A 2-year-old girl presents with her parents to the clinic for a well child visit. Her mother expresses concern that she does not respond to her name when called. She is able to run, walk upstairs, build a 6-block tower, play with other toddlers at day care, and says a few words but mostly babbles. She does not say two-word phrases. She is at the 45th percentile for height, 56th percentile for weight, and 57th percentile for head circumference.
There is no personal or family history of serious illness. Which of the following is the most likely diagnosis?
- A) Attention deficit hyperactivity disorder
- B) Autism spectrum disorder
- C) Hearing impairment
- D) Motor delay
- E) Normal development
C) Hearing impairment
The patient's inability to respond to her name being called and delay in language (2-year-olds typically have a 300+ word vocabulary, 2-3 word phrases, and can state own name) is concerning for hearing impairment. Her gross motor, fine motor, and social development are consistent with that of a 2-year-old. Hearing impairment is most often congenital but can also be acquired. Unaddressed hearing impairment can cause delays in speech, language, and cognitive development. Developmental language disorder is the most common developmental disability in childhood, affecting up to 10% of children. All children with speech impairment/delay should have a medical evaluation and audiology evaluation to detect hearing loss that may be contributing to the speech delay.
Answer choice A: Attention deficit disorder, is incorrect. This child does not have a reported history of hyperactivity, impulsivity, or inattention that occur in more than one setting that would suggest attention deficit disorder.
Answer choice B: Autism spectrum disorder, is incorrect. The child in the vignette plays with other toddlers and does not show the restricted social interactions or stereotypical behaviors that would suggest autism spectrum disorder.
Answer choice D: Motor delay, is incorrect. This child is demonstrating gross motor and fine motor skills that are age appropriate.
Answer choice E: Normal development, is incorrect. This child has a language delay and is not demonstrating normal speech and language development.
Key Learning Point
Speech or language delay is commonly caused by hearing impairment.