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Home / Station 16: Two-year-old with language delay

NAC OSCE preparation

Station 16: Two-year-old with language delay

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Two-year-old with language delay

11 minutes

Discipline: Pediatrics
Station type: Developmental history + counselling
Setting: Family medicine clinic

Your task

Take a developmental history from the parent. Explain assessment and next steps.

Information available at entry

Growth tracks previous percentiles

Coach prompt: Assess all developmental domains and arrange early supports.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 16 of 30

Standardized-patient profile

NameEthan

Age26 months

Pronounshe/him

RoleMother provides history

Demeanour: Parent worried she caused the delay.

Opening statement: “He only says two words and often doesn't look when I call his name.”

History and standardized-patient responses

Development

Candidate explores	Standardized-patient response
Language	Two words, no two-word phrases and does not point to request.
Social	Limited eye contact, rarely shares interest, often no response to name.
Behaviour	Lines up cars and resists routine changes.
Motor/self-help	Walks/runs, climbs with help, self-feeds.
Regression	No loss of skills.

Medical/hearing

Candidate explores	Standardized-patient response
Hearing	Passed newborn screen; recurrent otitis and uncertain response to quiet sounds.
Other	No seizures or vision concern.
Birth	Term uncomplicated.
Family	Cousin had speech delay.

Environment

Candidate explores	Standardized-patient response
Languages	English and Spanish at home.
Screen time	About three hours daily.
Safety	Stable home; no safeguarding concern.

Physical findings

Observe response to name, joint attention, play and eye contact.
Complete physical/neurologic examination, growth/head circumference and dysmorphology assessment are required.

Examiner prompts

Main concerns?

Language delay plus social-communication and repetitive features concerning for autism; hearing loss must be assessed.

Does bilingualism cause it?

No; bilingual exposure does not explain absent joint attention or repetitive behavior.

Referrals?

Audiology, speech-language and developmental/autism assessment, with early intervention before final diagnosis.

Differential diagnosis

Autism spectrum disorder
Hearing impairment
Developmental language disorder
Global developmental delay
Intellectual disability
Neurologic/genetic condition

Investigations

Formal audiology
Standardized developmental/autism assessment
Physical/neurologic exam and growth
Targeted genetic/metabolic tests by specialist/clinical findings

Management

Early speech-language/developmental intervention
Audiology and hearing management
Developmental/autism pathway
Reduce passive screen time and encourage interactive play without blame
Family support and follow-up

Communication behaviours

State parent did not cause delay
Use family-preferred language
Highlight strengths while honest about concern

Critical safety actions

Regression requires urgent evaluation
Do not wait for diagnosis before support
Hearing assessment is essential

Model closing summary

This 26-month-old has marked language delay plus limited response to name, absent joint attention, restricted play and distress with routine changes, raising concern for autism spectrum disorder; hearing loss is also possible. I would arrange audiology, speech-language and developmental/autism assessment, connect the family with early intervention now, complete a broad physical/developmental evaluation and reassure the parent that bilingualism or parenting did not cause this.

Common pitfalls

'Boys talk late' reassurance
Blaming two languages
No referral
Focusing only on word count

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

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