A 3 1/2-year-old boy says only three single words, and these are poorly articulated. He uses gestures to communicate. There are no other reported problems, gross and fine motor skills are normal for age and physical examination, including tympanography, is normal.
Which of the following is the MOST LIKELY explanation?
A Intellectual disability.
B Deafness.
C Manipulative behaviour.
D Dysarthria.
E Autism
CORRECT answer is B
Intellectual disability is characterised by delay in all aspects of development, although some may be affected more than others. The absence of delay other than in speech development rules out this cause.
Deafness is the most likely cause. Deafness frequently escapes detection unless specifically sought by audiography. Severe deafness may lead to speech delay and to poor articulation.
Manipulative behaviour may lead to mutism, usually transient and associated with other evidence of behaviour disorder. This would occur most commonly in older children and adolescents and would be very rare at this age.
Dysarthria has many causes, but is not associated with failure to develop a vocabulary unless due to profound deafness.
Autism is often associated with delayed speech development, but is unlikely to be associated with development of gestures for communication. Other aspects of development are likely to be atypical.