Communication Skills and Disorders

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The skills needed to use language (spoken, written, signed, or otherwise communicated) to interact with others, and problems related to the development of these skills.

Experts in child development generally agree that all babies develop skills for spoken and written language according to a specific developmental schedule, regardless of the language being learned. Although the milestones follow one another in roughly the same sequence, there is significant variability from child to child as to when the first word is spoken and the first sentence is composed.

The accompanying table illustrates the developmental milestones for communication.

Language employs symbols—words, gestures, or spoken sounds—to represent objects and ideas. Communication of language begins with spoken sounds combined with gestures, relying on two different types of skills. Children first acquire the skills to receive communications, that is, listening to and understanding what they hear (supported by accompanying gestures); next,

Age	Milestone
0-12 months	Responds to speech by looking at the speaker; responds differently to aspects of speaker's voice (such as friendly or angry, male or female). Turns head in direction of sound. Responds with gestures to greetings such as "hi," "bye-bye," and "up" when these words are accompanied by appropriate gesture by speaker. Stops ongoing activity when told "no" when speaker uses appropriate gesture and tone. May say two or three words by around 12 months of age, although probably not clearly. Repeats some vowel and consonant sounds (babbles) when alone or spoken to; attempts to imitate sounds.
12-24 months	Responds correctly when asked "where?" Understands prepositions on, in, and under; understands simple phrases (such as "Get the ball."). Says 8-10 words by around age 18 months; by age two, vocabulary will include 20-50 words, mostly describing people, common objects, and events (such as "more" and "all gone"). Uses single word plus a gesture to ask for objects. Refers to self by name; uses "my" or "mine."
24-36 months	Points to pictures of common objects when they are named. Can identify objects when told their use Understands questions with "what" and "where" and negatives "no," "not," "can't," and "don't." Responds to simple directions. Selects and looks at picture books; enjoys listening to simple stories, and asks for them to be read aloud again. Joins two vocabulary words together to make a phrase. Can say first and last name. Shows frustration at not being understood.
36-48 months	Begins to understand time concepts, such as "today," "later," "tomorrow," and "yesterday." Understands comparisons, such as "big" and "bigger." Forms sentences with three or more words. Speech is understandable to most strangers, but some sound errors may persists (such as "t" sound for "k" sound).
48-60 months	By 48 months, has a vocabulary of over 200 words. Follows two or three unrelated commands in proper order. Understands sequencing of events ("First we have to go to the grocery store, and then we can go to the playground"). Asks questions using "when," "how," and "why." Talks about causes for things using "because".

Source: U.S. Department of Health and Human Services.
60-72 months	By 60 months, can identify rhyming words. There are few obvious differences between child's grammar and adult grammar. Still needs to learn subject-verb agreement, and may not have mastered all irregular verbs. Can carry on a conversation. Communicates with family, friends, and strangers, and responds with information appropriately.

they will begin experimenting with expressing themselves through speaking and gesturing. Speaking will begin as repetitive syllables, followed by words, phrases, and sentences. Later, children will acquire the skills of reading and writing, the written forms of communication. Although milestones are discussed for the development of these skills of communication, many children begin speaking significantly earlier or later than the milestone date. Parents should refrain from attaching too much significance to either deviation from the average. When a child's deviation from the average milestones of development cause the parents concern, a pediatrician or other professional may be contacted for advice.

Spoken language problems are referred to by a number of labels, including language delay, language disability, or a specific type of language disability. In general, experts distinguish between those children who seem to be slow in developing spoken language (language delay)

and those who seem to have difficulty achieving a milestone of spoken language (language disorders).

Language disorders include stuttering; articulation disorders, such as substituting one sound for another (tandy for candy), omitting a sound (canny for candy), or distorting a sound (shlip for sip); and voice disorders, such as inappropriate pitch, volume, or quality. Causes can be related to hearing, nerve/muscle disorders, head injury, viral diseases, mental retardation,

drug abuse, cleft lip

or palate.

In the past, most parents, pediatricians, and educators recommended giving the child time to outgrow a difficulty with spoken language. As of the late 1990s, research had shown that early speech and language disorders could lead to later difficulties in learning to read, write, and spell. Thus, many professionals recommended evaluation by a speech-language pathologist for toddlers who demonstrated language delay. However, not all speech-language specialists agree on early evaluation and therapy. Those who feel early intervention is unnecessary cite the results of research by Rhea Paul at Portland (Oregon) State University. She found that about two-thirds of children who were not talking at age two showed continued delays until age three, and one-half were still behind the typical language development schedule at age four. But by kindergarten, only one-fourth of those children had not caught up with their peers.

Parents and their pediatrician should communicate frequently about a child's spoken language development, and should consider all factors related to spoken language delay when considering whether to have a specialist evaluate and treat the delay. Such factors as the possible stigma attached to labeling a child with language difficulties versus whether intervention will prevent social and educational difficulties should be considered in making the decision.

Berko-Gleason, J.

The Development of Language.

New York:

Macmillan, 1993. de Villiers, P., and J. de Villiers. Early Language.

The Developing Child series. Cambridge, Mass.: Harvard University Press, 1979.

Fletcher, P., and B. MacWhinney.

The Handbook of Child Language. Cambridge, MA: Blackwell Publishers, 1995. Goodluck, H. Language Acquisition: A Linguistic Introduction.

Cambridge, MA: Blackwell Publishers, 1991. Landau, B., and L. Gleitman. Language and Experience: Evidence from the Blind Child. Cambridge, MA: Harvard University Press, 1985. Pinker, S. The Language Instinct.

New York: Morrow, 1994.

Bates, Elizabeth, and Jeffrey

Elman. "Learning Rediscovered."

Science 274, December 13, 1996, pp. 1849+.

Cowley, Geoffrey. "The Language Explosion."

Newsweek 129,

Spring-Summer 1997, pp. 16+.

American Speech-Language-Hearing Association
Address: 1801 Rockville Pike
Rockville, MD 20852
Telephone: toll free voice or TTY (800) 638-8255; voice or TTY (301) 897-8682
e-mail: ircasha.org
website: www.asha.org
(Publishes brochures, booklets, and fact sheets on speech-language pathology.)

National Institute on Deafness and Other Communication Disorders
Address: National Institutes of Health
Bethesda, MD 20892
e-mail: webmaster@ms.nih.gov
website: www.nih.gov/nidcd/

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