# A nurse is conducting a developmental assessment on a 5-year-old child suspected of having intellectual disability. Which assessment finding would be most indicative of intellectual disability in this child? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542466 > language: ko > subject: Child Health ## 문제 A nurse is conducting a developmental assessment on a 5-year-old child suspected of having intellectual disability. Which assessment finding would be most indicative of intellectual disability in this child? ## 보기 1. The child can ride a bicycle with training wheels but cannot tie shoelaces independently 2. The child communicates primarily through single words and simple gestures, with limited ability to form sentences. **✔ 정답** 3. The child prefers to play alone rather than engage in group activities with peers 4. The child has difficulty sitting still during structured activities and becomes easily distracted **정답: 2** ## 해설 Intellectual disability is defined by significant limitations in intellectual functioning and adaptive behavior. A 5-year-old primarily communicating with single words and gestures indicates severe deficits in both areas, meeting diagnostic criteria. Other options describe common developmental variations (e.g., riding a bike, solitary play, distractibility) not definitive for intellectual disability. ## 심화 해설 Correct Answer: 2 Analysis of the Core Issue The question asks for the finding most indicative of an intellectual disability (ID) in a 5-year-old. According to the DSM-5-TR, ID is defined by deficits in both general intellectual abilities and adaptive functioning, with onset during the developmental period [1]. At a 5-year-old level, a key manifestation of impaired intellectual functioning is a significant delay in language development, which is a critical cognitive skill. Option 2 directly describes a severe language delay—using primarily single words and gestures with a limited ability to form sentences—which is a profound red flag for a global cognitive impairment at this age. In-Depth Rationale for Each Option Why Option 2 is the Most Indicative Language development is a direct reflection of cognitive processing and symbolic thinking. By age 5, a child with typical development has a vocabulary of over 2,000 words and speaks in complex sentences of five to eight words, telling stories and using future tense. The finding that a 5-year-old communicates “primarily through single words and simple gestures” represents a developmental level closer to that of a 12- to 18-month-old. This severe delay in a core intellectual domain is a hallmark sign of a neurodevelopmental disorder like ID. Systematic reviews identify the absence of two-word phrases by 24 months as a critical warning sign for neurodevelopmental disorders, and by age 5, the persistence of single-word communication is a powerful indicator of a global intellectual deficit, not just an isolated speech delay [2]. Why the Other Options are Less Indicative - Option 1: The child can ride a bicycle with training wheels but cannot tie shoelaces independently. This describes a discrepancy in motor skill development, which is common. Riding a bicycle with training wheels is a gross motor skill typically achieved around age 5. Tying shoelaces is a complex fine motor task requiring advanced visual-motor coordination and sequencing, often not mastered until age 6 or 7. A delay in an isolated fine motor skill, while gross motor skills are age-appropriate, is more suggestive of a specific developmental coordination disorder rather than a global intellectual disability [2]. In ID, you would expect a more pervasive delay that includes gross motor, fine motor, language, and social milestones. - Option 3: The child prefers to play alone rather than engage in group activities with peers. While children with ID may have social skill deficits, a preference for solitary play at age 5 can be a temperamental trait or a feature of other conditions. This finding is a hallmark characteristic of autism spectrum disorder (ASD), where the core deficit is in social communication and interaction, not necessarily intellectual ability. A child can have an average or high IQ and still prefer solitary play due to ASD. Therefore, this finding is not specific to intellectual disability [2]. - Option 4: The child has difficulty sitting still during structured activities and becomes easily distracted. This finding is a classic presentation of attention-deficit/hyperactivity disorder (ADHD). The core symptoms of inattention, hyperactivity, and impulsivity directly explain the inability to sit still and easy distractibility. While ADHD can be a co-occurring condition with ID, these symptoms in isolation are diagnostic of ADHD, not ID. The primary deficit in ID is in cognitive and adaptive functioning, not attention and activity regulation [2]. Clinical Reasoning and NCLEX Application When assessing for intellectual disability, the nurse must differentiate between a global delay and a specific developmental delay. A global delay affects multiple domains, with language and cognition being central. The most sensitive and specific early marker for a global cognitive issue is a significant language delay. A 5-year-old who cannot form sentences is not just behind in speech; this signals a fundamental deficit in the brain's ability to process, understand, and produce symbolic language, which is the foundation of intellectual function. This aligns with the diagnostic criteria requiring impairment in intellectual abilities, which for a pre-school child is best assessed through language and problem-solving milestones [1,3]. The other options describe isolated motor, social, or attention deficits that can occur independently of intellectual ability.References (research sources) - [1]Types and Diagnosis of Childhood Intellectual Disabilities: Advancing Accuracy for Better Outcomes.Research articleBabiker R, Sami MM, Ahmed HK, Salama RA. (2025) · DOI: 10.3390/children12121585 - [2]Warning signs for identifying neurodevelopmental disorders: a systematic literature review.Research articleAraújo LA. (2026) · DOI: 10.1016/j.jped.2025.101478 ## 임상 시나리오 5-Year-Old Intellectual Disability ScreeningLanguage as the Key Cognitive Marker At age 5, a child should speak in complex sentences of 5 to 8 words. Communication limited to single words and simple gestures represents a developmental level of a 12- to 18-month-old, signaling a profound global cognitive delay. This severe language delay is a direct reflection of impaired symbolic thinking and intellectual functioning, making it the most specific indicator of Intellectual Disability (ID) per DSM-5-TR criteria. CautionDo not confuse isolated motor delays (e.g., tying shoes) or behavioral symptoms (e.g., inattention) with ID. A failure to develop two-word phrases by 24 months is an early critical warning sign requiring immediate comprehensive evaluation. ## 핵심 개념 - **Intellectual Disability (ID)** — A neurodevelopmental disorder defined by deficits in intellectual and adaptive functioning with onset during the developmental period. - **Adaptive Functioning** — How effectively an individual copes with common life demands and lives independently; includes conceptual, social, and practical domains. - **DSM-5-TR** — The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision; the standard classification of mental disorders used by health professionals. - **Developmental Milestones** — A set of functional skills or age-specific tasks that most children can do at a certain age range, used to monitor a child's development. - **Symbolic Thinking** — The cognitive ability to use symbols, words, or objects to represent something that is not physically present, crucial for language development. ## 같은 주제 문제 - [A nurse is conducting a developmental assessment on a 7-year-old child suspected of having…](https://mymerci.kr/pages/nclex_q.php?qn_id=542465) - [A nurse is caring for a 10-year-old child with mild intellectual disability who is being p…](https://mymerci.kr/pages/nclex_q.php?qn_id=542467) - [A nurse is caring for a 12-year-old adolescent with mild intellectual disability who is be…](https://mymerci.kr/pages/nclex_q.php?qn_id=542468) - [A nurse is caring for a 10-year-old child with mild intellectual disability who is being a…](https://mymerci.kr/pages/nclex_q.php?qn_id=542469) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._