In this workshop we will cover….

1. Speech and language development for school-aged childrenUnderstanding the profile and working together to address support needsLeela BaksiSpeech and language therapist

2. Do you feel that your child would benefit from improved speech and language? Whether or not your child is currently receiving speech and language therapy, this workshop is for you! The workshop will discuss how to understand the profile of school-aged children with Down’s syndrome and how to work together with your child’s school to address their speech and language development needs.

3. In this workshop we will cover…. • What the international experts tell us about speech, language and communication skills and Down syndrome. • The profile of speech, language and communication strengths and needs associated with Down syndrome. • Strategies to use with school aged children.

5. Pupils who have Down Syndrome face complicated challenges in mastering and using speech, language and communication skills. With the right opportunities and support, they can develop communication skills that support them to • make relationships and socialise, • communicate wishes, needs and aspirations, • use language effectively as a tool in all sorts of situations. There are a range of tried and tested strategies, with research literature that describes and supports, that address the speech, language and communication needs (SLCN) associated with Down syndrome

6. Specific underlying impairments contribute to speech, language and communication issues Sue Buckley and Patricia Le Prevost of the Sarah Duffen Centre at the University of Portsmouth, in their article making recommendations about Speech and Language therapy for children with Down syndrome, state that “The needs of children with Down syndrome tend to be different from the needs of other children with learning difficulties. Their hearing, phonological loop impairment and speech-motor difficulties make them different and therapist needs to be skills in auditory discrimination, oral-motor function and speech work as well as language work.”

7. Direct teaching as well as language stimulation People who have Down Syndrome require direct teaching of specific aspects of speech, language and communication skills, as well as good language models and general language stimulation to support language learning. Writing in Speech and language development for individuals with Down Syndrome- An overview (Down syndrome Issues and Information Series), Sue Buckley states: “the evidence from available research does suggest that improving the quality, quantity and sensitivity of the talk to children with Down syndrome does help … this type of language experience approach is not sufficient on its own but needs to be accompanied by teaching specific vocabulary and sentences, using techniques which encourage the child to imitate production.”

8. Interventions There are plenty of widely used speech and language therapy interventions that are effective in addressing the underlying impairments and real-life communication challenges faced by people who have Down Syndrome. When describing some of these, Sue Buckley comments: “The proposals for intervention…follow logically from the available evidence from research, the profile of language development of children with Down syndrome and the probable causes”

9. A specific profile of communication strengths and impairments Are our children more skilled at understanding language or putting ideas into language? • Language comprehension > expressive language skills. What aspects of language are particularly challenging? Learning words? Learning grammar? Learning sentences? • Conceptual aspects of language (understanding concepts, word meaning)> computational aspects of language (the ‘codes’ of grammar, and how we use speech sounds to make words)

10. A specific profile of communication impairment Patterns of specific language difficulties (e.g. certain morphemes), rather than slower progress through typical patterns of development. Speech errors are different to those characteristic of typical development. There are issues with learning the sound structure of words, and with learning to say sounds and words. Differences in patterns linguistic competence- of patterns of cerebral specialisation, poor phonological short term memory (limited capacity in remembering and repeating back things you they have just heard).

11. Summaries of research findings Major communication challenges that children with Down’s Syndrome face (Miller, Leddy, Leavitt, Improving the communication of people with Down’s Syndrome, 1999) and Key research findings: the profile of strength and needs associated with Down’s Syndrome (Robin S. Chapman, Adolescents with Down’s Syndrome, 1997)

12. ‘Children with Down’s Syndrome will have better language comprehension skills than language production skill even at the earliest stage of development’ (Miller, Leddy, Leavitt 1999) People who have DS are better at understanding language than expressing themselves through language, from an early age. So…conversational language should be pitched at the level that the individual understands, rather than tailored to the sort of language s/he produces. Some implications of key research findings

13. ‘The majority of children with Down’s Syndrome will demonstrate slower productive vocabulary development than their other cognitive skills would predict’ (Chapman 1997) People who have DS are more skilled at understanding vocabulary and have more difficulty in learning names for things. So.. don’t oversimplify the vocabulary that you use in conversations with people who have DS. Make sure pupils are stretched with regard to teaching new topic based vocabulary- take baseline as what the child understands, rather than vocabulary s/he says or signs. Some implications of key research findings

14. Some implications of key research findings ‘In syntax production, children with Down’s Syndrome show greatest difficulties’ (Chapman 1997) Putting ideas into well formed sentences is an area of development that presents great challenges and lags behind. People who have Down’s Syndrome • Use shorter average length of sentences compared to mental age matched controls. • Omit grammatical words more frequently than by preschoolers using similar sentence length So… provide direct teaching using a language-through-reading approach, using written words to rehearse and learn sentences and grammar structures.

15. Great social sensitivity, appropriate non-verbal communication ‘Pragmatic skills that can be accomplished with limited language use are more advanced than those that depend on the mastery of complex structure’ People who have DS have strong motivation to interact with people and awareness of other people’s feelings; however learning more complex language to use in social interaction is challenging. So…teach social skills, and social language, to support strengths in this area. Some implications of key research findings

16. Some implications of key research findings ‘Children with Down’s Syndrome will have persistent problems in producing intelligible speech’ (Miller, Leddy, Leavitt 1999) Producing clear speech remains a long term challenge Libby Kumin’s survey of parents of adolescents with DS in 1994 found that 97% reported that their son or daughter had difficulty with intelligibility: 54% reported frequent difficulty, and 43% reported difficulty sometimes. Pueschel and Hopmann’s survey of parents of adolescents with DS found that 91% report that their children were effective in getting others to understand them. 88% of parents of 11-16 year olds stated that their children were understood by strangers. 91% of parents of 17-21 year olds reported this.

17. Difficulties with speech intelligibility are multifactorial in origin, including: • anatomical differences, • differences in the nervous system of people associated with disruptions in the accuracy, speed, consistency and economy of speech movements. • psycholinguistic processing: phonological processing/auditory discrimination, word storage and retrieval, and phonological development also impact on speech skills and speech intelligibility Much of the variation in the communicative abilities of children with Down’s syndrome is better understood when hearing status is taken into account (Chapman 1997).

18. Some implications of key research findings • Development of ability to produce speech sounds in delayed. • School age children with Down’s Syndrome show many more speech errors and inconsistencies than either other children with mental retardation, or children of similar mental age. • Intelligibility typically does improve with age. So.. provide a comprehensive programme of therapy activities that addresses the issues that contribute to speech difficulties. This includes getting mouths ready for talking, showing the sound structure of words using visual representations, and step by step teaching developing skills at using more and more complicated patterns of sounds in words.

19. Intelligibility is a continuing problem for adolescents with Down syndrome. • Studies have highlighted the need for effective repair strategies such as signing, symbols, pictures, and writing, as well as ‘verbal’ repair strategies, for example rephrasing the message rather than repeating it. (Jenkins in Buckley and Rondal 2003) Typically, young people with DS make good use of strategies to overcome these challenges, and achieve successful communication with great effort. Also identify and teach strategies that individuals can use to get their message across when there are difficulties with speech intelligibility, and build confidence as effective communicators

20. Short term memory will not develop as rapidly as the other cognitive skills of children with Down’s Syndrome: children with Down’s Syndrome have particular difficulty in remembering and repeating back things that they have just heard (the phonological loop) and this is a skill that can be addressed through specific intervention. Learning to read is associated with a significant advantage in language and memory skills: Teaching reading supports language development and memory skills.

21. ‘Language learning continues through adolescence, extending into adulthood: does not stop with simple sentences, or onset of adolescence, and can often include literacy skills’: People who have Down’s Syndrome can continue to develop their skills in communicating and reading throughout childhood and adulthood. These interventions can be deployed at any age, alongside motivation to become a more effective communicator.

22. Keys to Quality Communication High Expectations ‘Expectations are important determiners of outcome’ (Sue Buckley) Opportunities ‘Intervention will have only a limited effect in furthering development and functioning if the attitudes and opportunities of the inclusive educational or community setting are less that appropriate’ (Jean Rondal) Experiences Experiences of positive, successful and rewarding communication- facilitative communication environments Targeted Intervention at each stage of language development ‘Intervention might work better when….professionals try to tailor intervention to specific etiological groups’ i.e. characteristics of the syndrome (Jean Rondal)

23. Key strategies • Establish and support an effective means of communication. • Develop a facilitative communication environment, including: • Physical environment taking into account sensory challenges • Opportunities for making choices, asserting self, being independent, and socialising, as well as supporting learning. • Extensive use of visual supports.

24. Facilitative Communication Environments Speech is an auditory signal and more difficult to process Visual signals are morepowerful

25. Visual communication

26. Using visual communication • Labels • Opportunities to make requests • Visual schedules • Instructions • Explanations • Learning activities

27. Signing can... • Focus the child’s attention to listen to what is said • Support children to understand what is said, by showing as well as telling • Help children to learn and remember new words • Use signs for words s/he cannot yet say • Organise words into sentences • Get his/her message across when speech is unclear

28. Teaching reading to teach talking • The research team at DSE recommends that reading activities are introduced when are children are around 2 ½ years old. • We use flashcards and word matching to teach our children to read by whole word recognition (not by sounding out the words). • Reading sentences helps our children to learn and remember sentences, and develop their language skills. Reading is particularly helpful with learning to use longer sentences and linking words such as “is” and “for”. • Reading books introduces lots of new words, ideas and sentence structures to our children.

29. Reading: How? • Start off with words that are motivating to your child: perhaps family names, or favourite foods or animals. • Support children to match word to word, and to look at the word shape, as well as linking words and pictures. • Children learn to recognise words through lots of practise in games where they see the word, hear the word, and sign/say the word; ‘match-select-name’. • Move on to learning to read the words in target short sentences e.g. I like…, I went…., I saw…

30. Setting targets around specific skills • Work towards having realistic communication goals for your child: endeavour to always have “aims” that your child can achieve. • Let your child, and everyone else, know when you see achievement - celebrate success!

31. Language learning linked to curriculum topics • Identify targets for learning receptive vocabulary separately from pupil’s ability to communicate their knowledge through words/signs. • Identify relevant/meaningful aspects of the topic. • Start with a list of concepts that the whole class will study, and identify baseline and next steps in pupils knowledge. • Focus on names of items-action words-describing words. • Set up visual materials to support learning: signs, objects, pictures, symbols, written words. • As well as teaching the concept, also focus on how to say the word/make the sign.

32. Language learning linked to curriculum topics Identify sentence frames/carrier phrases that link to the topic and build ‘next step’ expressive language skills. e.g. Rabbit lives in the hole, fish lives in the water… rabbits like holes, fish like water. e.g. Ancient egyptians used to build pyramids, Ancient egyptians used to worship gods …. Ancient egyptians used to have pyramids, Ancient egyptians used to have gods… Ancient egyptians had pyramids, Ancient egyptians had gods.

33. Narrative skills- giving accounts and telling stories ‘First’ … ‘next’ … ‘then’ … Start with familiar, everyday sequences in the pupil’s life. Work on to familiar sequences that the pupil sees but may not carry out. Then work on novel story sequences. …. This builds skills for describing events. Then focus on adding information about the story: What was it like? Who? Where? When? Give the story a title.

34. Develop play skills • There is a strong connection between learning to represent things in play, and learning to use language. • Play skills practice the foundations of giving accounts/telling stories step-by-step- ‘narrative skills’. • Playing on your own for short and increasing periods is an important skill for independence- ‘self occupancy skills’. Teach our children to play, starting out with simple pretend play and working through to imaginative play- acting out situations

35. Speech skills: phonics • Teach letter-sound correspondence and focus on learning to produce all the speech sounds. • Break words down into syllables using syllable clapping. • Practice listening for single sounds, and then listening for sounds in simple short words (e.g. boy, pie, toe)… • Provide visual representations of the sound structure of words.

36. Speech skills: speech production • Get advice and information about tackling production of ‘tricky’ sounds. • Eating and drinking skills get mouths, breathing etc ready for talking- so aim to keep moving forward in small steps with more sophisticated challenges. • Touch on face routine and buzzy toys help to normalise sensation and get mouths and faces ready for new feeding challenges, and for talking. • Biting and chewing toys also builds skills for speech production. • Blowy toys also practice skills for speech production.

37. Getting ready for talking Touch on face song • (Rub your back) • Stroke your hair • Rub your cheeks • Press (or pat) your chin • Stretch your nose • Stretch your lips • Stretch your smile • Press (or tap) your lips • Sing to the tune of “skip to my Lou” • Do as much of the song as client can tolerate: watch for blinking, rubbing face, and startle responses indicating poor tolerance. • Tolerance varies within and between sessions.

38. Teach social language and social communication skills • Group skills • Teach social interaction routines • Teach language scripts • Work on personal presentation

39. Auditory Memory skills Direct work on auditory memory skills: listening, recalling, repeating back what you have heard • enhance awareness of speech sounds and word structure • teach cumulative rehearsal to develop auditory memory span • Listen • Repeat back to self: words, signs, visualisation • Rehearse • Recall