A 15-month-old boy is brought to the office for a well-child visit. His mother reports that he does not yet speak any words and does not respond when she calls his name. He can pull to stand and cruise along furniture but does not walk independently. Physical examination shows normal growth parameters. He makes limited eye contact and does not wave bye-bye. The physician reviews standardized developmental screening results indicating delays in both language and social domains. Which of the following screening timelines and actions is most appropriate for this patient? Age Screening Type Action if Delay Identified Key Red Flags 9 months General developmental Refer to early intervention (Part C) No babbling, poor social engagement 18 months General + autism-specific Immediate referral to early intervention + audiology No single words, no pointing, no imitation 24 months Autism-specific Immediate referral for autism evaluation No two-word phrases, loss of skills 30 months General developmental Refer to early intervention if not improving Persistent language or motor delays
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APerform autism-specific screening (M-CHAT) and refer based on results
BReassure the mother that late talking is common and follow up at 24 months
CImmediate referral to early intervention without audiology evaluation
DImmediate referral to early intervention and audiology evaluation
ERepeat standardized developmental screening at the 18-month visit
✓ Correct answer: D. Immediate referral to early intervention and audiology evaluationThis 15-month-old has significant red flags: no single words by 15 months (expected by 12 months), limited social engagement, and not responding to name. These findings warrant immediate referral to early intervention (IDEA Part C) and audiology evaluation to rule out hearing loss. Distractor1 delays necessary intervention. Distractor2 is premature for autism-specific screening before 18 months. Distractor3 inappropriately delays action. Distractor4 misses the need for audiology assessment when language delay is present.
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