment. (Choice E) Selective mutism is a failure to speak in a specific social situation (eg, school) but not in other situations (eg, home). It is often associated with anxiety, especially social phobia. This child's language impairment is not specific to a certain situation. Educational objective: At age 2, children should have a vocabulary of 50-200 words and be using 2-word phrases. Parents' concerns about delayed milestones should be validated; they should be reassured that children often catch up but may need help. Further evaluation and regular monitoring are required. __________ References: Causal effects on child language development: a review of studies in communication sciences and disorders. (http://www.ncbi.nlm.nih.gov/pubmed/26255254)

A 2-Year-Old Girl Is Brought to the Office Due to Concerns