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Andrew comes to see you with his mother. He is 40 months old and has recently started nursery. His mother has noticed that the other children have much better speech and language than Andrew does.
Andrew’s past history is unremarkable. At his 18 month check, he could say, Mama, Dada and Ta! and he passed his health-visitor distraction test at the second attempt.
Andrew plays happily in the surgery, looking at books and vocalising a fair amount. His mother can identify at least 20 words although they are difficult to understand. He will string words together but tends to back up his language with enthusiastic non-verbal clues. He frequently omits consonants, particularly off the end of words, and has many phonetic substitutions. He manages to recognise things by their function and will correctly identify size and colour.
Andrew’s mother reports that he can ride his bike with stabilisers, feeds himself washes and dresses with some supervision.