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Communicative and Motor Aspects of Preschooler Development

Communication

Changes in speech and language are the most dramatic transformation during the preschool period. Communication proceeds from largely unintelligible bullets of speech to language that allows him to ask complex questions, describe events, share feelings, and enter into independent relationships and learning. Children master most of the rules of grammar (syntax) by age 6, largely preschooler development, motor, speech, communications, talking, play.

Communication Skills in Preschoolers
	2-YEAR VISIT	3-YEAR VISIT	4-YEAR VISIT	5-YEAR VISIT
Vocabulary	No jargon; 150 to 500 words			Definitions
Sentence length/MLU*	2 words/1.5 to 2.5	3 to 4 words/2.5 to 5.0	4 to 5 words/3.5 to 6.5 in paragraphs
Intelligibility to stranger	25%	75%	100%
Grammatic forms	Verbs, some adjectives and adverbs	Plurals, pronouns	Past tense	Future tense
Typical examples	Talks about current action, no jargon, names pictures*	Tells own age and sex, counts to 3, metacognitive language (eg, "He said"; "I know")	Describes recent experiences, can sing songs, gives first and last names, counts to 4, identifies gender of self and others	Counts to 10 or more, recognizes most letters of the alphabet, knows telephone number and address
Fluency	Dysfluency is common	Dysfluency is common	Some dysfluency	Dysfuencies not expected
*MLU = mean length of utterance measured by the number of meaningful units or morphemes rather than words.

The 2-year-old child uses words for communication. Although such speech usually is not very intelligible to a stranger, it does consist of words rather than jargon. The child still is acquiring language rapidly and has a vocabulary of approximately 150 to 500 words. The child would be expected to be speaking in two-word utterances consisting initially of primarily the simplest noun phrases (eg, noun plus modifier such as "my Mommy" or "more milk") or verb phrases (eg, "Mommy go" or "baby sleep"). Sentence structure typically becomes more complicated by 2.5 years of age, with nouns.

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 slowly.

As a group, girls are more advanced than boys in language acquisition. Three to five percent of children may be affected by the developmental type of expressive language disorder. 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.

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 1-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.

School Readiness

Communication skills are often of concern because of their importance to schooling. Evidence during the visit may include: ability to answer questions asked by the clinician during the visit, such as name, age, colors, numbers, alphabet, general information; problems noted on the pure tone hearing test; or immature responses to the drawing and conversation about the drawing or other aspects.

Parents are eager and often anxious about their preschooler's school readiness, especially for the ultimate skill of reading. Although reading is not expected before age 6, prereading skills can be present, such as knowledge of letters, words, and symbols such as signs and awareness of letters.

Gross Motor Skills

Gross motor skills are a joy to the preschooler, who endlessly practices and shows them off. By age 2, children generally can walk, run, and balance at least a little, but refinements continue in balance, coordination, speed, and strength (Table 5). The slightly bent-over stance of the 2-year-old while running with changing speed and direction gives way to the more upright 3-year-old who swings arms in time with the strides. Movement forward and upstairs precedes the more difficult tasks.