A 30-month-old child does not speak single words, does not make eye contact, engages in repetitive spinning of objects, and does not point. Parents report the child had said 'mama' and 'dada' until 18 months and then stopped. Which feature of this history is MOST significant for classifying this as a 'red flag' for autism spectrum disorder?
- A Absence of eye contact
- B Repetitive object manipulation
- C Regression of previously acquired speech (language regression) ✓
- D Absence of pointing gesture
Correct answer: C. Regression of previously acquired speech (language regression)
Explanation
Loss of previously acquired skills (regression) is the most alarming red flag for autism spectrum disorder and also necessitates evaluation for rare but treatable conditions such as Landau-Kleffner syndrome (epileptic aphasia) and Rett syndrome. The DSM-5 distinguishes ASD with regression as a distinct pattern. While absence of eye contact, lack of pointing, and repetitive behaviors are all diagnostic criteria, skill regression — particularly language — mandates urgent comprehensive developmental and neurological evaluation to exclude epileptic encephalopathy.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.