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Communicative and Motor Aspects Preschool Development

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

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.

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.

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.

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.

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.