Review Question - QID 109450

An 11-year-old boy presents to the pediatrician to be evaluated for learning difficulties. The patient’s grades have been falling since he started middle school this year. The patient previously attended a smaller elementary school that focused more on the arts and creative play. The patient bathes and dresses himself independently but requires help with more difficult tasks, such as packing his backpack and making a schedule for homework. He enjoys reading comic books and playing video games. He said his first word at 19 months and walked at 21 months. His mother notes that she herself struggled to pay attention in her classes and completed college in 6 years after taking a reduced course load. The patient’s temperature is 98.6°F (37°C), blood pressure is 109/63 mmHg, pulse is 96/min, and respirations are 20/min. On physical exam, the patient has a long, narrow face with large ears. His testicles are larger than expected for his age. Which of the following additional findings is most likely to be found in this patient’s history?