Speech and language present many challenges for children with Down syndrome. However, there is information that can help infants and children begin communicating with others and support the progress of young children in developing language and speech skills. While most children with Down syndrome learn to have conversations and use speech as their primary means of communication, they understand language and have the desire to communicate well before they are able to speak. In this context, total communication — using sign language, pictures, electronic voice output, or a combination of all three — is an effective option during the transitional period before speech emerges.
Are Hearing Problems Common in Children with Down Syndrome?
Ear infections are common in all children during infancy and early childhood, but the anatomical differences in the ears of children with Down syndrome — narrow and short ear canals — make them more susceptible to fluid accumulating behind the eardrum, a condition known as "otitis media with effusion" (glue ear). This fluid impedes hearing and leads to varying degrees of conductive hearing loss.
The child's condition should be monitored by a paediatrician and an ENT specialist, and a hearing test should be carried out by an audiologist — which can be done shortly after birth. It is recommended that hearing tests be performed every six months until the age of three, then once a year until the age of thirteen. Treatment involves antibiotics or the insertion of grommets (ear tubes) to drain the fluid.
What Is the Effect of Hearing Loss on Language and Speech Development?
Children learn language and speech through listening, looking, and touching. Listening is a critically important factor in the acquisition of speech, and studies have shown that chronic fluid build-up in the ears negatively affects the development of speech and language. When a child experiences ongoing hearing difficulties, it becomes harder for them to learn sounds and associate them with surrounding objects. Parents should therefore regularly ensure their child's hearing is intact. Paediatricians and ENT specialists achieve great success in treating fluid retention in the ear, provided the condition is carefully and consistently monitored.
What Is the Relationship Between Feeding and Speech and Language?
Speech is a secondary function that uses the same anatomical structures as feeding and breathing. For this reason, low muscle tone affects feeding to the same extent that it affects speech. Through feeding, children develop the skill and strengthen the muscles that will later be used for speech. If a child experiences difficulty with feeding, parents should seek advice from a specialist — whether a speech-language pathologist or a highly qualified occupational therapist — as feeding therapy helps strengthen the facial muscles, which in turn has a positive impact on speech development.
What Other Skills Are Linked to Speech and Language Development?
Pre-language and pre-speech skills include: the ability to imitate and repeat sounds; turn-taking skills developed through play; visual skills (looking jointly at the speaker and at objects); listening skills (attending to music, speech, and letter sounds); tactile skills (exploring objects orally); oral-motor skills (moving the tongue and lips); and cognitive skills (understanding object permanence and cause and effect). Family members can stimulate all of these skills at home.
When Will My Child Say Their First Word?
Children with Down syndrome typically begin using single words between the ages of two and three, and their "first word" may in fact be a sign rather than a spoken word. Most communicate from birth through crying, gaze, and gestures, and understand that making sounds and noises influences the people around them.
Many children with Down syndrome understand the relationship between a word and its concept within the first ten to twelve months of life, but do not yet have the neurological and motor skills required for speech. A transitional communication system should therefore be provided to enable the child to communicate and learn language before they are able to speak.
What Is Total Communication?
Total communication is a system that combines language, sign language, and gestures to teach speech. Adults using this system speak while simultaneously signing, and the child learns specific signs, links them to speech, and begins using them to communicate. Other options include a picture communication board, electronic voice output communication systems, or a combination of all these approaches.
Most children with Down syndrome are ready to use a language system months or even years before they can use speech effectively as a means of communication — hence the need for transitional communication systems. A speech-language pathologist or augmentative and alternative communication (AAC) specialist can help design a system tailored to the child's needs. It is worth noting that most children with Down syndrome will ultimately use speech as their preferred primary means of communication.
How Can Parents Help Their Child Learn Language and Speech?
The home is the ideal place for learning many pre-language and pre-speech skills. To help their child develop these skills, parents are encouraged to:
- Remember that language is more than words: When teaching a word or concept, focus on connecting it to its real meaning through play or sensory experiences (hearing, touch, and sight).
- Repeat and model: Most children with Down syndrome need many repetitions to learn a single word. Repeat what the child says and model the correct form to help them master it.
- Use real objects and real-life situations: Teach food names while eating, body parts while bathing, and spatial concepts (under, in, on...) while playing.
- Make communication part of the daily routine: Turn every daily activity into an opportunity for communication and language learning.
- Read and explore: Read varied stories to your child and provide new experiences daily to expand their vocabulary and concepts.
- Follow their interests: If the child shows interest in something or someone, introduce the word associated with it. Children pass through many stages before speaking — from responding to familiar sounds and recognising faces, to repeating sounds and linking them to meanings.
When Should Parents Consult a Speech-Language Pathologist?
A speech-language pathologist can be consulted from the infant stage. Treatment may include vocal stimulation, speech prompting during play and feeding, and oral-motor exercises. The family must be a core partner in the therapy process, as they are the child's first and most important teachers of language and speech.
Early speech intervention refers to the range of services provided to infants and young children from birth through the end of the second year of life. Speech and language services should form part of a comprehensive treatment plan that includes sessions at home or in speech clinics, and may form part of a multidisciplinary approach involving physical therapists, occupational therapists, and other specialists working hand in hand with the child's family.
Source: The information in this article has been reproduced under an exclusive agreement with the National Down Syndrome Society. Available at: ndss.org
