A school nurse suspects that a 5-year-old child has autism spectrum disorder. The nurse’s suspicion is based on which of the following observations? The nurse noted that the child: Select all that apply

Speech and language milestones are critical indicators of a child’s development. Certain delays or persistent speech difficulties are red flags that warrant referral for a speech and language evaluation.

Rationale for correct answers:

A. Failure to speak any meaningful words at 2 years old is a developmental red flag. By this age, children should be using several single words spontaneously. Lack of expressive language warrants referral.

C. Failure to use sentences of three or more words by 3 years old indicates a possible expressive language delay. Most 3-year-olds should be able to form short, understandable sentences.

D. Stuttering or dysfluency can be normal in preschoolers (ages 2–5), especially during language bursts. However, persistent or significant dysfluency (such as repeating sounds, words, or phrases) can indicate a need for evaluation.

E. Frequent omission of final consonants in a 3-year-old is concerning. While some articulation errors are normal, consistent omission of final consonants after age 3 is not developmentally appropriate.

Rationale for incorrect answers:
B. Using different words or nicknames for people is typical of normal language development and shows creativity in communication.
E. Omission of word endings such as plurals or verb tenses may still be developmentally normal at 3 years old. Many children master these grammatical rules closer to age D.

Take home points

• By age 2: Child should use at least 50 words and begin combining words.
• By age 3: Child should form 3–4 word sentences and be mostly understandable to familiar listeners.
• Speech referral red flags: no meaningful words at 2, no short sentences at 3, and persistent articulation errors (e.g., omitting final consonants).
• Some errors (stuttering, word endings) are developmentally normal at 3 years.

Discipline in children with developmental disabilities should be consistent, developmentally appropriate, and aligned with family values. Nurses should guide parents toward strategies that foster independence, promote acceptable behavior, and respect the child’s unique needs.

Rationale for correct answer:

A. “You should choose methods that are most congruent with your values about discipline.” This response emphasizes the importance of aligning discipline strategies with the family’s beliefs, which promotes consistency and follow-through. It avoids a one-size-fits-all approach and instead empowers parents to apply discipline in a way that supports both the child’s development and the family’s framework.

Rationale for incorrect answers:
B. “Children like this really can’t follow directions, so they may be very hard to discipline.” This is discouraging, non-therapeutic, and untrue. Children with developmental disabilities can follow directions with structure, patience, and consistency.

C. “Punish your child only for socially unacceptable or offending behaviors.” Discipline should focus on teaching, guiding, and reinforcing positive behavior, not solely punishment. Limiting discipline to punishment misses the opportunity for positive reinforcement and skill development.

D. “Spanking works well for this type of child, as they really don’t like pain.” Corporal punishment is inappropriate and harmful. It does not teach desired behaviors, may cause fear or aggression, and is not recommended in pediatric nursing practice.

Take home points

• Discipline for children with developmental disabilities should be consistent, individualized, and value-based.
• Positive reinforcement, clear expectations, and patience are more effective than punishment.
• Nurses should empower and support parents with strategies that respect both the child’s abilities and the family’s beliefs.
• Corporal punishment is never an appropriate recommendation in pediatric nursing.