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You are seeing a 2½-year-old boy for a routine health supervision visit. On a general developmental screening questionnaire, his mother reports that he is not yet talking. She has not been too concerned because the child's father was a late talker and they live in a bilingual household. Although the boy has had several episodes of otitis media, she feels strongly that there is no question of hearing loss because he seems to understand what is said to him. Other domains of development are reported as age-appropriate. His physical examination results are normal, and he appears to be a socially engaging toddler. However, you have concerns about his apparent low frustration tolerance and tendency to throw tantrums.

It has been said that all typically developing children in all cultures master the basics of their language by 4 years of age. (...

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