Speech & Language Therapy

As Down syndrome selectively impairs speech and language, all children with Down syndrome will have speech and language disorders over and above what would be expected for their intellectual ability. Read that sentence again, and try to imagine how frustrating it must be to be continually underestimated because of poor speech and language!

Speech and Language need to be considered separately. The easiest way to think of them is in terms of form and content.

Language is the content. This is separated into receptive and expressive language. Receptive language is what the child understands. Expressive language is the message the child is trying to convey.

It can be difficult for a child with Down syndrome to process language. Difficult to distinguish between words. Difficult to recognise and remember the words for long enough to understand the message. It can be difficult to think of words, and then organise them into a phrase or sentence in order to respond. It can be difficult to absorb new vocabulary just by exposure, which is how most other children learn.

Speech is the usual form: how the child is trying to get their message across. It is not the only form, though. We also use sign, gesture, writing, facial expression and behaviour to convey messages.

People who have Down syndrome often have unclear speech for various reasons. There can be difficulties in remembering the pattern or order of sounds and syllables in a word. It can be difficult to coordinate muscles to make those sounds, and to make them in the right order consistently so that someone can understand. The ability to speak clearly may vary according to the complexity of the message, the time of day, tiredness, etc. It is unfair to assume that the child is being lazy if they don’t speak as clearly today as they did yesterday. Many children will supplement their speech with signing, at least in the early school years.

Speech and Language impairments affect access to all areas of the curriculum, not just language tasks. Language impairment is probably the most significant disability for the majority of children with Down syndrome in schools.

How can parents and teachers help?

  • Accept that language is a significant difficulty, and adjust your own language to compensate.
  • Use short, simple sentences.
  • Allow processing time: count to 10 before you say anything else!
  • Use positive sentences. It’s much easier to understand “we walk in the corridor” than “don’t run in the corridor”. In the first sentence, the key word is WALK. In the second, the key word may be RUN.
  • Think about word order. “We’ll go to the yard after you’ve finished your snack” may be understood as “yard, then snack” by a child who has difficulty processing language, leading to frustration all round!
  • Don’t give multiple instructions in one sentence. The child with Down syndrome is likely to pick up on either the first or the last, and be oblivious to the others. (You may think you don’t do this, but: “ok everyone, time to finish your work, put your books in your bag then get into line ready to go to the hall” is 4 instructions.)
  • Use visual supports, visual timetables, lists, pictures, etc. to support understanding.
  • If the child uses signs, ensure that everyone knows those signs. This includes the other children in the class, and any other adults that the child comes into contact with. If you learn one sign a day, they build up quickly, and many children love learning to sign.
  • Identify the key vocabulary and concepts for each classroom topic, remembering to differentiate both the complexity and the amount as needed.
  • Pre-teach vocabulary ahead of new topics. Families can support, by remembering to reinforce the target words in the home environment. Using resource time for preparation of new topics, rather than catch-up is one of the most important ways of supporting a child with Down syndrome to succeed.
  • Over time, developing good literacy skills is one of the best ways we know to overcome some of these difficulties. Language and literacy tend to develop in tandem. Being able to see the words increases awareness of sounds and of word order. Having things written down means you can process language at your own pace.
  • Remember that literacy skills were almost unheard of in children with Down syndrome 40 years ago, whereas now the vast majority acquire at least functional literacy. This is probably due to higher expectations and better teaching. Parents and teachers working together to support literacy will benefit the child with Down syndrome.

 

Communication books:

At least in the early years, children who have Down syndrome are likely to struggle to communicate outside of the ‘here and now’.

It is good practice for a communication book system to be established. This serves several purposes. It allows the parent to have an idea about what has happened in school and the teacher to know what happened at home. It promotes successful communication, since people can ask relevant questions, and have a good chance of understanding the answers. It allows parents to help consolidate new vocabulary and concepts in real life situations.

The communication book should be the responsibility of the parent and class teacher initially, though in later classes the child could take ownership, and choose what information to share.

What can you do?

  • Be positive! Try to include at least 4 positive points for each negative one. (This will help in lots of ways- if you’re looking out for positive things to write, you are more likely to notice positive behaviour and provide timely reinforcement).
  • Keep it short. A few relevant points is better than a long essay.
  • Be proactive. Let the parent know what topics or events are lined up for next week, so that they can talk about things at home. Let the teacher know what happened last night, so they can ask the right questions.
  • If there are persistent negative issues arising, arrange a meeting and communicate face to face (even then, make sure that the positives are also highlighted).

 

The content in this section has been compiled specially for Down Syndome Ireland by Clare Carroll BSc., MSc., MIASLT, MRCSLT, National University of Ireland Galway.