Speech, language and communication for individuals with Down syn

Speech, language and communication for individuals with Down syndrome — An overview
Sue Buckley
Children with Down syndrome are usually good communicators. They are keen to interact socially right from infancy but they have to rely on non-verbal skills such as gesture for longer than other children because they usually experience significant speech and language delay. Once they start to talk, they make good use of the speech and language skills that they have for the same range of communicative activities as everyone else, particularly if encouraged to do so by sensitive support from those around them at home, at school and in the community. However, they have specific difficulty with learning grammar and with developing clear speech. Some of the reasons for their difficulties with learning to talk are known and provide pointers to effective intervention strategies. Researchers and practitioners worldwide now agree on the principles for effective intervention. Since speech and language skills are central to the development of mental abilities such as thinking, reasoning and remembering as well as to social inclusion, it is essential that speech and language is a focus for parents, teachers and therapists from infancy through to adult life. This overview covers development from birth to teenage years, and to understand the speech and language needs of primary and secondary age children, teachers and parents are encouraged to read the whole overview as the children\'s difficulties have their roots in the preschool years.

Buckley SJ. Speech, language and communication for individuals with Down syndrome — An overview. Down Syndrome Issues and Information. 2000.

doi:10.3104/9781903806005


--------------------------------------------------------------------------------
Individuals with Down syndrome have specific speech and language impairments
Their speech and language skills are significantly delayed - more delayed than non-verbal abilities
Research has identified a specific profile of speech and language delays and difficulties associated with Down syndrome
Recent research has also identified some of the reasons for these delays and difficulties
The key principles for effective interventions are agreed by experts worldwide
Speech and language skills underpin social and cognitive (mental) development, therefore affecting all aspects of development
Improving the speech and language skills of individuals with Down syndrome will improve all aspects of their development and their quality of life
Activities to improve speech and language skills can be implemented by parents, therapists and teachers from birth through to adult life
Introduction
Speech and language skills are an area of particular difficulty for most children and adolescents with Down syndrome, even though they are keen to communicate right from infancy and usually have strengths in non-verbal communication skills such as gesture and sign. Spoken language skills are usually delayed relative to the children\'s non-verbal ability and this suggests a profile of specific language impairment. This should be a focus for targeted and intensive intervention throughout infancy and childhood, as it is in other language impaired children who show a gap between verbal and non-verbal abilities.

There has been a considerable amount of research effort over the past thirty years focused on understanding the speech and language profile associated with Down syndrome. In the last ten years there have been many important papers,[1-7] book chapters[8-21] and books[22-24] published on speech and language development in individuals with Down syndrome, and the reader wishing to read the literature in more detail is advised to consult these. These publications have all contributed to an increased understanding of the language learning needs of children with Down syndrome. There is now considerable agreement among the experts on the principles which should guide effective interventions.[1,4,9-12,24-27]

This module explains speech and language development, highlighting the key findings from research into

the processes and influences on speech and language development in typically developing children
the specific speech and language difficulties of children with Down syndrome and their possible causes
effective interventions
This module should be read before using the accompanying practical modules.

Speech and language skills are central to social interaction
Controlling your world - asking for things, expressing discomfort
Understanding what is happening around you
Making friends
Playing together
Discussing past and future events
Sharing worries, joys and new experiences
The importance of learning to talk
Learning to talk is the most important thing that children do. It is central to all other aspects of their development. It is critically important for social and emotional development and for the development of cognitive or mental abilities. This is a theme that will be explained and reinforced as the module develops.

Speech and language skills are central to social interaction
Being able to talk allows children to gain control over their social and emotional world. Talking enables children to ask for what they want, to share experiences, to understand what is about to happen, and to express themselves when they are hurt or upset. In short, talking enables children to relate to others.

By the preschool years, being able to communicate enables children to play together, to share and to learn together. In school and throughout life, communication underpins the development of friendships, the sharing of experiences, supporting one another, and negotiating our way through the world - shopping, travelling and working.

Speech and language skills are central to mental ability
Words for knowledge
Words for thinking
Words for reasoning
Words for remembering
Words for communicating
Being able to talk also underpins the development of mental abilities
It is important to note that word learning begins in the first year of life and continues to old age. Words are knowledge. Each new word learned is a concept learned and the rate at which words are learned reflects the rate at which we are gaining knowledge about our world. As language skills develop, words become a tool for thinking. Once children begin to string words together, words take over as the most powerful way to think and reason and remember - we do these things most often as silent speech in our heads.

The human brain has clearly evolved to be very efficient at developing spoken language and using language as a tool for other mental processes, such as working memory.

See also:
Memory development for individuals with Down syndrome
Speech and language development for infants with Down syndrome (0-5 yrs)
Working memory is the short-term memory system that supports the initial processing of incoming spoken and visual information as well as current mental activities such as reading text or adding sums. It is typically a speech-based system and its efficiency increases as children\'s speech processing and speech production abilities improve. Speech and language skills also influence, and are influenced by, progress in reading skills.

In summary, talking underpins our mental development and our ability to interact with the world around us. Talking is not the only way to communicate and we all use many non-verbal means to express ourselves in addition to words, however words are the most powerful form of communication for social life and for learning.

This module focuses on the development of spoken language as almost all individuals with Down syndrome will use speech as their main mode of communication after five years of age. Signs may be used as a bridge to teaching spoken language skills but these signs should be \'keyword\' signs used to augment spoken words, they are not taught as an alternative language. Signs may continue to be helpful throughout life for many individuals with Down syndrome to support their spoken language, as their speech often remains difficult to understand.

The skills and knowledge needed for talking
A complex range of knowledge and skills interact to give us our ability to communicate by talking. These can be considered under three main headings - interactive communication skills, spoken language knowledge and speaking. Spoken language knowledge can be further subdivided into vocabulary and grammar. In Table 1 the terms that professionals may use for these different aspects of talking are included in brackets.

Table 1. The skills and knowledge needed for talking Interaction Spoken language knowledge Speaking
Non-verbal skills Vocabulary Grammar Speech/motor skills
Smiling, eye-contact, taking turns, initiating a conversation, maintaining the topic
Body language
Facial expressions
(pragmatics and discourse skills) Building a dictionary of single words and their meanings (lexicon and semantics) Learning the word ending rules for plurals, tenses and word order rules for questions, negatives, (morphology and syntax) Learning to make speech sounds and to produce clear words with correct stress and intonation (articulation, phonology and prosody)

At any age, children\'s progress in all areas (i.e. in interactive communication skills, vocabulary knowledge, grammar knowledge and speech skills) always need to be considered. These skills are acquired over a period of years from infancy through primary and secondary school and a great deal is known about the processes that influence their development in typically developing children.

Table 2. The typical timetable for learning to talk Age Communication Vocabulary Grammar Speech
Infants (0-12 months) Crying
Eye-contact
Smiling
Listening/looking
Vocalising - coos
Turn taking
Joint attention
Gestures Understanding some words Babble
Babble tuned to native language
12-24 months Conveying an increasing number of meanings in words Beginning to say words
First 10 words
First 50 - 100 words Begin saying two words together Initial consonants and vowels developing
Words not very clear/intelligible
24-36 months Initiating conversations 300 words
Rate of word learning increases (25 words per month) Three and four key words together
\'telegraphic\' sentences
Grammar begins Consonant, vowel and word production improve in accuracy
36-60 months Repairing conversations when not understood Vocabulary learning continues to accelerate Increasingly correct sentences Consonant and vowel production continue to improve in accuracy
5-7 years Learning to continue narratives,
Taking part in longer topic related conversations
Telling stories
Requesting clarifications - . What?, Where? Average vocabulary of about 2000 words at 5 years Correct syntax being mastered
More difficult prepositions65533;
above, below,
conjunctions - because,
comparatives - \'longer than\' Blends improve
Speech intelligible
7-16 Developing social use of language further - social small talk
Taking account of listener\'s knowledge - know how to provide appropriate amounts of information for person or social situation
Give longer explanations or instructions
Telling jokes
Recounting experiences
Discussing attitudes and beliefs, with rationales From 7 years 3000 new words learned each year
50,000 words or more at 16 years Grammar steadily extended to include passives and other features such as
\'not only65533; but also\'
\'however\', \'therefore\'
Many of these features are learned and used first in reading and writing and then in speaking Speech rate and speech clarity continue to improve, influenced by reading
Comprehension and production of language
Children understand spoken language before they use it
Therefore, children\'s understanding of language should be assessed separately from their spoken language skills
Spoken language skills are referred to as production or expressive language skills by researchers and speech and language therapists
Understanding of language is referred to as comprehension or receptive language knowledge
Table 2 provides a guide to the way in which progress in each area relates to ages and to stages of development in typically developing children. The table describes the milestones for children\'s spoken language skills in each area. Most children will understand these actions, words and grammar in everyday communication earlier than they are able to use them in their speech. Therefore, when assessing children\'s language skills, production and comprehension of vocabulary and grammar are assessed separately.

The range of skills required for individuals with Down syndrome to communicate are no different from the range of skills employed by anyone else. Unfortunately, a number of difficulties with the skills required for speech and language are associated with Down syndrome. Promoting these skills and helping children with Down syndrome to overcome these difficulties is clearly fundamental for all aspects of their social and mental development. The way in which each of the skills develop in non-disabled children is discussed in the following section to set the scene for understanding the difficulties faced by children with Down syndrome and ways in which they may be reduced or overcome.

Learning to talk is an everyday activity
Children learn to talk in everyday interactions
Children learn to talk because they want to communicate
Communicating in gestures leads to talking
Communicating in words leads to sentences
Learning to talk is an everyday activity
Children learn to talk because they want to communicate. Communicating with gestures in infancy leads to communicating with words and sentences. Children learn to talk as they take part in all the ordinary, everyday communication that they experience during their waking hours. The quality and quantity of the language that they experience as they are talked to each day influences the rate at which children progress with learning to talk. [28-30]

Parent\'s talk styles influence children\'s progress