A 20-month-old girl is brought to the office because her parents are concerned about her development. She speaks only 5 single words and does not combine words. She can walk well and run, but she does not yet walk up stairs. She feeds herself with a spoon and drinks from a cup. She points to objects she wants and waves bye-bye. Physical examination shows normal growth parameters and no dysmorphic features. Which of the following is the most appropriate management at this time?
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APerform autism-specific screening with M-CHAT and refer based on score
BRefer directly to speech therapy without hearing evaluation at this time
CRepeat standardized developmental screening in 2 months and reassess trajectory
DRefer to early intervention and audiology for language delay evaluation
EReassure parents this is normal variation and recheck at 24-month visit
✓ Correct answer: D. Refer to early intervention and audiology for language delay evaluationA 20-month-old should have 10-25 words and be starting to combine two words (expected by 24 months). Isolated language delay with normal social and motor skills still requires early intervention referral (IDEA Part C) and audiology evaluation to rule out hearing loss. Early intervention maximizes outcomes. Distractor1 inappropriately delays intervention beyond critical window. Distractor2 misses the early intervention opportunity. Distractor3 is premature without hearing evaluation. Distractor4 represents watchful waiting when action is indicated.
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