A nurse is assessing a 4-year old preschooler. Which of the following findings should indicate to the nurse a need to refer the child for a possible developmental delay? (Select all that apply.)

A. Occasional letter reversal is common at this age and not a concern for developmental delay. B. At 4 years old, a child should be able to follow simple two-step instructions. Difficulty doing so may indicate a developmental delay. C. Occasional stuttering when excited or nervous is common and does not indicate a developmental delay. D. A vocabulary of fewer than 50 words is concerning, as children at this age typically have a much larger vocabulary. E. Difficulty sharing toys is developmentally normal for a 4-year-old and does not necessarily indicate a delay.