Speech and Language Development in Children
by Julie Sherman, M.S., CFY-SLP
The medical diagnosis of Down syndrome is a term given to explain a genetic condition. Knowing this diagnosis can help to explain why you may have noticed a number of symptoms and behaviors in your child, but it does not tell you what you can expect for your child. When a child has Down syndrome, family and friends are also affected. The first step in helping the child with Down syndrome is helping the family members to understand how it may affect this child’s daily activities. A child with Down syndrome may have difficulties with communication, play, speech, and language. Each of these will impact on your child's daily activities in a unique way.
Communication is the way in which all children and adults interact with their environment. Recognize how children interact with their environment and in turn how the environment interacts with them is an important step in understanding your child. Your child may be interacting with objects or people in the environment but may be doing so in a way that is different from other children. Identifying the method of your child's interactions will help family members, caregivers, and educators encourage and enhance the child's communication abilities. Communication involves processing thoughts and information in a number of different ways.
When we put thoughts together and send them to others we are expressing ourselves. This is called expressive language. We sent messages through speech, writing, body language, facial expressions, and gestures. Children with Down syndrome may have difficulty expressing themselves through speech, but may express themselves effectively with gestures or facial expressions. Use of augmentative communication such as sign language and pictures may help a child develop better expressive language skills.
When we receive a message from others and break it down in order to understand its meaning, we are using receptive language skills. Messages may be received through hearing, seeing and touching. A child with Down syndrome may have difficulty with hearing information but have a strong ability for understanding information sent to them visually.
Speech is the process of producing sounds in combination to form words. This complicated action requires abilities to control and coordinate the muscles of the face, tongue, lips, jaw, and throat. The child with Down syndrome may have weak muscles that make it difficult to control movements for sound production, but may learn exercises to help develop better speech production skills.
A speech and language pathologist (SLP) specializes in recognizing and treating problems in any or all of the above areas of communication. The SLP will provide you with a realistic picture of your child's current speech and language skills as how well those skills are being used, to communicate with others. The SLP works with the family, caregivers, and educators in recognizing and understanding the child's communication needs, and assists with developing a plan to help develop communication skills to your child’s best potential. The SLP uses observation and formal measurements to evaluate your child's speech and language abilities and functional communication needs. Information from these observations and measurements is then used to develop a treatment plan to meet your child's specific needs. The SLP will help family members, caregivers, and educators learn how to respond to the child's communication needs and model certain speech and language strategies for use in the home environment. Speech and language services may begin as early as the time of diagnosis and continue as needed throughout your child's life.
In any individual with Down syndrome, it is often difficult to predict the actual course of speech and language development. As a group, children with Down syndrome acquire language skills at a slower rate than the average child. The following information is designed to help you begin to build an understanding of the child with Down syndrome's communication development. For each developmental age range, information regarding general developmental milestones are given, areas of communication strengths and weaknesses are discussed, and activities are suggested for family members, caregivers, and educators to help children in this particular age range further develop communication skills in their home and/or school environments. Remember that you are the most important factor in your child's environment. The following developmental guidelines represent a broad range for which speech and language milestones are acquired in children with Down syndrome. No two children are alike. (These guidelines were developed from the works of Anne Fowler, Jon Miller, Carol Stoel-Gammon, and Lars Smith, and others, all of whom are listed in the References).
Children communicate from birth. Different cries are used to indicate hunger, pain, and discomfort, while whole body movements indicate when the child is fatigued or excited. Strengths:
- Social smile in response to your sounds
- Differential crying
- General awareness of their surroundings
- Muscle weakness in the mouth and face region may cause poor sucking skills for feeding.
- During feeding, bath time, and changing, position your child for face-to-face interaction and try to maintain eye contact.
- If feeding difficulties are present, consult a feeding specialist for suggestions specific to your child's needs. An occupational therapist and SLP may work together in developing a plan with positioning and exercises to help your child develop a stronger suck.
The child begins making more sounds at this level. Infants laugh and squeal and produce "raspberries" sounds in the front of their mouths. Consonant sounds are produced first alone and, then combined with other sounds to produce babbling. Children may also begin producing approximations of real words during this developmental range. For example, "ba" for bottle. Infants begin to participate in turn-taking games with gestures, such as peek-a-boo, pat-a-cake, or ball. Infants respond to "no" and identify objects within colored photographs.
Strengths:
- Social skills during game playing
- Gestures
- Play with sound production
- Attention to pictures
- Weakness in the muscles of the face and mouth may cause increased drooling, tongue protrusion, and difficulty chewing and drinking.
- Play peek-a-boo and patty-cake.
- Sing songs that have easy gestures with them such as "Eensy, Weensy, Spider" or "Wheels on the Bus."
- Imitate sounds or facial expressions that your child produces immediately after they are made.
- Be as animated as possible to encourage continued turn-taking and involvement in play activities.
- Begin sharing special time reading together. Read stories aloud at bedtime, encourage your child to tell you the story, and identify pictures in the story books. "Bulky" books are ideal for this developmental level. They are made to be played with, chewed on and thrown.
At this level, children begin using real words for their intended meaning. No longer do they randomly produce word approximations or sound combinations, but they begin applying specific meaning to what is said. Common first words include names of familiar people and objects and may include gestures such as "Hi" and "Bye". They will begin to request objects, call people by their own name, and ask questions, such as "What's that?" Children at this level may recognize names of objects within their immediate environment. Identification of objects within colored photographs and line drawings also occurs at this level, working towards an understanding of objects and actions occurring outside of their immediate environment.
Strengths:
Encourage your child to continue exploration of the environment by providing activities to stimulate all senses—vision, touch, smell, hearing, and taste. Make cookies, play in the snow, and sing songs together. Recognize your child's abilities to identify objects in pictures. Read short stories together and begin to encourage your child to take a more active role in story telling. Make a book together by writing down the days, experiences and drawing a picture at bedtime each night. The next day, encourage your child to retell the story made the night before. Sing lots of songs, tell nursery rhymes, and do finger plays with your child to help develop good speech production skills. Children's songs and rhymes are filled with words that require lots of control for good sound production. Use lots of gestures and pictures to help bring the song or rhyme to life for your child.
Preschool-level children begin to participate in a group setting. Understanding the interactions and turn-taking skills required to be a member of a group can be difficult for a child with Down syndrome. Children at this level begin putting 3- and 4-word phrases together to form simple sentences and initiate conversations with other children. Child with Down syndrome may have difficulties expressing thoughts through speech with other children but they may do well using gestures, formal signs, or pictures to communicate.
Strengths:
- Prereading skills
- Vocabulary and understanding of language
- Gesture skills
- Producing speech that other children can understand
- Social skills in a group setting
- Following directions
Encourage all of your child's attempts at communication: talking, gestures, or pointing. Most important is your child's feeling that what he has to communicate to you is important. Continue to encourage your child's interest in reading by sharing a special story time together each day. Play games that require you and your child to take turns. Games such as Candyland and Shoots and Ladders, and simple songs make learning the rules of turn-taking fun and enjoyable for both you and your child.
Encourage your child to look in the direction of the person he or she is talking to. Many children with Down syndrome have difficulties looking people in the eye or maintaining eye contact with a conversational partner. By making a game or contest out of this hard-to-learn task, eye contact may be learned naturally.
As children progress though the developmental levels, focus is shifted away from what the child offers through communication to what is expected of the child communicatively. When the child begins a school program, communicative demands increase and change focus. The child must now be able to follow directions, write, recall information read in a story, speak in sentences, and readily engage in conversation with their peers.
Strengths:
- Processing of visual information
- Conveying information through gestures
- Vocabulary skills
- Recalling information processed only through hearing
- Following complex directions given verbally
- Understanding the importance of social skills for maintaining distance and touching during conversations.
- Speech production
- Encourage your child to write down information as it is presented verbally. This will help the child to follow directions and remember information read in a story.
- Provide your child with pictures to help remember how things happened or what needs to be done next. Visual representations of information presented verbally will help your child process the same information more readily.
- Practice social skills during role-playing games. For example, pretend that you are going to a fast food restaurant and your child needs to order for both of you.
- In addition, joke telling is an excellent way to work on turn-taking skills for conversation at this developmental level.
As your child progresses through adolescence and early adulthood, the communication focus shifts again from increased demands for academic performance to social communication skills for use in work or school club activities. Verbal and nonverbal communication are equally important at this developmental level. Often people are perceived through their abilities to maintain conversations and interact socially with peers and fellow employees.
Strengths:
- Perseverance and job performance
- Desire to interact and communicate effectively with others
- Nonverbal communication skills
- Speech sound production for sentence length communication
- Understanding information presented only through hearing
- Responding in socially acceptable ways
- Through role-playing activities, encourage your child to use eye contact, maintain appropriate distances from the speaker, use appropriate gestures, and appropriately yield turns to speak with others. This activity may now be viewed as work instead of work done in the context of play. Your child now recognizes the importance of communicating effectively and will be willing to work at it to improve their own skills.
- Practice filling out forms (e.g., job applications) and following work related instructions using the following suggestions:
Teach your child to:
- Repeat the direction silently before completing it and then repeat it again afterward to check for accuracy.
- Check off directions or steps as they are completed.
- Ask for clarification when messages are misunderstood.
- Write down directions in addition to giving them verbally.
- Give clear, detailed directions rather than vague ones.
However, the suggestions for activities will help get you started in helping your child develop speech and language skills. It is recommended that you consult a speech and language pathologist for further suggestions for help with your child's specific communication needs. The speech and language pathologist is there to help you as well as your child, so ask questions and share. The two tables given below summarize language development in children with Down Syndrome.
Range (in Months)
Newborn-8 Infants will begin smiling in response to your sounds, crying, laughing, squealing and may produce "raspberries" (sounds made at the front of the mouth)
6-20 Children begin cooing and babbling (producing consonant sound with vowel sounds). These sounds may be isolated or paired into strings of sound patterns. The most common consonant sounds produced include: m, n, p and b.
12-24 Children begin jargoning (stringing together sounds which do not have any particular meaning). Children may also begin producing a few real word approximations, such as "mama", "dada", and "ba" for bottle. Sounds that may be heard include, m, n, p, g, or k approximations. They begin to participate and respond to gestural games, such as peek-a-boo and pat-a-cake, or turn-taking games, such as rolling the ball.
18-36 Children continue producing word approximations (such as "ho" for hot,) and begin producing real words. The sounds that are heard include: m, n, p, b, t, d, and possibly k and g. The words children produce include names of familiar people and objects. Children also begin to gesture and say "Hi" and "Bye". Some may also begin using formal sign language systems to communicate their wants and needs to enhance the development of their expressive language.
24-36 Children often begin to pair two words together such as "Want cookie." They will begin to request objects, call people by their own names and ask questions, such as "What's that?"
Range (in Months)
12-24 Infants orient to sounds in their environment. They begin to turn their head to sounds and may smile in response to seeing their face in a mirror. They will also turn in response to their name being called. Newborn-8 Children begin to respond to their name and the names of familiar others, they respond to "no" with inflection and may begin to recognize the names of a few objects within their visual field. Children also respond to gestured commands or requests. They may begin to identify objects within colored photographs.
24-36 Children begin to understand two-word utterances and simple directions without a gesture. They may also understand action labels and refer to objects that are not in their visual field. Children begin to identify objects within colored pictures or line drawings.
Acknowledgment: This text is a revision of an earlier version written by Ms. Catherine Reckord, M.S., CCC-SLP, who has since left the Kennedy Krieger Institute. Ms. Reckord's insight and knowledge served as a guide in the writing of this section. Her work and dedication are greatly appreciated.
Fowler, A. (1988). Determinants of language growth in children with Down syndrome in L. Nadel (Ed.), The psychobiology of Down syndrome (p. 217-245). Cambridge: MIT Press.
Haney, J., Wilson, J. & Halle, J. Adults with mental retardation: Who they are, where they are, and how their communicative needs can be met. In S. Calculator & J. Edrosian (Eds.), Communication assessment and intervention for adults with mental retardation. Boston: College-Hill Press. Little Brown and Company.
Horstmeier, D. (1988), But I don't understand you: The communication interaction of youth and adults with Down syndrome. In S. Pueschel (Ed.), The young person with Down syndrome: Transition from adolescence to adulthood. Baltimore: Paul H. Brookes Publishing Co.
Klumin, L. (1994). Communication skills in children with Down syndrome: A guide for parents. Rockville, MD: Woodbine House.
Miller, J. (1990). Language and communication characteristics of children with Down syndrome. New perspectives on Down syndrome. Baltimore: Paul H. Brookes Publishing Co.
Morris, S.E. & M.D. Klein (1987). Pre-feeding skills: A comprehensive resource for feeding development. Tucson, Arizona: Communication Skill Builders.
Smith, L., von Tetschner, S., & Michalsen, B. (1988). The emergence of language skills in young children with Down syndrome. In L. Nadel (Ed.), The psychobiology of Down syndrome (p. 217-245). Cambridge: MIT Press.
Stoel-Gammon, C. (1990). Effects on language development. Journal of the American Speech-Language Hearing Association, September, 42-44.
The article above is reproduced from the Down Syndrome Guide disseminated by the Down Syndrome Clinic at Kennedy Krieger Institute. In accordance with federal copyright restrictions, the contents of this booklet may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 George Capone, M.D.
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