A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 13-month-old girl is brought to the physician for a well-child examination. She was born at 38 weeks' gestation. There is no family history of any serious illnesses. She cannot pull herself to stand from a sitting position. She can pick an object between her thumb and index finger but cannot drink from a cup or feed herself using a spoon. She comes when called by name and is willing to play with a ball. She cries if she does not see her parents in the same room as her. She coos “ma” and “ba.” She is at the 50th percentile for height and weight. Physical examination including neurologic examination shows no abnormalities. Which of the following is the most appropriate assessment of her development?
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A
Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayedIncorrect. she has a pincer grasp (fine motor normal — matches), but social skills are normal (she comes when called, plays ball, shows separation anxiety) — not delayed.
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B
Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayedIncorrect. gross motor is delayed (cannot pull to stand), not normal; and social skills are normal, not delayed.
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C
Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normalIncorrect. fine motor is normal (pincer grasp present); language is delayed (only nonspecific babbling at 13 months).
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D
Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normalCorrect. Fine motor normal (pincer grasp), gross motor delayed (cannot pull to stand), language delayed (no meaningful words), social skills normal (comes to name, separation anxiety).
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E
Fine motor: delayed | Gross motor: delayed | Language: delayed | Social skills: delayedIncorrect. Global developmental delay describes deficits in all four streams — but this child has a normal pincer grasp and intact social milestones (responds to name, separation anxiety), so global delay is incorrect.
↑ Tap an answer to reveal the reasoning
Answer: D. Developmental milestone assessment at 13 months: gross motor — should be pulling to stand by 9–12 months and cruising or taking first steps by 12 months; she cannot pull to stand, so gross motor is delayed. Fine motor — pincer grasp (thumb and index finger) is expected by 9–12 months and she has it, so fine motor is normal. Language — by 12 months a child should say 1–3 meaningful words (e.g., 'mama,' 'dada'); cooing 'ma' and 'ba' without using them with meaning is at the 6–9 month level, so language is delayed. Social skills — coming when called by name, playing with a ball, and stranger/separation anxiety (crying when parents leave the room) are normal 9–12 month social behaviors, so social skills are normal.
The correct profile: fine motor normal, gross motor delayed, language delayed, social skills normal.
Pearl: Stranger anxiety appears around 6–9 months and separation anxiety peaks at 12–18 months — both are reassuring social milestones.
**Why each option:**
**A.** Incorrect: she has a pincer grasp (fine motor normal — matches), but social skills are normal (she comes when called, plays ball, shows separation anxiety) — not delayed.
**B.** Incorrect: gross motor is delayed (cannot pull to stand), not normal; and social skills are normal, not delayed.
**C.** Incorrect: fine motor is normal (pincer grasp present); language is delayed (only nonspecific babbling at 13 months).
**D.** Correct. Fine motor normal (pincer grasp), gross motor delayed (cannot pull to stand), language delayed (no meaningful words), social skills normal (comes to name, separation anxiety).