Question:medium

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
Show Solution

The Correct Option is B

Solution and Explanation

Language development follows predictable checkpoints. A toddler should be saying multiple single words by $18$ months and combining two words by $24$ months. At $20$ months a child limited to one word has clear expressive language delay, which is never something to simply watch.

The clinician's job is to find a cause. The leading and most readily correctable explanation for delayed speech is undetected hearing loss, so audiometry plus a structured speech-language assessment is the logical first investigation. Identifying and treating a hearing deficit early can restore normal language trajectory.

Reassurance, deferral to age $5$, or an outright autism label are all inappropriate: the first two ignore the delay and the third jumps to a diagnosis without excluding hearing impairment, especially when social and motor development are reportedly normal.

\[\boxed{\text{Next step} = \text{Speech and hearing evaluation}}\]
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