Johns Hopkins Psychiatry Guide
Communication Disorders
DEFINITION
- A communication disorder is a neurodevelopmental disorder characterized by impairments in sending, receiving, processing, or comprehending verbal, nonverbal, or graphic language, speech, and/or communication.
- Communication disorders may be developmental or acquired (secondary to trauma or neurological disorder).
- Language is one of five major streams of development, within which developmental milestone acquisition occurs at a specific rate in an orderly and sequential manner[1].
- See Table Language and Social Milestones for language and social milestones in a typically developing child.
- Deviation from these milestones may signal the presence of a communication disorder.
- For further developmental information, please see the American Academy of Pediatrics’ Bright Futures (http://brightfutures.aap.org/index.html) or the CDC’s Milestones (http://www.cdc.gov/NCBDDD/actearly/milestones/index.html).
Age | Language Milestone | Social/Adaptive Milestone |
Birth through 6 months | Alerts to sound, Coos (musical long-vowel sounds), Orients to voice, Babbles, Responds to name | Pays attention to faces, Reaches for familiar people and objects, Differentiates strangers, Social smile |
9 months | Says "mama, dada" indiscriminately, Gestures, Waves bye-bye, Understands "no" | Starts exploring environment; Copies sounds and gestures of others; Plays gesture games (pat-a-cake); Initiates bids for interaction, actions, or objects |
12 months | May use 2 words other than "mama, dada" or proper nouns for communicative purposes, Follows 1-step command with gesture such as “give the bottle” | Comes when called by someone nearby, Cooperates with dressing |
15 - 18 months | Uses 4-10 words consistently and communicatively, Follows familiar 1-step commands without gesture, Mature jargoning (with intelligible words), Understands the label for 5 body parts | Uses spoon and cup, Points to share attention/enjoyment with another person, Plays in company of other children |
24 months | 50% of speech is intelligible, Uses pronouns (I, you, me) appropriately, Follows 2-step commands, At least 50-word vocabulary, 2-word phrases | Parallel play |
3 years | 75% of speech is intelligible, Uses a minimum of 250 words, Phrase speech is established with 3- or more-word sentences produced communicatively, Uses plurals and other grammatical markers such as "ing" (e.g., "throwing"), Uses pronouns, Repeats 2 digits | Shares toys; Takes turns; Plays well with others in 1:1 and group settings; Can state full name, age, gender |
4 years | Speech is mostly intelligible, Knows colors, Recites song or poem from memory, Asks questions | More creative with make-believe play, Moves back and forth between what is real and what is make-believe, Plays cooperatively with a group of children |
5 years | Prints first name, Asks meanings of words | Plays competitive games, Abides by rules, Likes to help in household tasks |
- Communication disorders fall into a number of separate diagnoses (language disorder, speech sound disorder, childhood-onset fluency disorder, social communication disorder) and are classified under the Neurodevelopmental Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)[2].
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