For a two-year-old twins where one twin is verbal and the other is nonverbal and fearful, the most appropriate intervention is

For a two-year-old twins where one twin is verbal and the other is nonverbal and fearful, the most appropriate intervention is

• A. Encourage mother to initiate and play verbal games with both children
• B. Schedule speech, language, and hearing evaluation for the second twin
• C. Perform audiometry examinations to rule out hearing deficits in the second twin
• D. Continued observation and reassurance

Answer: (B)

When a two-year-old shows a clear difference in development compared with a co-twin—one being verbal and the other nonverbal and fearful—the first priority is to evaluate for underlying causes that could impair communication, especially hearing. Scheduling a comprehensive speech-language-hearing evaluation for the nonverbal twin is the best next step because it directly assesses whether a hearing deficit is present and also examines speech and language abilities. If hearing is normal, you can confidently move forward with targeted speech-language therapy and parental coaching. If a hearing issue is found, you can address that immediately (e.g., amplification, medical or educational referrals) and still pursue language intervention as appropriate. Encouraging verbal activities alone, while helpful for development, does not address a potential hearing problem and may delay diagnosis. Observation and reassurance aren’t appropriate given the red flag of nonverbal status at age two. An audiometry test alone could identify a hearing deficit but misses the broader picture of speech and language development that guides early intervention planning.

When a two-year-old shows a clear difference in development compared with a co-twin—one being verbal and the other nonverbal and fearful—the first priority is to evaluate for underlying causes that could impair communication, especially hearing. Scheduling a comprehensive speech-language-hearing evaluation for the nonverbal twin is the best next step because it directly assesses whether a hearing deficit is present and also examines speech and language abilities. If hearing is normal, you can confidently move forward with targeted speech-language therapy and parental coaching. If a hearing issue is found, you can address that immediately (e.g., amplification, medical or educational referrals) and still pursue language intervention as appropriate.

Encouraging verbal activities alone, while helpful for development, does not address a potential hearing problem and may delay diagnosis. Observation and reassurance aren’t appropriate given the red flag of nonverbal status at age two. An audiometry test alone could identify a hearing deficit but misses the broader picture of speech and language development that guides early intervention planning.