A 2-Year-Old Boy Is Brought to the Office for a Routine

A 2-year-old boy is brought to the office for a routine visit.  His parents are concerned that he is not as talkative as his twin sister.  The patient's sister talks "constantly" and is starting to put 3 words together.  The boy tends to be quieter and says about 70 words with some 2-word phrases; both children will be enrolled in preschool in the fall.  The patient likes making beeping sounds when playing with toy trucks, but he does not play with his sister, only alongside her.  The boy is up to date with vaccinations, and his growth parameters are average for his age.  He points to a toy across the room, looks at his mother and smiles, and then brings the toy over to show her.  When the physician approaches, the patient runs to hide behind his father and initially refuses to cooperate or make eye contact.  When his mother tries to help him onto the examination table, he pushes her away and says, "Me do."  Which of the following is the most likely diagnosis in this patient?

A) Autism spectrum disorder
B) Cognitive delay
C) Conductive hearing loss
D) Language delay
E) Normal development

Correct Answer:

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