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Early Intervention Speech Therapy

Working with Children with Down Syndrome

Published July 21, 2009 11:57 AM by Stephanie Bruno-Dowling
I recently received an email from a speech pathology graduate student inquiring about strategies I could recommend regarding how to stimulate speech and language with a child with Down syndrome. Reading her email reminded me that I have not yet written a post about children diagnosed with Down syndrome, despite the fact that this population of children is often a significant portion of my EI caseload.

One of the first thoughts I had regarding my experience in working with children with Down syndrome is that although they share the same primary diagnosis, their personalities, characteristics, strengths and weaknesses are all different and vary between individuals and families.

For example, I currently have three little ones on my caseload with Down syndrome and each of them of course requires their own individualized therapeutic plan. Two of the children are turning 3 within the next two months. One of them has incredible verbal skills, yet just started walking within the past 6 months, while the other walked by around 18 months and yet continues to struggle significantly to communicate. This little one also has several older siblings and has wonderful role models to help her along. The third child is similar to the latter. She will be three in December and only has about 10 words/signs that she uses independently; however their home is much quieter and there is less reinforcement for speech and language.

Below is the email I received from our graduate student reader, which I would like to share with the public with the intent of prompting a variety of helpful responses:

"I currently am a grad student in Buffalo, NY for Speech Path and am working with a 2 1/2 year old with Down syndrome. So far, I've done a lot of play therapy with her, but those skills are pretty well developed. I am having trouble thinking of more structured activities that will meet her goals that are also age appropriate. I want to include books in every session also. We are working on artic sounds (b,m,h,s,d, and wh), as well as following directions involving actions, labeling pictures/objects/actions, and using two combined signs to request, label, or comment. If you have any great ideas, or books that you've found kids her age just LOVE, I'll take any advice!"

My response: Some initial suggestions I have are to use a complete oral motor plan (if that is not happening already), as well as a picture communication system to help her become more independent in her daily routine. Also, I use a speech book with the one very verbal child I work with and it has proven to be very successful. We use the book to work on both speech (artic sounds) and language ("I want _____"). This also gives the family something concrete to practice throughout the week. Next, make sure to include the family in your plan. Ask them where she is struggling right now and figure out how you can address these areas to help make your work more functional.

Please write in and share your suggestions as well as any other helpful information regarding working with young children diagnosed with Down syndrome.

24 comments

Hi,

my friend's daughter is mild down syndrome baby. she is 5 years old & behaving very politely and nicely like other children. the only problem my friend is facing, her ability to speak. she speaks only few words. main stream schools are not allowing her to get admission. my friend doesn't want to send her in special schools cause she will learn from those children and will start behaving like them. right now she is just like a normal child, she always learn everything by seeing people.

kindly suggest her how to use speech techniques at home. she can not afford speech therapists in Dubai as they are very expensive in Dubai.

hope you people guide her. thanks in advance

Maham May 23, 2013 1:33 AM
Dubai UAE

I am  a zambian teacher working with a child with Down syndrome she has problems with  the letter D, any ideas  on activities that can help.I love this site.%0d%0a%0d%0awarm regards %0d%0a%0d%0aMiss madeleine

madeleine , assistant Teacher February 12, 2013 3:19 AM
Lusaka Zambia WV

A great book to use with children w/Down syndrome, especially

2 and 3 year olds is "Fuzzy Yellow Ducklings" the child loves feeling the textures used in this book.  Try it!

Nancy B, early childhood - Home visitor, school district October 10, 2011 8:10 PM
Plymouth MA

Hi.  I'm working with  this boy who  has DS   he 10 years old and in special education class  and I'm his   crismangagement para . He is very verbal  and talks  a lot and he is very cute and funny. He is very low. He hard time writing the letter  he can do it but he  always says  I cann't do it  so i  have stickers  for him  He can write his first  name. and some letters.  He really needs help with numbers too. He does do it and then he gives up and starts to act up. The  teacher  i work with is wonderful. We tell him if he does his work  when i go to lunch he can play with  blocks. His fingers are short and it hard to hold a pencil but when it does it he really trys. But how can it make it fun  for him is the computer a good way. Thanks really need help.

carmeal, school - Educational Assit, school September 17, 2011 5:19 PM
new york NY

I am in China, fostering 2 special needs children--one with DS and one with CP. Due to illness and other circumstances in the orphanage, they both got a late start on everything, especially the DS child. She was 2 1/2 before I brought her home. She couldn't even sit up so talking was far down the list. That was two years ago and now she is talking but it is very limited at 4 1/2. The boy is 21 months old and not talking yet either. I am just getting started with actual speech therapy and I need help! Thanks.

March 8, 2010 8:11 AM

When dealing with young children with Downs Syndrome using a two prong approach can elicit a strong teacher child interaction.  Young down children benefit from being taugh american sign language in order to communicate more effective when taught early in their lives 1-2 to be more accurate.  Incorporating sign language learning and play therapy makes learning signs and rules of play fun.  I have used it many times one on one and in play groups and is very effective.  More agencies, parents and school should encourage this.

kay w, educator - cm January 21, 2010 1:51 AM

When dealing with young children with Downs Syndrome using a two prong approach can elicit a strong teacher child interaction.  Young down children benefit from being taugh american sign language in order to communicate more effective when taught early in their lives 1-2 to be more accurate.  Incorporating sign language learning and play therapy makes learning signs and rules of play fun.  I have used it many times one on one and in play groups and is very effective.  More agencies, parents and school should encourage this.

kay w, educator - cm January 21, 2010 1:50 AM

Visual Phonics is also another great program for stimulating phoneme production.  It is very similar to Cued Speech and I use it often.

Margaret Holland, Early Childhood - Speech Pathologist November 20, 2009 2:59 PM
Sioux City IA

With any population I use things like straws, whistles, blowing bubbles, licking sugarless suckers, eating cheerios, etc., as a means of developing some awareness of the articulators, having some fun and getting some non-verbal imitations going.  Children with Down Syndrome can be very playful and when I can't get them to directly imitate me I start with imitating them and some of their actions and vocalizations .  It becomes a game and then they start to imitate me in return.  This also can work well with children with autism.

Margaret Holland, Early Childhood - Speech Pathologist November 20, 2009 2:57 PM
Sioux City IA

We as therapist need to be careful that we do not loose sight of the goal.  The goal is to improve our students ability to communicate.  If this means to use oral motor therapy and sensory integration when appropriate with appropriate documentation of growth, then you as a therapist can not be wrong in the service you deliver.  These techniques will not be right for every child you meet and will work for some but not others.  Therefore, the key is to have your back pack full of different techniques and pull out a new one when needed to ensure that your student is progressing towards their goals.

Nettie, Speech Therapist October 30, 2009 11:21 AM
Beaver Falls NY

I am beginning to tutor a 7 yr. old boy with DS and his parents want me to work on his speech and language skills, as well as potty training.  First of all, do you have any thoughts on how to begin with his speech and lang.?  I am not sure what level he is on or anything, but what would be the appropriate beginning levels/activities for me to start with to see what he can/cannot do?  Also, I do not have many resources so I am looking to spend the least amount of money, but get the most out of the tutoring.  

Also, any thoughts on how to work on potty training?  Any certain methods (a few of them if possible) anyone has seen that works well with non verbal or limited verbal children with DS?  

Thanks much  :)

Katie September 18, 2009 3:22 PM
MI

1.  I use the M.O.R.E. program , by Patti Oetter, OTL-R ,as one of the many tricks of the trade with all of my kiddo's with oral motor deficits. ( Yes, Lisa the whistles do work! ) The M.O.R.E. program helps the child to develop more efficient coordination of respiration, oral motor movements and eye coordination.  PLUS it is very motivating which is necessary to keep therapy working!  also chewy tubes are great to keep fingers out of the mouth (another OM technique) if not distracting to the child) and parents like it cause it's not a pacifier.  They really can help improve attention to tasks.  I especially like the ones you can clip onto the shirt so they don't drop onto the floor and the child can easily locate them.  Some kids may become distracted by the chewy itself so that is just one of those many things you have to play arond with.  A  

Adelaide Simpson, SLP - SLP, Rainbow Road therapies, Inc August 9, 2009 12:23 PM
Las Vegas NM

Has anyone considered a relatively new mode of communication -- Cued Speech, also called Cued English (or whatever language you are speaking)?  I am the father of a 4 year old girl with DS, and because I used Cued Speech growing up (I am profoundly deaf) I expect all my children will learn CS just because it is a great system!  However, in the case of our daughter, we have made sure that her SLP uses Cued Speech (it is mandated by her IEP because we made sure it was included) with her and we use Cued Speech with our daughter to help her formulate the words and intricate sounds in words with complex blends.  

An easy example is this -- she says "Where is the Bus?" but actually says with a lisp "Whereth the Buth" and we can correct her and reinforce her actual speech by cueing back to her "WhereSSSSS the BuSSSSS" and she will immediately recognize this and even repeat what we said while cueing for herself.

Cued Speech is great for teaching, reinforcement and practice with any speech therapy.  In the case of the exceptional child, CS will help them compartmetalize the myriad of patterns of speech therapy and just by cueing, they can immediately repackage and reinforce everything they learn.

The bottom line here is -- Cued Speech is not just for the deaf.  It is a great tool to be utilized with any person who has pervasive speech and language difficulties.  It is incredibly easy to learn, use and will make a fantastic addition to any SLP's portfolio.  

Joshua Libby, Advocacy - Father of DS Child, National Cued Speech Association www.cuedspeech.or July 31, 2009 10:59 AM
Boston MA

I would like to remind people that ASHA does not promote using oral motor therapy for articulation/speech therapy.  Horns and whistles do not help articulation, practice with sounds and words help articulation.

With those children with low oral/facial tone, we can help to increase strength in and around the oral area to help feeding skills, or to reduce tongue protrusion.  Whistles and horns don't help but rather as some readers have suggested straws to, or spoons, or licking, etc.

Also please remember that children with Down's Syndrome need to be looked at as individuals.  There is no one technique that works but rather a variety.  

Please don't fall for a bunch of dollar store horns and whistles for any or your children.  Read, watch others, practice and use common sense.

Lisa, Pediatric EI - Speech Path July 30, 2009 5:11 PM
Kulpsville PA

Hi, I have never worked with children with down syndrome and am very interested in finding ways, strategies, to work with them.  I currently have a 5 year-old student with down syndorme he seems to be functional but has low small motor skills (can hold a pencil, crayon, scissors, but can't write or cut). Please help me.

Maria Hernandez, Education - K-Teacher July 30, 2009 4:06 PM
Los Banos CA

It is such a coincedence that this article came out now because I just got a 15 month old on my work load.  He has about 10 words and is fine receptively, able to follow simple commands.  Most of the posts here seem to be geared towards toddlers.  Any suggestions and activites for a 15 month old?

Thanks

Daphnie Doirin, EI - Speech Pathologist July 27, 2009 8:19 PM
NY

I recommend using PROMPT (Prompts for Restructuring Oral Motor Phonetic Targets) with kids with Down's.  www.promptinstitute.com

Christie Francis, Preschoolers - SLP July 27, 2009 7:58 PM
Sault Ste Marie

For those parents who insist on sippy cups, the best one I've found that is closest to drinking from a regular cup is the Playtex Coolster!!!!

Rosemarie, , Speech-Lang. Path November & Associates July 27, 2009 7:30 PM
Port St. Lucie FL

I, too, work with a Down Syndrome child who will be attending our kdgtn this year. I worked with him only parttime last year b/c he was homeschooled and they came in for therapy 1X aweek. He has several anti-social behaviors -  spitting, throwing, and occ.kicking, and/or. hitting. He refuses any formal speech attempts of choices, imitation. He does have a few spontaneous words and some are quite intelligible. (no, Sandy (grandmas'dog, see ya, bye, hmmmm to name the very few) %0d%0aI tried several play items to try to engage him and did my own play and tried to see if he would imitate either the movement, words, sounds but none was ever done. It will be different this year b/c I will have him 4/5 days so my hope is that that might improve. Videos do interest him and I showed several with signing of nursery rhymes.....We'd watch and I'd sign and sing and see if he would attempt any of the signs or words but there were none. It did at least make him sit for that short time which was also difficult for him. We played ball , blew bubbles and I would give him words Throw, pop, stomp (or even bop) but never heard one of those even attempted.  Parents believe he is not LOW functioning and I tend to believe that as well. He is spoiled by the parents I believe and doesn't have to do anything he doesn't want to do....at therapy if he threw something they did however make HIM get down and pick it up (hand over hand, leading him) but no firm discipline was ever exhibited. So I guess my question is....am I starting back far enough? What other ideas/activities could I have tried. I am kind of dreading this year b/c I know it'll be a hassle -- him having to just sit in a classroom will be interesting. I welcome and appreciate any ideas....

PLynn , Speech - SLP, School Corp. July 27, 2009 6:47 PM
Francesville IN

I, too, work with a Down Syndrome child who will be attending our kdgtn this year. I worked with him only parttime last year b/c he was homeschooled and they came in for therapy 1X aweek. He has several anti-social behaviors -  spitting, throwing, and occ.kicking, and/or. hitting. He refuses any formal speech attempts of choices, imitation. He does have a few spontaneous words and some are quite intelligible. (no, Sandy (grandmas'dog, see ya, bye, hmmmm to name the very few) %0d%0aI tried several play items to try to engage him and did my own play and tried to see if he would imitate either the movement, words, sounds but none was ever done. It will be different this year b/c I will have him 4/5 days so my hope is that that might improve. Videos do interest him and I showed several with signing of nursery rhymes.....We'd watch and I'd sign and sing and see if he would attempt any of the signs or words but there were none. It did at least make him sit for that short time which was also difficult for him. We played ball , blew bubbles and I would give him words Throw, pop, stomp (or even bop) but never heard one of those even attempted.  Parents believe he is not LOW functioning and I tend to believe that as well. He is spoiled by the parents I believe and doesn't have to do anything he doesn't want to do....at therapy if he threw something they did however make HIM get down and pick it up (hand over hand, leading him) but no firm discipline was ever exhibited. So I guess my question is....am I starting back far enough? What other ideas/activities could I have tried. I am kind of dreading this year b/c I know it'll be a hassle -- him having to just sit in a classroom will be interesting. I welcome and appreciate any ideas....

PLynn , Speech - SLP, School Corp. July 27, 2009 6:47 PM
Francesville IN

I completely agree with those SLPs promoting oral motor programs for youngsters with Down Syndrome.  When we refer to oral motor programs though, I don't think these programs are as technical as they seem.  In fact, the same programs are often used with all youngsters both with and without a diagnosis.  First and foremost, GET RID OF SIPPY CUPS ASAP!!!!  These should only be used BRIEFLY as a transition from a bottle/breast to a regular cup.  When using Sippy cups, try the Nuby brand that requires a little more work than the hard plastic ones.  Second, encourage straw drinking and fun activities like whistles/bubbles.  Several of us seasoned SLPs have found GREAT success with Sara Rosenfeld Johnson's programs (Talk Tools) for straw drinking and whistle blowing.  I don't think you'll be sued or do any harm if you look into trying these programs with your clients as long as you keep expectations realistic!

Nanette, EI - SLP July 27, 2009 4:47 PM

Lola --

I am confused as well about promoting the use of oral-motor therapy to improve speech articulation.  In the evidence-based world in which we live, how can we justify the use of this strategy?

Kara Young, early intervention - slp July 27, 2009 10:47 AM
norman OK

Can anyone help me make a decision about the use of "oral motor therapy (OMT)" when ASHA's stance is that there is no valid research that supports using it? I want to do the best possible therapy for all the children I serve but I'm confused that I'm still hearing about OMT when our national office doesn't support it. Same holds true for sensory integration. There is an OT in the area who has had amazing results working with children on my caseload who have severe autism. Although she has offered to train me at no charge ( brushing, swinging, pressure, etc.), I am reluctant to go there as again, ASHA does not approve it and I don't want to end up getting sued for "doing it wrong." Thanks.

Lola Coleman, speech pathology - speech language pathologist, home visitor July 23, 2009 12:56 PM
Marlboro County SC

One suggestion that I have to be sure that any speech production difficulties are not automatically attributed to "cognitive delay".  Be sure that your assessment is thorough and includes a speech motor assessment so you will know if the child may have a motor speech disorder.  There is some limited data that some children with DS may have apraxia of speech.  We know that these children may also have a dysarthria.  Be sure the evaluation is thorough so that you have considered all of these possibilities.

Sharon Gretz, , Executive Director Childhood Apraxia of Speech Assoc. of North Americ July 21, 2009 8:14 PM

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    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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