Speech and language present many challenges for children with Down syndrome but there is information that can help infants and toddlers begin learning to communicate, and help young children progress in speech and language. Although most children with Down syndrome learn to speak and will use speech as their primary means of communication, they will understand language and have the desire to communicate well before they are able to speak. Total communication, using sign language, pictures, and/or electronic synthesized speech can serve as a transitional communication system.
Are Hearing Problems Common in Children with Down Syndrome?
Ear infections occur frequently in infancy and early childhood in all children. But, because of anatomic differences in the ears of children with Down syndrome (narrow and short canals), they are more susceptible to accumulations of fluid behind the eardrum. This is known as Otitis Media with Effusion (OME). These problems result from fluid retention and inflammation in the middle ear; sometimes with infection. The presence of fluid makes it more difficult for the child to hear, resulting in fluctuating conductive hearing loss. Children should be followed by their pediatrician and otolaryngologist (ENT) and visit an audiologist for auditory testing. This testing can be done soon after birth. Hearing testing should also be done every six months until three years of age and annually through age 12 years. Treatment usually involves either an antibiotic regimen or the insertion of tubes to drain the fluid. These recommendations follow the schedule found in the Down Syndrome Health Care Guidelines.
What Effect Does Hearing Loss Have on Speech and Language Development?
Speech and language are learned through hearing, vision and touch. Hearing is very important to speech, and studies have shown that speech and language development are negatively affected by chronic fluid accumulation. Children with Down syndrome often have fluctuating hearing loss due to the frequency of fluid accumulation. When fluid is present, hearing is affected; as fluid drains, hearing improves. When children do not consistently hear well, it is difficult to learn how sounds and events are related, e.g. the ring of the telephone or someone calling you. So, it is important to ensure that your child is hearing well. Pediatricians and otolaryngologists have great success in treating fluid accumulation, but treatment requires close monitoring.
How Is Feeding Related To Speech and Language?
Speech is a secondary function that uses the same anatomic structures used for feeding and respiration. Low muscle tone (hypotonia) affects feeding and will also affect speech. In feeding, children gain practice with strengthening and coordinating the muscles that will be used for speech. If your child has difficulty feeding, it is important to seek guidance from a feeding specialist (a speech-language pathologist or occupational therapist who has advanced training). Feeding therapy can to help strengthen the oral muscles. This can also have a positive effect on speech.
What Other Skills Are Related To Speech and Language Development?
Other important pre-speech and pre-language skills are the ability to imitate and echo sounds; turn-taking skills (learned through games such as peek-a-boo); visual skills (looking at the speaker and looking at objects); auditory skills (listening to music and speech for lengthening periods of time, listening to speech sounds); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving lips); and cognitive skills (understanding object permanence, cause and effect relationships). The family can stimulate these pre-speech and language skills at home. Contact Child Find in your area, and ask for speech-language pathology services for your child. The SLP can help you learn the skills that you need to help your child move along the journey to learning language and using speech.
When Will My Child Say His First Word?
Children with Down syndrome frequently begin to use single words between the ages of two and three, but the age of the first word varies, and the first true word may not be a spoken word, but it may be a signed word. Most children with Down syndrome communicate from birth through crying, looking and gesturing. They have the desire to communicate and learn that crying or making sounds can affect their environment and bring them help and play and attention. Many children with Down syndrome, by 10-12 months of age, understand the relationship between a word and a concept. However, at that age, the child generally does not have sufficient neurological and motor skills developed to be able to speak. That's why it is important to provide another system so that the child can communicate and learn language before they are able to speak.
What Is Total Communication?
Total communication (TC) is the combined use of signs and gestures with speech to teach language. Total communication provides the child with an output system to communicate when he or she has not yet developed the skills needed for speech. In total communication, the adult uses sign and speech when talking with the child. The child learns signs in conjunction with speech and uses the signs to communicate. Sign language is a transitional system for children with Down syndrome. Other choices for transitional communication systems are pictures used on a communication board or in a communication exchange system, and/or electronic communication systems which use synthesized speech. Most children with Down syndrome are ready to use a language system many months or even several years before they are able to use speech effectively to communicate. Therefore, a transitional communication system such as sign language, pictures or synthesized voice is frequently needed. A speech-language pathologist and/or augmentative communication specialist (AAC) can help design a transitional communication system for your child. Most children with Down syndrome will use speech as their primary system for communication.
What Can Parents Do to Help Infants and Young Children Learn Speech and Language?
Parents are the primary communicators interacting with their babies and young children; thus, parents can do a great deal to help their children learn to communicate. Many of the pre-speech and pre-language skills are best learned in the home environment.
- Remember that language is more than spoken words. When you are teaching a word or a concept, focus on conveying meaning to the child through play or through multisensory experiences (hearing, touch, seeing).
- Provide many models. Most children with Down syndrome need many repetitions and experiences to learn a word. Repeat what your child says, and give him a model to help him learn words.
- Use real objects and real situations. When you are teaching a concept, use daily activities and real situations as much as possible. Teach the names of foods as your toddler is eating, names of body parts while you are bathing your child, and concepts such as under, in and on while your child is playing. Communication is part of daily life.
- Read to your child. Help your child learn concepts through reading about them, field trips in the neighborhood and daily experiences.
- Follow your child's lead. If your child shows interest in an object, person or event, provide him or her with the word for that concept. There are many milestones as the child progresses toward using speech. The child responds to a familiar voice, recognizes familiar faces, experiments with many different sounds, produces strings of sounds over and over and makes a sound to mean you (dada, mama). Many children enjoy looking in a mirror, and increase their sound play and babbling when vocalizing in mirrors. Effective ways to work on these skills at home can be learned through early intervention sessions, through books, workshops and speech and language professionals.
When Should Speech-Language Pathology Services Begin? What Is Early Language Intervention?
Speech-language pathology services can begin in infancy. Treatment may involve sound stimulation, language stimulation accompanying play, feeding, oral motor exercises and/or other techniques. It should always include the family as a partner in treatment because the family is the primary teacher of speech and language. Early language intervention (ELI) is the designation given for services provided to infants and toddlers from birth through the end of age two. Speech-pathology services should be part of a comprehensive overall treatment plan for infants and toddlers. It may involve sessions at home or in a center, and may be part of a team approach involving physical, occupational and other therapists working together with the family.
A government-sponsored early intervention program is available in all communities in the U.S. Speech-language and other therapy services are often provided at these programs for eligible children under age three, based on disability and an evaluation. Most children with Down syndrome qualify for speech-language services. After age three, there may be continuing services sponsored through the school system with an IEP or through community agencies, private practitioners, university clinics, medical centers and other sources.
How Do You Find a Qualified Speech-Language Pathologist?
Qualified SLPs are certified by the American Speech-Language-Hearing Association and licensed by the state. When a professional is certified, they can use CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) following their name. This means they have completed a master's degree in an accredited program, have completed required hours of clinical practice internship and passed a national certification examination. If you are receiving services through Child Find (a federal program that identifies the needs of children with disabilities), the health department or school system in your local area, they will have professionals working with them or they can refer you to local professionals. Members of local Down syndrome support groups can often refer you to speech-language pathologists in your area who have experience working with children with Down syndrome.
NDSS thanks Libby Kumin, PhD, Professor of Speech-Language Pathology/Audiology, Loyola College in Maryland for preparing this piece.
- American Speech-Language-Hearing Association
Connect with Certified Audiologists and Speech-Language Pathologists through on-line seach function
- National Institute on Deafness and Other Communication Disorders Clearinghouse
An extensive website with resources on all things communication
- Early Communication Skills for Children with Down Syndrome. Kumin, L. Bethesda, MD: Woodbine House. (2003)
- The New Language of Toys:Teaching Communication Skills to Special Needs Children (Third Edition). Schwartz, S. Bethesda, MD: Woodbine House. (2004)
- Speech and Language Development and Intervention in Down Syndrome and Fragile X Syndrome. Roberts, J., Chapman, R., and Warren, S. Baltimore, MD: Brookes Publishing. (2008)
- Shott, S. R. (2000). Down syndrome: Common pediatric ear, nose, and throat problems. Down Syndrome Quarterly, 5, 1-6.
- Shott, S.R., Joseph, A., and Heithaus, D. Hearing loss in children with Down syndrome. International Journal of Pediatric Otolaryngology 1:61 (3): 199-205, 2001.