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.
- American Speech-Language-Hearing Association
Provides resources and an online search tool to help parents connect with certified Audiologists and Speech-Language Pathologists
- National Institute on Deafness and Other Communication Disorders Clearinghouse
Conducts and supports research in the normal and disordered processes of hearing, balance, taste, smell, voice, speech and language
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