Children with Down syndrome (DS) are usually good communicators, meaning that they can get their message across and interact well with other people. However, clear speech is more difficult and therefore, speech can be a challenge. Their speech can be difficult to understand. It is important to remember that for all children developing clear speech takes time and there are individual differences. For children with DS there are also differences between individual children’s development.
Developing clear speech for a child with DS is impacted by;
- Hearing difficulties
- Their anatomical and physiological differences (that is their hypotonia, small oral cavity, high arched palate, respiratory difficulties)
- Phonological difficulties
- Weak processing of auditory information.
Research is growing to understand speech difficulties and DS but thus far it is limited. Some of their speech development can follow normal development; some of their speech development follows a disordered/non typical pattern; speech errors can persist; there is a greater delay of their speech development compared to their mental age.
Babbling is important and is likely to last longer that you would expect. For children with DS development of first words is delayed.
Remember that each child is an individual with individual factors impacting on their speech development.
If you are waiting for speech and language therapy the suggestions below will guide you and you can use them to work on your child’s speech development. Ideally working together with a speech and language therapist (SLT) you will develop a programme for your individual child and the SLT will help you monitor progress and guide you through the process of speech development.
What can you do to support speech development?
These are some suggestions that may help you.
- Start early
- Be conscious that sound patterns need to be stored and learned by the child before they produce them. This means that
your child needs extra practice at listening to speech sounds.
They need to be able to hear the difference between two speech sounds.
- Children need to be able to hear the difference between non speech sounds such as a mobile phone and a door bell or a cow and a sheep before they will hear the difference between the speech sounds ‘b’ and ‘p’.
- Encourage babbling
- Encourage putting two sounds together, that is, consonant + vowel (referred to as CV words, for example, baa) or vowel + consonant (referred to as VC words, for example, in/out)
- Encourage your child to produce words
- Listen to the sounds your child is producing and focus on those ones first
- Acknowledge all your child’s attempts to use their voice by responding, imitating their sounds and interpreting their intended meaning
- Use pictures as visual aids to learning sounds and words
- It is important to understand that saying a word such as cat involves putting together a consonant +vowel +consonant. To get to that stage your child will develop earlier speech skills. It is useful for you to listen to your child’s speech and see what type of structure your child is using. They could work through the different levels of consonant and vowel structures such as:
- Vowels (V)
- Simple Consonants (C)
- Simple syllables (CVCV) mama, wawa
- Consonant+vowel (CV) me, boo, no, bye
- Vowel+consonant+vowel (VCV) ama, apo
- Repetitive syllables with the vowel changing (C1V1C1V2) mammy, baby
- Words where the first and last consonant are the same, referred to as assimilation (C1VC1) mam, bib.
- Words using simple consonants (CVC) hot, boat
- Simple multi-syllablic words (CVCVCV) banana
- More complex consonants at the start of words such as k, g, sh, s etc and blends sl, tr, sk
What games can I play?
- During the second half of the first year of the child’s life you can play sound games e.g. boo (during peek-a-boo), mmm at meal time before each mouthful of food.
- Use speech sound cards, that is, a picture of a ball with the letter ‘b’ written on it. You can use pictures from an alphabet book or make a book with pictures yourself that start with the different consonant sounds. You will need pictures to represent each consonant sound (p, b, t, d, m, n, f, v, k, g, l, w, r, s, h, j, sh, ch, th, z, y).
Downsed recommend jolly phonics cards. Information on Jolly Phonics is available on http://www.jollylearning.com/jp.htm. The focus of this programme is on reading and writing. There are pictures with the letter written on the picture available as a wall chart that can be cut up so the cards can be used individually. This is available on http://www.jollylearning.com/matwal.htm . Other sound cards are available on http://www.monkeymouths.com/soundcards.html
The idea is that you are helping your child to discriminate speech sounds. You are saying the initial sound of the word only, for example, ‘b’ for the picture of the ball, ‘s’ for the picture of snake, ‘k’ for the picture of cake and so on. You are showing the child the picture cards and saying the sound only. You are expecting your child to listen and look only and if they imitate the sound that is a bonus. Over time, with practice and repetition and when your child stores the speech sounds in their memory, he/she will make the speech sounds. Your focus is not on the name of the letter. You will know how many sounds your child will be able for at a time, for example, 5-10 sounds at a time.
Another visual aid to doing speech work with children with Down syndrome and children with speech sound difficulties is Jane Passy’s method of cued articulation which uses a simple hand sign to represent each consonant speech sound. Each of the 26 consonant speech sounds has a simple hand sign which provides children with an extra visual clue when doing speech sounds. This information is available on the Stass Publications website on http://www.stasspublications.co.uk/index.php?cPath=22 and your SLT will be able to show you and guide you.
- Play speech sound games and use the sounds that child says, for example, child says mmmm you say mmmm, child says bbbb you say bbbb.
Attach sounds to everyday objects using sounds that are similar to babble (that is consonant plus vowel and consonant plus vowel referred to as CVCV words) for example, choo choo, mama, dada, papa, moo moo, baa baa, boo boo).
- There are basic oral-motor skills that are necessary for speech. These are being able to close lips, being able to spread lips, being able to round lips and being able to pull back the tongue. Downsed are researching links between oral-motor development and speech development. There are many tools that you can use to promote your child’s awareness and strength of their oral-motor skills.
- Blowing bubbles, horns
- Blowing out candles
- Sucking through a straw
- Chewing foods of different textures
- Biting teethers
- Bite blocks (from TalkTools TherapyTM)
TalkTools TherapyTM involves tools and techniques to improve oral-motor skills. It is an organisation selling products such as horns, straws, chewy tubes and bite blocks which can be used to facilitate oral-motor development in a structured and step by step way. There is a set of horns that are rated from easy to hard and there are straws that require different levels of sucking to work. This hierarchy can be helpful to give you a starting point and to monitor your child’s progress through the horns and the straws. It is important to be aware that there is little evidence of their efficacy, although there is evidence from parents and therapists that they are useful. For more information go to http://www.talktools.net.
A lot of speech and language therapists are trained to assess and use the Talktools equipment and it would be important to ask your SLT for guidance.
Resources that may be helpful
Speech and language development for infants with Down syndrome (0-5 years) by Sue Buckley and Gillian Bird is available free to download at http://www.downsyndrome.org/information/language/early/ This is an excellent resource for families with very practical examples and information to help develop speech and language skills.
Speech Sounds Checklists and Record Sheets are available from Downsed and they can help you monitor your child’s progress and development with speech.
Written by Clare Carroll, BSc, MSc, MIASLT, Lecturer, Discipline of Speech and Language Therapy, School of Health Sciences, NUI Galway.