What is the most likely cause of the symptoms observed in the 14-year-old boy with cognitive decline and ataxia?

Inhalant abuse can lead to significant neurological impairment, which aligns with the symptoms of cognitive decline and ataxia observed in the 14-year-old boy. Inhalants, such as solvents, glues, and aerosol sprays, produce effects by causing hypoxia or directly damaging brain tissue, particularly in young adolescents whose brains are still developing.

The pattern of ataxia indicates issues with motor coordination, which can occur due to damage in the cerebellum or other areas of the central nervous system affected by inhalants. Additionally, the cognitive decline points to possible neurotoxicity and long-term effects of early substance use, which is consistent with the chronic impact of inhalant abuse.

In contrast, while substances like cocaine, ethanol, and methamphetamine can also lead to various neuropsychiatric symptoms, they do not typically present with the same specific combination of cognitive decline and ataxia, particularly in adolescents. Rather, those substances may lead to other acute or chronic effects that are more variable in their manifestation. Inhalant usage has a distinctive profile that makes it a probable cause of these symptoms in a young adolescent.