Challenge Your Exam Readiness With Our Free USMLE Practice Questions

At 24 months, expected language milestones include a ≥50-word vocabulary and two-word phrases, with the ability to follow two-step commands and use gestures like pointing to share interest. Delays in expressive language with inconsistent response to name raise concern for hearing impairment, a common and reversible cause of speech delay in toddlers—especially with a history of recurrent otitis media that can cause conductive hearing loss and fluctuating auditory input. The first, most high-yield step is to obtain an objective hearing assessment via age-appropriate audiology (e.g., visual reinforcement audiometry, tympanometry/otoacoustic emissions). If a deficit is identified, addressing middle ear disease (e.g., tympanostomy) and ensuring amplification when indicated can markedly improve language outcomes. While autism spectrum disorder remains on the differential (limited pointing and inconsistent name response), diagnosis requires a broader social-communication evaluation after hearing has been ruled out. Early Intervention and speech-language services are beneficial but should follow or proceed in parallel with confirming intact auditory pathways. Reassurance alone risks missed critical neurodevelopmental windows, and starting ASD-specific therapy without excluding hearing loss can misdirect resources. Thus, formal audiology is the appropriate next step.