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A 20 month old boy is brought to the physician by his mother because she is concerned about his language development. His mother says, he can understand. His 4 year old sister had no problems with speech when she was his age. He is able to make some sounds, including b and p spontaneously, but he seems slow to imitate words the parents say. He is active, able to run a few steps, and can recognize shapes & do simple puzzles. He is at the 60th percentile for length & weight, & 75th percentile for head circumference. He is friendly & cooperative & has good eye contact. Physical examination shows no abnormalities. Which of the following is the most appropriate initial statement by the physician?

a) I recommend that he undergo a hearing screening as soon as possible
b) I wouldn't worry. Boys often speak later than girls do
c) I am going to schedule him for an MRI of the brain to exclude hydrocephalus
d) You should give him things only if he attempts to ask for them
e) You should have him evaluated by a child psychologist for possible autistic disorder

I CHOOSE D ( WRONG ANSWER )
 

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i would say A go for a hearing test a according to the other developmental milestones he seems perfectly normal maybe jut hard of hearing.
 

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A

I would choose A.

- He should at least have words at 20 months (the "2 rule" is 200 words and 2-word sentences at 2 y/o, right?), so B is wrong. It is possible that he is just late in speaking, but correctable problems like hearing disorders have to be ruled out.
- He is active and shows no neurological Sx except for his lack of speech development. Hydrocephalus is not a good differential, so C is wrong.
- D is a behavioral intervention intended to engage the child and help him overcome a reluctance to adopt speech. This is a friendly and engaged child already.
- Friendly + good eye contact = no autism, so E is wrong

A set of hearing tests (A) would be the best next step in diagnosis.
 

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B

I would choose A.

- He should at least have words at 20 months (the "2 rule" is 200 words and 2-word sentences at 2 y/o, right?), so B is wrong. It is possible that he is just late in speaking, but correctable problems like hearing disorders have to be ruled out.
- He is active and shows no neurological Sx except for his lack of speech development. Hydrocephalus is not a good differential, so C is wrong.
- D is a behavioral intervention intended to engage the child and help him overcome a reluctance to adopt speech. This is a friendly and engaged child already.
- Friendly + good eye contact = no autism, so E is wrong

A set of hearing tests (A) would be the best next step in diagnosis.
I would CHOOSE B.

I think the 2 rule is at 2 years, which is 24 months. This child is 4 months short of 24 months.
So I would advise the parent that the child is normal. I would only do further testing if this continues after the age of 24 or 25 months.
 

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I'd argue B as well... given that I have a philosophy of never referring anything on the step 1 and also, along those lines if I was to refer the kid it would be to a speech language pathologist and not to only do a hearing test.
 

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I'll go with A.

' but he seems slow to imitate words the parents say.

this is the main clue for the need to screen for hearing difficulty. language development and hearing go hand in hand, as speech requires auditory feedbacks.so if he cannot hear well, he cannot repeat what the parents say.

B) i dont think there is any documented evidence for this, besides if there is, 20 months is too late to consider normalcy.
C) there is no information in the question to suggest hydrocephalus.
D) this is obviously wrong, and may frustrate the child.
E) he is friendly, cooperative with good eye contact. this excludes autism.
 

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the child can pronounce the letters b and p , is that a clue for the child not having a hearing impairment disorder ?
but I would choose A too. do no harm :)
 

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a) I recommend that he undergo a hearing screening as soon as possible

Correct ans is a) I recommend that he undergo a hearing screening as soon as possible

This seems like the boy's expressive language is not appropriate for his age. He is suffering from a mild to moderate hearing loss this should be corrected as early as possible otherwise he'll go deaf and mute.
 

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child with poor language development

Answer : A
The question is asking the initial statement or in other words what will be the next step in order to make a Dx .

The answer should be : Hearing test .

The rest of choices can come after the result of Hearing test .
 

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why not B

wel generally the rule is if a child is having problem in only one development milestone...then it is not considers as developmental delay.....wel this child is showing delay in only social development....;more-over these milestones are not accurate....i mean they are generalized...they always have some or the other variations when compared individually (that's what the mother did )

:notsure:
 

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either deaf or mentally challenged

This child cant say a SINGLE word and he is 2 years old , even if we stretch the milestones a lot its abnormal , so I'd say A)
 

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my openiom

A 20 month old boy is brought to the physician by his mother because she is concerned about his language development. His mother says, he can understand. His 4 year old sister had no problems with speech when she was his age. He is able to make some sounds, including b and p spontaneously, but he seems slow to imitate words the parents say. He is active, able to run a few steps, and can recognize shapes & do simple puzzles. He is at the 60th percentile for length & weight, & 75th percentile for head circumference. He is friendly & cooperative & has good eye contact. Physical examination shows no abnormalities. Which of the following is the most appropriate initial statement by the physician?

a) I recommend that he undergo a hearing screening as soon as possible
b) I wouldn't worry. Boys often speak later than girls do
c) I am going to schedule him for an MRI of the brain to exclude hydrocephalus
d) You should give him things only if he attempts to ask for them
e) You should have him evaluated by a child psychologist for possible autistic disorder

I CHOOSE D ( WRONG ANSWER )
b i think is satisfactory
 
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