by Catherine Elizabeth Reckord, M.S., CCC-SLP, and Jan Turner, Ph.D., CCC-SLP

As children with Down syndrome grow older, independent communication skills become more important in school, vocational and social situations. Some individuals may be unable to communicate effectively using verbal means only; therefore, multiple methods may have to be integrated to obtain functional success (Horstmeier, 1988). Additional methods of communication include eye gaze, gestures, sign language, word attempts, and electronic (e.g., small computers with pictures or words) and nonelectric augmentative communication devices (e.g., picture boards). Using a variety of communication methods may help an adolescent or adult interact with others in different settings.

An employer, parent, or teacher should consider how well an individual understands language before requiring a specific level of performance. Analyzing the contexts where the person will work, learn, or spend leisure time shows what language skills are required for successful communication or job performance. Single word comprehension is easier and often a strength for those with Down syndrome. Understanding combinations of words at the sentence level or paragraph level is often more complex.

Horstmeier (1988) states "many employers or vocational trainers form impressions of the trainability of an individual by the way he or she initially follows directions." If unaware of differing communication demands or individual skill levels, some teachers or employers may misunderstand the individual's problems with performing a task. They may think the person is being uncooperative, rather than having difficulties with language understanding or short term memory.

The process of following directions, understanding a sequenced task, and performing new tasks relies heavily on language comprehension and social awareness. Directions can be easily misinterpreted if combinations of words are grouped in unusual ways (e.g., "Pick up your shoes and call your aunt.") or if contextual cues are absent (e.g., giving directions in a situation where they are not normally used).

Within independent living or residential settings, individuals may be responsible for many tasks and participate in community and social activities. They may be responsible for personal self-care such as grooming, eating, and taking care of their own rooms. Chores within the facility may also be a requirement. They may include planning, shopping for, preparing or cleaning up after meals. Additional chores may include housekeeping tasks or assisting with the care of others by making housemates' lunches or helping someone onto a bus (Calculator & Bedrosian, 1988). All of these tasks require the ability to understand and use some form of language.

An equally important area of language, especially to employers is social interaction skills. Social skills include communication tasks like greeting, initiating interaction, and conversation with coworkers and supervisors, and responding appropriately to criticism. To be successful in interacting with others, the individual must know how to accomplish these tasks and know when a situation calls for their use. Strong social skills increase individuals' chances for success in vocational settings ranging from adult activity centers to competitive employment. The following is a list of social survival skills that adults should be able to perform in some way when seeking an entry level job position (Rusch, in Calculator & Bedrosian, 1988).

• Following one-step directions
• Reciting full name, address, telephone numbers and previous employer
• Dressing appropriately for work, grooming self
• Maintaining personal hygiene
• Communicating basic needs such as sickness, toileting and pain
• Speaking clearly enough to be understood by someone by the second repetition
• Responding appropriately to instructions with only one reminder
• Responding appropriately to safety instructions
• Initiating contact with a supervisor when a job cannot be completed
• Initiating contact with co-worker when needing help on a task
• Working without engaging in major disruptive behaviors more than 3-5 times per month
• Reaching work by means of own arrangements

These social survival skills can be accomplished, whether the person uses verbal means of expression or communicates with the support of a high or low technology assistance device.

Participating in leisure and social settings requires the use of good language and social skills as well. Socially, nonverbal behavior is just as important as verbal language. Using appropriate social manners, such as greeting adults and peers, is crucial to being accepted. Children are taught early to use greetings, but they require further teaching and models to adapt greetings to the person with whom they are interacting (e.g., greeting a friend versus greeting an employer). Knowing how to begin, take turns, and end conversations are equally important. Individuals learn by watching others' verbal and nonverbal behavior, experimenting with their own communication and receiving the natural feedback of others' responses.

Developing structured routines helps to foster language use in similar situations. In fact, some individuals may prefer to communicate primarily with people who are unfamiliar. Spontaneous opportunities also facilitate increased language use and understanding. Encountering a novel situation sometimes encourages individuals to initiate interaction of communication. As the number of social contacts and opportunities increase, individuals may feel a greater need and desire to communicate.

Expression of emotions accompanies language in all forms. While interacting with others, expressing emotions can be conveyed using facial expressions, gestures, tone of voice or verbal means. An individual can use these methods individually or in varying combinations. As children grow older and their interactions with people become more complex, being able to communicate emotions effectively and within appropriate settings is important. These social rules are learned from family, peers, classroom instruction, vocational leaders, and through, having a variety of experiences. It is not only important for people to express the emotions they feel, but to understand the circumstances that lead to the feeling. Professionals and families can help a person identify different emotions such as happiness, anger, frustration, affection, or sadness. They can suggest possible reasons for feeling these emotions. The level of explanation obviously depends on the individual's age and level of understanding. Individuals with Down syndrome may need to use a variety of forms for expressing emotions, because of difficulty with verbal expression. Gestural and facial means are just as effective as verbal means or picture boards, if used.

An individual's language understanding and use can be improved through direct training or by having conversation partners learn different ways of presenting information. The following are some suggestions for improving language skills through direct training:

• Orienting the individual to the situation where they will be required to perform their job.
• Working directly on skills that will increase performance or functioning (e.g., teaching vocabulary to be used in following directions).
• Teaching the strategy of repeating a direction to oneself before completing it and repeating it again afterward to check for accuracy.
• Teaching self-monitoring by checking off directions or steps as they are completed.
• Training the individual to ask for clarification when messages are misunderstood (e.g., "Please tell me that again." Give you the red one?").

Suggestions for those who directly interact with the individual include the following:

• Simplifying words in directions or breaking long directions into shorter steps
• Writing down directions for readers
• Providing picture or gesture sequences of steps for nonreaders
• Repeating steps frequently and including visual cues, when a new sequence is being taught
• Providing a check-off system (e.g., crossing off the picture of the word for each step after it has been completed)
• Giving clear, detailed directions (e.g., "Clear the table and put the dishes in the sink.") rather than vague ones (e.g., "Take it to him.")

Different situations may require the individual to use communication skills that are specifically adapted to them. Using multiple ways of conveying and organizing information may help the person be successful in a number of daily events. Daily schedules with list times and specific chores are helpful. Schedules can be made using written language or pictures. Photographs are even easier to recognize and understand. Sticking to a time schedule helps the person know what to expect, but varying activities within certain time frames are possible and allow for some independence and creativity.

As noted earlier, offering people multiple options for expression may be equally beneficial as they move from one situation to another. Easing the transition into novel activities may be accomplished by not demanding spoken language. Choices can be given that offer nonverbal options for responding (e.g., pointing to pictures). Fast food restaurants now offer picture menus, which provide an alternative means of ordering food. A picture board could be made to allow choices for activities like bowling, going to the movies, or shopping.

The process of choice-making through picture selection can be continued during specific activities. For example, movie choices can be represented by pictures cut from the newspaper. When purchasing candy at a movie theater, two or three choices can be presented at one time, encouraging a pointing response and/or verbal answer. In each case, the individuals should be given the opportunity to initiate interaction and ask for what they want when choices are presented.

In social situations, others can provide opportunities for the person to share in casual conversation. Keeping current with age appropriate activities, topics of interest such as music, clothes, hobbies, sports, TV and movies will help the person join in conversations. Information about community events, social engagements, and sports can be adapted to include individuals with different levels of understanding. Experiences in vocational and independent living situations are just as important when conversing with others. Shared knowledge about a situation encourages communication. By relating to even one topic of information within peer, family, or coworker groups, individuals can actively participate in communicating with other group members.

Role playing can be used to help people learn and practice social and communication skills for specific situations. This method is useful for building a variety of verbal and nonverbal interaction skills in social and educational or vocational settings. Role playing is generally easier for people when the situation and the character roles are familiar and realistic and the reason for the interaction is apparent. For example, role playing can be used to practice asking for help with something a person would actually like to buy in a department store. For this task, one person can play the role of the customer and another the salesperson. The closer the practice is to the actual task, the easier it will be for the person to apply the new learned skills.

As noted here, communication skills are critical in determining success in leisure, educational and vocational settings. Though people with Down syndrome may have different levels of language skills, each can be helped to use verbal, nonverbal, or electronic communication techniques to accomplish many tasks in their everyday lives.

References

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 community 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.
Miller, J. (1990). Language and communication characteristics of children with Down syndrome. New perspectives on Down syndrome. Baltimore: Paul H. Brooke Publishing Co.
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. ASHA, September, 1990.

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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