Question:
A 20-month-old child says only one word and is otherwise developmentally normal in motor and social domains. What is the most appropriate next step?
A 20-month-old child says only one word and is otherwise developmentally normal in motor and social domains. What is the most appropriate next step?
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What reversible cause must you exclude before anything else in a child with speech delay?
Updated On: Jun 25, 2026
- Reassure the parents
- Speech and hearing evaluation
- Diagnose as autism
- Reassess at 5 years of age
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The Correct Option is B
Solution and Explanation
Step 1: Identify the expected language milestone. By 18 months a typically developing child should have a vocabulary of several words (about 3-10 words), and by 2 years should join two words and have roughly 50 words. A 20-month-old with only a single word is significantly delayed in expressive language.
Step 2: Recognise this as a red flag. Isolated expressive speech delay warrants evaluation rather than watchful waiting, because an undetected cause may be treatable and early intervention improves outcomes.
Step 3: Choose the most appropriate next step. The single most important first step is to rule out a hearing deficit and formally assess speech/language - hearing impairment is the commonest reversible cause of speech delay. Hence a speech and hearing (audiological) evaluation is the correct action.
Why the others are wrong: • Reassurance ignores a genuine delay. • Labelling autism is premature when social/non-verbal domains are normal and no hearing assessment has been done. • Deferring assessment to 5 years wastes the critical early-intervention window.
Key fact: Speech delay to always evaluate hearing first along with formal speech-language assessment.
Step 2: Recognise this as a red flag. Isolated expressive speech delay warrants evaluation rather than watchful waiting, because an undetected cause may be treatable and early intervention improves outcomes.
Step 3: Choose the most appropriate next step. The single most important first step is to rule out a hearing deficit and formally assess speech/language - hearing impairment is the commonest reversible cause of speech delay. Hence a speech and hearing (audiological) evaluation is the correct action.
Why the others are wrong: • Reassurance ignores a genuine delay. • Labelling autism is premature when social/non-verbal domains are normal and no hearing assessment has been done. • Deferring assessment to 5 years wastes the critical early-intervention window.
Key fact: Speech delay to always evaluate hearing first along with formal speech-language assessment.
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