A nurse is collecting data on an 18-month-old toddler at a wellness visit in the health care provider's office. During the appointment, the nurse asks the parent about developmental milestones. The parent states that the toddler has not said their first word yet. Which of the following actions by the nurse is accurate?

A. Complete a screening test for autism spectrum disorder (ASD). By 18 months, most toddlers have said their first word, and a lack of speech development can be an early sign of ASD or other developmental delays. The M-CHAT (Modified Checklist for Autism in Toddlers) is a common screening tool used at this age to assess for autism. Early identification allows for timely interventions. B. Ask the parent about recent immunizations. While immunization history is important for overall health, there is no connection between vaccines and delayed speech development. This question does not directly address the developmental concern at hand. C. Educate the parent that toddlers do not typically say their first word until 18-20 months of age. This is incorrect. Most toddlers say their first word around 12 months, and by 18 months, they typically have a vocabulary of several words. A lack of speech at this age warrants further assessment. D. Ask the parent if the toddler has a history of hospitalizations or surgeries. While medical history is important, hospitalizations or surgeries are not the most common causes of delayed speech. Developmental screening is the most appropriate next step in evaluating speech delays.