Speech and language development can be challenging for many children with Down syndrome. Here is information that can help infants and toddlers begin learning to communicate, and help children and adolescents progress in speech and language.
Speech & Language Therapy for Infants, Toddlers & Young Children
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 for them to learn how sounds and events are related, e.g. the ring of the telephone or someone calling them. It is important for parents to ensure that their 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 a child has difficulty feeding, it is important that his or her parents 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, which in turn can 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 speakers and objects); auditory skills (listening to music, speech, and speech sounds for lengthening periods of time); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving the lips); and cognitive skills (understanding object permanence and cause and effect relationships). The family can stimulate these pre-speech and language skills at home. Parents can contact Child Find (a federal program that identifies the needs of children with disabilities) in their area and ask for speech-language pathology (SLP) services for their child. SLP can help parents learn the skills that they need to help their child begin 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. Also, the first true word may be signed, not spoken. 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, play, and attention. Many children with Down syndrome understand the relationship between a word and a concept by 10-12 months of age. However, at that age, a 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 a child with an output system to communicate when he or she has not yet developed the skills needed for speech. In total communication, adults use 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 pre-speech and pre-language skills are best learned in the home environment. To help their children develop those skills, parents should:
- Remember that language is more than spoken words. When they are teaching a word or a concept, they should 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. Adults should repeat what a child says and give him or her a model to help reinforce a word.
- Use real objects and real situations. When teaching a concept, parents can use daily activities and real situations as much as possible. They can teach the names of foods as their toddler is eating, names of body parts while bathing the child, and concepts such as under, in and on while the child is playing. Communication is part of daily life.
- Read to their child. They should help their child learn concepts through reading about them, field trips in the neighborhood and daily experiences.
- Follow their child’s lead. If a child shows interest in an object, person or event, parents should 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 refer to his or her parents (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. This 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 a family is receiving services through Child Find or through the health department or school system in their local area, those organizations will either have professionals associated with them or be able to refer parents to local professionals. Members of local Down syndrome support groups can often refer parents 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.
Speech & Language Therapy for Children & Adolescents with Down Syndrome
Children with Down syndrome have strengths and challenges in development of communication skills, including receptive (understanding) language and expressive (speaking and composing sentences) language skills and reading. It takes a team to help children and adolescents progress well in speech and language; that team typically includes speech-language pathologists, physicians, classroom teachers, special educators and families. Speech-language pathologists have information and expertise to help address the speech and language problems faced by many children with Down syndrome. Physicians treat ear, nose and throat conditions and metabolic and hormonal concerns that may affect respiration, hearing, voice and articulation. School learning is language based, so classroom teachers, special educatos and speech-language pathologists help in modifying language and curriculum to help children learn. Parents play an important role in their child’s speech and language development because home and daily activities are the core of communication.
What Are the Language Characteristics of Children and Adolescents with Down Syndrome?
Research and clinical experience demonstrate that some areas of language are generally more difficult for children with Down syndrome while other areas are relatively easier. Children with Down syndrome have strengths in the area of vocabulary and pragmatics (social interactive language). They often develop a rich and varied vocabulary as they mature. They have good social interactive skills and use gestures and facial expressions effectively to help themselves communicate. They generally have the desire to communicate and interact with people. Syntax and morphology (including grammar, verb tenses, word roots, suffixes and prefixes) are more difficult areas, possibly because of their complex and abstract nature. Children with Down syndrome frequently have difficulty with grammar, tenses and word endings and use shorter sentences to communicate.
Most children with Down syndrome are able to understand much more than they can express. As a result, their test scores for receptive language are higher than for expressive language. This is known as the receptive-expressive gap.
Children with Down syndrome learn well through visual means, so often reading and the use of computer programs focusing on language skills can help them learn. Seeing words and images associated with sounds and being able to read words can help speech and language develop. For some children, the written word can provide helpful cues when using expressive language.
What Are the Speech Characteristics of Children and Adolescents with Down Syndrome?
There are a wide range of abilities that children with Down syndrome demonstrate when using speech. Speech intelligibility (speech that can be easily understood) is one of the most difficult areas for people with Down syndrome at all ages. Many children have difficulty with the strength, timing and coordination of muscle movements for speech. Speech involves coordinating breathing (respiration), voice (phonation), and the production of speech sounds (articulation). Factors that can contribute to speech intelligibility problems include: articulation problems with specific sounds, low oral-facial muscle tone, difficulty with sensory processing and oral tactile feedback, use of phonological processes (e.g. leaving off final sounds in words) and difficulties in motor planning for speech.
What Does a Speech-Language Pathologist Do?
A speech-language pathologist (SLP) can provide evaluation and treatment for the speech and language difficulties experienced by children and adolescents with Down syndrome. They can help develop a comprehensive treatment plan to address all of the areas in which the child may be experiencing difficulty, including receptive and expressive language, semantics (vocabulary), syntax (grammar), pragmatics (uses of language and social and conversational skills) classroom language skills, speech, oral motor planning and oral motor strengthening. SLPs can work with families and teachers to design and implement an effective school, home and community program to help children develop stronger communication skills.
What Language Skills Are Needed for School?
Parents can help by working as a team with their school personnel to develop an individualized treatment program. In school settings in the United States, the plan will be part of the IEP (Individualized Education Program). Speech and language IEPs may include diagnosis and evaluation, individual therapy sessions, group therapy sessions, classroom-based therapy sessions and/or outcome goals. The IEP may also include provisions for information, consultation and guidance to parents and classroom teachers.
When children are in inclusive settings, the speech-language pathologist may consult with the teacher to provide information about a child’s speech and language needs, and may suggest modifications, such as providing the student with written rather than verbal instructions or including fewer items on a class worksheet. Accommodations such as preferential seating to help problems in hearing and listening may be used. Certain skills may also help prepare a child to get the most out of classroom learning; children who have learned to follow directions, have a good grasp of classroom routine and have basic subject knowlege are well prepared for a successful educational experience. Other communication skills needed include the ability to talk and interact with other children, teachers, custodians, cafeteria staff and other school personnel such as school bus drivers.
It is difficult for children in school when their speech and language can’t be understood by the teacher or other children in the class. Behavior problems are sometimes related to frustration in not being understood and the relationship between communication and behavior should be explored. In the schools, a child can be referred for a Functional Behavioral Analysis. Based on the findings, a Positive Behavior Intervention Program can be developed.
What Can Parents Do to Help Their Child’s Speech?
Parents can provide practice in speech and language skills at home and in the community. Varied and inclusive home and community experiences help children and adolescents with Down syndrome continue to acquire and use new communication skills. Activities that involve social interaction, such as scouting or participating in youth groups, can help young people with Down syndrome develop and practice speech and language skills. When a child has more opportunities to communicate, his or her skills will expand.
The speech-language pathologist can provide information and can design a home activities program to help the child practice the communication skills being addressed in therapy. It is important that parents stay in regular contact with the speech-language pathologist so that their child can practice speech and language skills. Regular phone or e-mail contact, a journal or audiotapes can provide that continuous contact. Parents can also seek additional services as needed. Books, workshops, conferences and newsletters can provide state-of-the-art information.
How Can I Get Help for My Child?
Parents are often frustrated because they feel that their child needs more speech and language therapy than is being provided by the school. School systems are the major provider of speech-language services, but they have guidelines that determine whether a child is eligible for their services. Sometimes eligibility depends on whether a child’s test scores are below those for his or her age; other criteria include the relationship between cognitive and language levels. Parents should make sure they are aware of the eligibility criteria, as well as the federal, state or local legislation and policies that apply to service delivery in speech and language.
Although most children receive speech and language services through their local educational system, speech-language pathology services are also available in hospitals, rehabilitation centers, university clinics and private practices. Parents should seek additional help for their children when needed.
How Can I Find a Qualified Speech-Language Pathologist (SLP)?
Qualified SLPs are certified by the American Speech-Language-Hearing Association and licensed by the state. After professionals have been certified, they can use CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) following their names. This means they have completed a master’s degree in an accredited program, completed required hours of clinical practice internship and passed a national certification examination. The American Speech-Language-Hearing Association or a specific state’s Speech-Language-Hearing Association can refer parents to local SLPs. Members of Down syndrome support groups can also often refer parents to local speech-language pathologists 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.