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Communication
Changes in speech and language are the most dramatic transformation during the preschool period (Table 2). The young child proceeds from largely unintelligible bullets of speech to language that allows him or her to ask complex questions, describe events, share feelings, and enter into independent relationships and
TABLE 2. How does communicate what she wants?
2-YEAR VISIT 3-YEAR VISIT 4-YEAR VISIT 5-YEAR VISIT
Vocabulary No jargon; 150 to Definitions
500 words
Sentence length/ 2 words/1.5 to 2.5 3 to 4 words/2.5 to 4 to 5 words/3.5 to
MLU* 5.0 6.5 in paragraphs
Intelligiblity to 25% 75% 100%
stranger
Grammatic forms Verbs, some Plurals, pronouns Past tense Future tense
adjectives and
adverbs
Typical examples Talks about current Tells own age and Describes recent Counts to I0 or
action, no jargon, sex, counts to 3, experiences, can more, recognizes
names pictures* metacognitive sing songs, gives most letters of
language (eg, "He first and last the alphabet,
said"; "I know") names, counts to 4, knows telephone
identifies gender number and
of self and others address
Fluency Dysfluency is Dysfluency is Some dysfluency Dysfuencies not
common common expected
During the 4- to 5-year age range, parents generally are quite accurate in their concerns about articulation, such as in response to a general question as to whether they have any doubt about the clearness of their child's speech. Their impressions are confirmed about 50% of the time when compared with results of standard diagnostic tests, but surprisingly, most children found by testing to have articulation problems are not identified by their parents. The
Dysfluency (aberration of speech rate and rhythm) occurs transiently between about 2.5 and 4 years of age. Persistent and worsening stuttering beyond the age of 4 should be taken seriously. Other signs of the need for referral include: grimacing with blocking of speech, self-consciousness, delayed language forms, or stuttering that persists for more than 6 months. The family history is often positive for stuttering. Families should be counseled to make eye contact, speak more
There is great variation in the development of language. Recent evidence suggests several different patterns of normal progression for language acquisition. As a group, girls are more advanced than boys in language acquisition. Ethnic differences
The pediatrician finding superior language skills in a child can congratulate the parents and encourage them about its important advantages. Children who have superior language skills have fewer behavior problems (especially with aggression), are more amenable to parental discipline, can negotiate better with peers, are more resilient to stress, and are less likely to have reading-related academic problems.
Comprehension
To assess comprehension through the second year of life, the clinician must consider how the child responds to parental commands (Table 4) and distinguish "simple requests," the possible response at the l-year visit, from "simple instructions without gestured cues" for the 15-, 18-, and 24-month visits. An example of the 1-year "simple request" would be to ask the child for the toy or tongue depressor he or she is holding and prompt him or her by holding out a hand for it or accept a parental report of a similar response. Expectations for following verbal-only instructions range from the child ever having been noted to follow an instruction at home (at the 15-month visit) to being able to demonstrate it rather consistently (by the 24-month visit). As with the gestured request at 1 year, the physician could ask for the
TABLE 4. Comprehension
|
2-YEAR VISIT |
3-YEAR VISIT |
4-YEAR VISIT |
5-YEAR VISIT |
Number step command |
100% for 1 without gesture |
2 |
3 |
|
Number of body parts |
names 1, identifies 7 |
|
|
|
Number of colors |
|
2 named |
4 named |
|
Gender |
self |
self and others |
|
|
Own names |
refers to self by name |
first and last |
|
|
Numbers counted |
says "2" (not counted) |
counts to 3 |
|
10, knows number |
Relationships |
|
which is bigger, on, under |
which is longer,2 opposites |
|
The comprehension ability of "naming body parts" is a "possible response" for the 15-, 18-, and 24-month visits. However, "identifies body parts" would be a better marker to look for at the 15-month and probably 18-month visit because naming a body part (usually parts of the face initially) emerges as an expected item at 18 months, while identifying by correctly pointing on themselves (or a doll) can be expected by 15 months of age. These