Down Syndrome Speech Therapy and Activities

1. At Speech & Occupational therapy of North Texas, we have treated many children who have Down syndrome. As pediatric therapists we enjoy helping each child, with their unique profile, make progress with speech, language, motor and sensory development. If you are reading this, you may have a family member or friend with Down syndrome. So you may already know that Down syndrome is the most common genetic cause of developmental disabilities. Down syndrome, a chromosomal disorder, causes physical and cognitive differences. Individuals with this syndrome may have a few characteristics or many, making the population with Down syndrome very diverse. According to the National Down Syndrome Society (NDSS.org), Down syndrome occurs in 1 in 691 births, and about 6,000 are born with this syndrome each year.

2. Characteristics Associated with Down Syndrome Unique facial, brain and skeletal features, including an upward slant to the eyes Short stature Low muscle tone Intellectual impairment Cognitive challenges Keep in mind that there is a broad range of characteristics and each individual is unique! There Are Different Types of Down Syndrome Trisomy 21, the most common, is found in about 95% of the occurrences. Translocational accounts for approximately 4-5% of individuals with Down syndrome. Mosaicism, the least common, makes up about 1% of occurrences. These individuals are often less impacted physically and cognitively. Speech Development in Down Syndrome is impacted by Intellectual, Cognitive, Motor, and Sensory Development Individuals with Down syndrome have abnormal brain development which leads to intellectual and cognitive challenges such as difficulty with processing, retaining, and retrieving visual and auditory information. These challenges can result in short term memory challenges, difficulty with recalling sequences, and difficulty with decision making. Motor deficits and sensory challenges related to structural and neuromotor differences are typically found in Down syndrome as well. Individuals with Down syndrome generally have sensory deficits that will result in over responsiveness or under responsiveness to sensory input. Sensory systems of hearing, vision, tactile, proprioceptive and vestibular can all be impacted to varying degrees. Speech & Occupational Therapy of North Texas is a pediatric clinic so we will talk about some of the characteristics we see in children with Down syndrome and the kinds of goals we address in therapy in helping them meet their potential. Speech-Language Therapy Pediatric speech-language pathologists assess and treat communication disorders. There are certain strengths and weaknesses associated with communication in Down syndrome. Strengths Vocabulary Receptive language – what is understood

3. Pragmatics for social interactive language, typically enjoying communication with others Extra-linguistics such as facial expressions and gestures Challenges Expressive – what is expressed, tends to lag behind receptive language Syntax (sentence structure) Morphology (word structure such as tenses or progressives) Abstract language needed for concepts like prepositions, why, and when Intelligibility may be compromised due to motor strength, timing, and motor coordination challenges Assessment Therapy should be assessment driven, which means we must combine standardized (whenever possible), non-standardized, observational, and family input to develop an accurate picture of a child’s strengths and weaknesses. The specific goals and objectives are then determined based on the results of the evaluation process. Speech & Occupational Therapy of North Texas has a detailed case history that families are asked to complete prior to the evaluation visit. Your medical history information, observations and concerns are key to developing a clear picture of your child’s therapy needs. A typical speech and language evaluation for a 4 year old with a diagnosis of Down syndrome would likely include a language assessment, like the Preschool Language Scale, 5th Edition (PLS-5), an articulation assessment, such as the Arizona Articulation Proficiency Scale, 3rd Edition (AAPS-3), an oral-motor assessment, and possibly a functional profile, such as the Adaptive Behavior Assessment System, 3rd Edition (ABAS-3). These tools would help us establish measurable goals for this 4-year old which become a part of the formal treatment plan. For instance, if we found that this child was inconsistent with “who” questions, we would set this as a goal: When given “who” questions, Mary will correctly answer orally in 4 out of 5 opportunities (or 80%) with moderate verbal cues. Deficits in oral-motor strength range of motion might be addressed with the following goal: Using oral-motor stretches and exercises, Mary will increase her range of lip/cheek/jaw movement, as measured by the execution of at least 5 bilabial sounds or oral-motor imitation tasks, in 2 out of 3 therapy sessions. A therapy plan will typically be organized into receptive language, expressive language, speech (articulation), pragmatics, and motor, depending on the needs of a child, so there may be 2-5 goals under each appropriate area.

4. Therapy Once we have a treatment plan, we can begin! Speech & Occupational Therapy of North Texas utilizes play based strategies with young children. Research has shown play based therapy to be more successful with the pediatric population. Basically, treatment objectives are imbedded in the play activities. So younger children will have more “floor time” in treatment. Children with Down syndrome have visual strengths, so pictures, books, and hands on toys and activities are used extensively in therapy. Visual schedules and tools are often used in therapy as well, especially when a more structured activity is introduced. This helps a child see how they are moving through varying activities. Highly valued reinforcers are also used in therapy, so for example, if a child loves a particular puzzle, that puzzle can be used to teach colors, turn taking and plurals. All kinds of goals may be addressed with favored activities. Some Specific Strategies Used in Therapy Pair visual cue with auditory cue Build in repetition of a concept Provide choices Turn taking games Modeling Waiting for a response Children with Down syndrome typically experience considerable delay when learning to talk, though they often comprehend more than they can express. It’s important to help your child with Down syndrome to revise speech errors at any age, but the toddler years offer a most impressionable period in your child’s speech and language development, as they are just beginning to say words and phrases. If you are parenting a toddler with Down syndrome, here are some fun speech therapy activities that will keep your child entertained as they learn to communicate both verbally and with visual clues. Tell Me More Toddlers with Down syndrome need more time to begin forming multi-word phrases than most of their peers. The will typically need to have a 100-word vocabulary before they start doing so. You can help your toddler transition from one-word to two-word phrases by using a technique involving imitation and expansion. You will first repeat a word your toddler says and expand on it by one word. For instance, if your child says “cup”, you can say “Cup. Red cup.”

5. Sign It, Say It Visual learning generally comes easily for children with Down syndrome, but understanding and remembering verbal communication is more difficult. Help your toddler learn the names of everyday objects by using simple visual clues along with the words. When the phone rings, for instance, put your finger to your ear and say “phone”, or say “drink” while you pretend to drink. Together, You and I Choose an object to which you draw your child’s attention, such as a favorite toy or picture, and encourage them to look at the object as you talk about it. You can gradually increase the amount of time you describe an item as your child’s attention to it increases. This type of joint attention when both you and your child look and communicate about the same thing, helps them to learn language more quickly and improve their attention span. Rainbow of Learning Gather several items around the house that are the same color, such as a blue shirt, blue cup and blue ball. Put them in a blue bag or painted blue box. If your toddler is at the one-word level, name the color when you pull out an item. If they are at the two-word phrase level, say the color and the name of the object. If you have questions or concerns about your toddler with Down syndrome and their speech and language development, don’t hesitate to contact us at Speech and Occupational Therapy of North Texas to schedule a consultation. Speech & Occupational Therapy of North Texas uses a parent-caregiver partnership model. We ask the parent to join the session during the last 5 minutes so they can observe strategies and ask questions within the privacy of the treatment room. Therapists provide input, activities and guidance so that families can practice goals at home between sessions. Addressing treatment goals across all environments helps new skills generalize. We want to provide the best treatment and support for our clients and families! Please contact us if we can assist you with any questions. We provide speech therapy in Frisco, Plano and McKinney and are network providers for many insurance plans.