A diagnosis of Down syndrome comes along with seemingly infinite questions about what the future will bring. How different will this child be compared to his/her peers? Do all individuals with Down syndrome struggle to communicate? Can speech therapy help? Where does one begin?? While each child with Down syndrome is unique in their own life journey, there is some clarity as to what one may expect when it comes to speech and language development.
Down syndrome, also known as Trisomy 21, occurs when a baby is born with an extra copy or part of chromosome 21. This affects the way the child will grow and develop. Physical differences, such as low facial muscle tone, a large tongue with a small mouth and high arched palate, and shorter, more narrow ear canals. A child with down syndrome may also experience cognitive differences, such as a slower learning capacity, which can heavily impact overall speech and language development.
Sometimes, a child with Down syndrome may come to understand the language but not begin speaking their first words until later than their typically developing peers, and these words will likely be difficult to understand. As they age, their expressive lexicon will develop at a slower pace and it will take them longer to learn to begin putting two words together to create more sophisticated sentences. Frequent ear infections and hearing loss as well as difficulty with feeding and swallowing are also common characteristics of individuals with Down syndrome.
But just like children with autism or kids with ADHD and other neurological learning impairments, children with down syndrome are not unteachable or a lost cause. Children with Down syndrome are often highly creative and intelligent, but they may require different types of teaching and scaffolding to learn new skills.
So how can I best help my child?
Early intervention, meaning beginning speech therapy early on, is key in capitalizing on a given child’s strengths and preferences and addressing areas of weakness. Understanding what to expect when it comes to speech and language development, hearing, and feeding is key to knowing when and how to seek help. So let’s break it down:
Two-thirds of children with Down syndrome will experience some degree of hearing loss, and a mind-boggling 96% of children with Down syndrome experience infections of the middle ear which further impede hearing. Hearing loss can be subtle, so it is imperative that the child’s hearing be monitored with regular hearing tests. In the case of frequent infections, a pediatrician may recommend that tubes be inserted into the child’s eardrum which will prevent a build-up of fluid.
Children with Down syndrome often present with cognitive delays and therefore tend to develop speech and language skills at a slower rate than their typically developing peers. When there’s hearing loss in the picture on top of all that, it can seem like an uphill battle. How can a child who already has challenges learn to understand and express himself if he can’t hear? And even if he can hear, those cognitive delays are daunting in and of themselves…here’s where speech therapy can help.
How can speech therapy help?
When a child has a developmental delay, it is essential to address the area of the delay as soon as possible and as much as possible. When a child has a speech and/or language delay, it is imperative to immerse them in a language-rich environment. As they say, the more you put into a child the more you get out of them; that’s true with any child and when there’s some form of delay it is only more true.
Speech-language pathologists can provide parents with strategies for speaking to their children to maximize language input. For example, a speech therapist may recommend that a parent speaks in short sentences, sometimes only one to two words, while using sign language or gestures. While sign language is typically used among the hearing impaired, children with a speech and language delay can benefit as the child is provided with an additional modality upon which to build a basis for understanding what is being said and, if the child copies the gestures, provides the child with an alternate method of communication that they can use to state their needs until they are ready to speak. (Children with Down syndrome typically understand what is being said to them, but are often not ready to speak until closer to age 2-3 due to physical or cognitive differences; using these gestures can prevent a lot of frustration.)
A speech therapist can also provide the family with a communication board to assist the child in expressing his/her needs. Without a sufficient expressive vocabulary, a child may tantrum to indicate hunger; a child with a communication board can simply point to the picture that indicates “hungry”, thus cluing the devoted parent that no life-threatening issue has arisen but a sandwich may well be in order. A communication board is a board with a variety of pictures depicting various activities of daily living (getting dressed, going to the bathroom, eating a meal) and/or high use vocabulary relevant to the child (pictures of family members, a favorite toy, etc.); a child may point to the picture which bests depicts the message that he/she would like to convey. The parent in turn may point to the same picture the child did and then verbalize what they understood, “Oh! You’re hungry? Let’s go make you a sandwich!” This speaking aloud provides the child with still more verbal input and will facilitate increased verbal expression long-term. A speech-language pathologist can help set up a communication board that is personalized for the child and teach him/her as well as the family to use it properly.
When a child does attempt to communicate verbally, their utterance should be expanded upon. For example, if the child says, “Bread!” the parent ought to respond by saying, “Want bread?”. This model’s good language skills, building on what they already know and helps them to learn to produce more sophisticated sentences.
The Mouth Matters
Low oral muscle tone is common in children with Down syndrome; some signs of low oral tone can include an open mouth posture at rest, drooling, tongue protrusion, and a weak suck. This low tone will impact overall speech intelligibility as well as feeding and swallowing skills.
Speech therapists have many methods of addressing articulation and phonological errors which a given child may develop. They will first facilitate correct pronunciation of the target sound often using multi-sensory methods: giving physical prompts, showing them a mirror, etc. Once a target sound is properly produced, that sound will slowly be carried over into more complex words, phrases, etc. with the ultimate goal of carrying it over into spontaneous speech.
When working with a child with Down Syndrome, a therapist may utilize oral motor exercises to strengthen lip, tongue, and jaw muscles. These exercises can improve speech intelligibility and also assist with feeding and swallowing skills. A child with hypersensitivities to certain tastes or textures can present a real challenge. Speech therapists can teach parents how to slowly expose the child to a given texture in a way that allows the child to adjust and grow accustomed to it.
A New Beginning
Down syndrome is a daunting new reality that most people never dream will affect them… until it does. It’s not the end of life though – it’s really just the beginning, and knowing how to address the challenge from the outset is crucial. Speech therapy is key in addressing speech, language, hearing, and feeding deficits that are common among individuals with Down syndrome, and early intervention will go a long way in ensuring that your child grows to become a well-adjusted and happy adult.