- The parents of a 3-year-old girl bring her to see you. They are concerned because their daughter has only an 8- to10-word vocabulary, and she does not put words together into phrases or sentences. They report that she seems to have no hearing problems; she responds to her name and follows directions well. In general, she has been in good health. Her development, aside from delayed speech, is normal. During the physical examination, which is also normal, the girl does not speak.
- The child described in the case history has delayed development of expressive language skills. At the age of 3 years, she should have a 250-word vocabulary and speak in 3-word sentences; in addition, her speech should be primarily intelligible to strangers. Because of the delay, she should be referred immediately for a hearing assessment and speech and language evaluation. Hearing loss is an important diagnosis to rule out. Simply because her parents report no hearing problems does not mean she does not have a deficit. She may have learned to respond to nonverbal cues, or she may hear only some things
Questions
1. What language skills should children have at 1, 2, and 3 years?
receptive-Normal Language Development
- At 12 mo, many children can follow a simple, one-step request without a gesture (e.g., “Give it to me!”).
- between 1 and 2 yr, comprehension of language accelerates rapidly. Toddlers can point to body parts on command, identify pictures in books when named, and respond to simple questions (e.g., “Where’s your shoe?”).
- The 2 yr old is able to follow a 2-step command, employing unrelated tasks (e.g., “Take off your shoes, then go sit at the table”), and can point to objects described by their use (e.g., “Give me the one we drink from”).
- By 3 yr, children typically understand simple “wh-” question forms (e.g., who, what, where, why).
expressive-Normal Language Development
- At 9 to 10 mo, babbling becomes truncated into specific words (e.g., “mama,” or “dada”) for their parents.Over the next several mo, infants learn 1 or 2 words for common objects and begin to imitate words presented by an adult. These words might appear to come and go from the child’s repertoire until a stable group of 10 or more words is established.
- The rate of acquisition of new words is approximately 1 new word per wk at 12 mo, but it accelerates to approximately 1 new word per day by 2 yr. The first words to appear are used primarily to label objects (nouns) or to ask for objects and people (requests).
- By 18 to 20 mo, toddlers should use a minimum of 20 words and produce jargon (strings of word-like sounds) with language-like inflection patterns (rising and falling speech patterns). This jargon usually contains some embedded true words.
- Spontaneous 2-word phrases (pivotal speech), consisting of the flexible juxtaposition of words with clear intention (e.g., “Want juice!” or “Me down!”), is characteristic of 2 yr olds and reflects the emergence of grammatical ability (syntax).
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By 3 yr, sentence length increases and the child uses pronouns and simple present tense verb forms. These 3-5 word sentences typically have a subject and verb
2. Approximately how many words should 3-year-olds have in their vocabulary?
250-word vocabulary
3. By what age should children’s speech be intelligible to strangers at least 75% of the time?
75% of speech intelligible to strangers
4. What are the Danger Signals in Language Development?
Inconsistent or lack of response to auditory stimuli at any age
• No babbling by 9 months
• No intelligible speech by 18 months
• Inability to respond to simple directions or commands (eg, “sit down,” “come here”) by 24 months
• Speech predominantly unintelligible at 36 months
• Dysfluency (stuttering) of speech noticeable after 5 years
• Hypernasality; inappropriate vocal quality, pitch, or intensity at any age
Superintendent, ICH.