If we could summarize what we hear most often from parents of children with Down Syndrome, it would be, "I want my child to speak clearly." "Speaking clearly" involves a number of skills and abilities that must interact precisely in order for a listener to understand what the child is saying. Some of the physical and cognitive limitations that typically accompany a diagnosis of Down Syndrome significantly impact the ability to talk and/or the level of intelligibility of that speech.

Low muscle tone - Children with Down Syndrome typically have low muscle tone. Their bodies have fewer muscle fibers and those muscles can be described as "floppy" or weak. Although this can be seen in delayed acquisition of gross motor abilities such as sitting up, standing or walking, it also influences muscles that aid in respiration and speech. To be able to talk, you must take air in and control the amount of air you exhale as you talk. This involves postural control as well as coordination of the diaphragm and the external intercostal muscles.

So what does this have to do with speech? Unlike most consonant sounds, vowel sounds require a continuous stream of air, which in turn require the ability to precisely control the amount of air exhaled during speech. Without that precise control, words, phrases and sentences tend to be produced on short bursts of air. In children with Down Syndrome, this results in short, choppy speech patterns which decrease intelligibility.

Note: Decreased muscle control is also something to keep in mind when sign language is recommended for your child. Precise signing requires precise fine motor control.

Apraxia and/or Dysarthria - These conditions are common among individuals with Down Syndrome. It is particularly noticeable in younger children who are just beginning to acquire speech and language skills. Apraxia refers to the inability to neurologically program sequences of motor movements. It is the brain's way of coordinating the type, order and timing of oral-motor movements for speech. For further explanation, please refer to our page on Apraxia. Dysarthria refers to muscle weakness that is specifically related to the speech mechanism. Oral-motor muscle weakness makes speech sound indistinct or slurred. Dysarthria and apraxia can co-exist and often do in individuals with Down Syndrome.

Oral-Motor Therapy is very popular right now. However, there is no research to support the efficacy of using devices such as whistles, straws or vibrating tools in order to improve oral-motor function for speech. Oral-Motor treatment should be approached with caution. Keep in mind that with any type of speech or language therapy, you get out what you put in. If you are dealing with a speech problem, your child should be doing tasks that involve speech.

Memory plays a significant role in Communication & Learning. Young children with Down Syndrome may speak in single words or sentence fragments. In many cases, they do so because they are unable to remember more than one or two chunks of information at a time. Typical strategies that involve prompting the addition of words and phrases generally don't work in the long term because the child becomes entirely dependent on the adult's prompts. In conversation, the child reverts to the two-chunk system because it is easier. Language therapy must have a component that addresses memory deficits in order for the strategies to generalize to spontaneous speech.

"Word-finding" refers to the ability to recall a word within an acceptable period of time in conversation. Everyone has word-finding difficulties at times. The expression "It's right on the tip of my tongue" reflects the inability to remember a name or word in a timely manner. Word-finding difficulties that significantly impair communication occur when information is not stored in the memory in an organized manner. The words may be there, but if they can't be retrieved when they are needed, communication is significantly impaired. Visual supports, such as picture symbols and picture schedules, help organize information for a person with Down Syndrome. We can train the use of strategies to improve independent vocabulary recall as part of a comprehensive treatment plan.

Learning - For a more detailed explanation of learning difficulties, please see our page on Learning Disabilities.

For more information on Down Syndrome resources in northern Indiana see www.dsani.org