A 30-month-old child (2.5 years) is brought by parents concerned about lack of speech. The child uses only 5 words, does not point to objects, does not follow 2-step commands, and has limited eye contact. He lines up toys repetitively and has meltdowns when routines change. Which developmental surveillance finding at what earlier age should have triggered formal evaluation for autism spectrum disorder?
- A No babbling by 9 months; no pointing or waving by 12 months ✓
- B No sitting by 8 months; no standing by 12 months
- C No stranger anxiety by 8 months; no pincer grasp by 12 months
- D No social smile by 6 weeks; no head control by 4 months
Explanation
The DSM-5 and AAP guidelines recommend formal ASD evaluation for any child showing: no babbling by 12 months, no pointing or waving or other gestures by 12 months, no single words by 16 months, no 2-word spontaneous phrases by 24 months, or any regression of language or social skills at any age. Earlier red flags include absent babbling by 9 months and absent joint attention (pointing, showing, waving) by 12 months. In the case presented, absence of pointing and limited eye contact are critical ASD red flags that should have been screened at 18-month visits using M-CHAT-R. Physical milestones (sitting, standing) are more motor-related and are not specific for ASD.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.