Which of the following is the most likely underlying cause for the patient's speech and language delay?


A 3-year-old white boy is bought to the office by his mother after referral by his day-care center because they have been concerned about his language development. The mother says the boy has a vocabulary greater than 100 words and that he can put two words together, yet he speaks in few intelligible sentences. The mother was told she had gestational diabetes while she was pregnant with him. The patient was a full-term normal neonate and delivery was normal. He sat up at age 5 months, crawled at age 10 months, and walked at age 13 months. He is not yet toilet trained. The teachers describe him as an active boy who is easily distractible and has a difficult time following directions. Medical history is significant for chronic otitis media with effusions in both ears since age 1 year, for which he has been treated with multiple antibiotics. The boy is 91.5 cm (36 in; 10th percentile) tall and weighs 17 kg (38 lb; 90th percentile). Vital signs and physical examination are normal except for retracted, scarred tympanic membranes. Which of the following is the most likely underlying cause for the patient’s speech and language delay?

A) Attention-deficit/hyperactivity disorder
B) Autism
C) Chronic antibiotic use
D) Chronic otitis media
E) Maternal gestational diabetes

Ans:D) Chronic otitis media