A 2-year-old boy is brought to the office for a routine visit. His parents are concerned that he is not as talkative as his twin sister. The patient's sister talks "constantly" and is starting to put 3 words together. The boy tends to be quieter and says about 70 words with some 2-word phrases; both children will be enrolled in preschool in the fall. The patient likes making beeping sounds when playing with toy trucks, but he does not play with his sister, only alongside her. The boy is up to date with vaccinations, and his growth parameters are average for his age. He points to a toy across the room, looks at his mother and smiles, and then brings the toy over to show her. When the physician approaches, the patient runs to hide behind his father and initially refuses to cooperate or make eye contact. When his mother tries to help him onto the examination table, he pushes her away and says, "Me do." Which of the following is the most likely diagnosis in this patient?

Question

A 2-year-old boy is brought to the office for a routine visit.  His parents are concerned that he is not as talkative as his twin sister.  The patient's sister talks "constantly" and is starting to put 3 words together.  The boy tends to be quieter and says about 70 words with some 2-word phrases; both children will be enrolled in preschool in the fall.  The patient likes making beeping sounds when playing with toy trucks, but he does not play with his sister, only alongside her.  The boy is up to date with vaccinations, and his growth parameters are average for his age.  He points to a toy across the room, looks at his mother and smiles, and then brings the toy over to show her.  When the physician approaches, the patient runs to hide behind his father and initially refuses to cooperate or make eye contact.  When his mother tries to help him onto the examination table, he pushes her away and says, "Me do."  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec25c8_d6eb_144b_bc81_f9e0f5274165_MD0003_00 Language development begins in infancy with cooing and babbling, and most children say their first word around age 1. Although a 2-year-old may know as many as 200 words, a child at this age should have a vocabulary of at least 50 words and be able to form 2-word phrases. Children age 2-3 years are also in the process of learning pronouns and will frequently use "me" instead of "I." In addition, a stranger should be able to understand half of the child's speech at this age, and the child should be able to follow 2-step commands. Two-year-olds can also run, throw a ball overhand, and kick a ball. They should be able to copy a straight line when drawing and turn pages in a book. Children at this age often show defiance as they become more independent and confident with new skills. Two-year-olds commonly engage in parallel play; imaginative and cooperative play gradually predominates in older toddlers. This child is developmentally appropriate for his age. Although his twin sister is more vocal and has slightly precocious language development (eg, 3-word sentences), the patient uses 2-word phrases and has no signs of language delay (Choice D). (Choice A) Autism spectrum disorder usually presents by age 2 with poor social communication (eg, limited language and eye contact, solitary play) and repetitive behaviors (eg, hand flapping). This patient demonstrates eye contact and shared attention with his mother. His language development, stranger anxiety, and intermittent defiance are appropriate for age. (Choice B) By age 2, children should be able to sort and match objects and understand the use of familiar objects. This child plays with a truck appropriately and imitates typical truck noises, consistent with appropriate cognitive development. (Choice C) Audiologic testing should be performed in all children with language delay to assess for underlying hearing loss. Conductive hearing loss is unlikely as this child's language is appropriate for age. Educational objective: Two-year-old children with appropriate language development should have a vocabulary of ≥50 words, combine words into 2-word phrases, and follow 2-step commands. In addition, a stranger should be able to understand at least half of a 2-year-old's speech. References: Developmental milestones. (http://www.ncbi.nlm.nih.gov/pubmed/26729779) A study of language development and affecting factors in children aged 5 to 27 months. (http://www.ncbi.nlm.nih.gov/pubmed/26829690)

A 2-Year-Old Boy Is Brought to the Office for a Routine