Introduction • Allie, Amy and Malory • Tonight’s topics • Oral motor and feeding • Hearing • Speech and Language • SLP’s Role • Augmentative Alternative Communication (AAC) • Parent’s Role
Oral-Motor and Feeding • Infants, toddlers and children with Down syndrome have anatomical (structural) and physiological (functional) differences in the mouth and throat making it difficult to make precise movements required for oral motor control and feeding. • Areas affected may include: • Breast feeding • Bottle feeding • Cup drinking • Chewing solid foods • Swallowing • *Oral motor will also affect speech
Anatomical and physiological differences… • Some anatomical differences that might be seen include: • Small and narrow upper jaw • Highly arched, narrow palate • Causes tongue to protrude • Some physiological differences that might be seen include: • Low muscle tone • Weak oral facial muscles
Other contributing factors… • Some children with Down syndrome have hypersensitive (high) or hyposensitive (low) reactions to touch around the mouth. • Difficulty with sensory feedback will affect oral motor and swallowing. • Kumin, L., Resource Guide to Oral Motor Skill Difficulties in Children with Down Syndrome. http://www.ndsccenter.org/resources/documents/speech/OralMotor.pdf
Hearing • Surveys suggest that as many as 80% of people with Down syndrome will have some problem with hearing. • (Shott, S.R. (2000). Down syndrome: Common pediatric ear, nose and throat problems. Down Syndrome Quarterly, 5(2), 1-6.) • Conductive loss: common along with Chronic ear infections • Children with Down syndrome have an increased incidence of upper respiratory tract infections, which predisposes chronic ear infections. The facial anatomy of Down syndrome also predisposes chronic ear disease. (ndss.org) • Some children may need repeated placement of pressure equalization (PE) tubes to eliminate chronic infections. • Balkany suggests that middle ear problems account for 83% of hearing loss in children with Down syndrome. • Balkany, T.J., Mischke, R.E., Downs, M.P. & Jafek, B.W. (1979). Ossicular abnormalities in Down's syndrome. Otolaryngology: Head and Neck Surgery, 87, 372-384.
Hearing Continued… • Stenotic ear canals (narrow ear canals) can occur in up to 40-50 percent of infants with Down syndrome. • Narrow ear canals can make the diagnosis of middle ear disease difficult. • Ear canals grow with age, and may no longer be of concern after age 3. • If a child with Down syndrome has stenotic ear canals, he should see an ENT specialist every 3 months to avoid undiagnosed and untreated ear infections. • www.ndss.org
Speech and Language Characteristics • Individuals with Down syndrome demonstrate an overall delay in the rate of speech acquisition. • Children with Down syndrome do not appear to learn language at a constant rate. • They have stronger visual than verbal skills, receptive vocabulary stronger than expressive language and grammatical skills, and often strengths in reading abilities. • They have good social interactive skills and use gestures and facial expressions effectively to help them communicate. They generally have the desire to communicate and interact with people
Language Skills Continued… • Most children with Down syndrome will enter school at 5 years with a spoken vocabulary of about 300 words and probably a larger receptive vocabulary of about 400 words. • Due to the inability to accurately produce phonemes children with Down syndrome often lack speech intelligibility. • Not all people with Down syndrome are the same. • They all don’t demonstrate the same characteristics or to the same degree.
SLP’s role • Therapy may occur at Early Intervention, school services with an IEP, community agencies, private practitioners, university clinics, medical centers and other sources. • Therapy should maximize on the child’s strengths • May involve a combination of: • Sound stimulation • Language stimulation with play • Feeding and swallowing • Oral motor exercises • Includes the family
Early Language Intervention • Early Intervention is critical • Birth-Three years old • Speech Services are part of an overall treatment team and plan • Includes the family and conducted at home • Every community in the U.S. should have an Early Intervention program • Today, with early intervention programs and medical advances, the possibilities for individuals with Down syndrome are almost limitless.
Using AAC • It is NOT a question of choosing between AAC or natural speech • AAC involves the use of strategies & techniques to enhance communication when speech is inadequate • AAC offers a potential means to enhance: • Functional communication • Social development • Language development • Learning / cognitive development • Literacy development • Quality of life
Types of AAC • AAC systems include: • Low tech strategies such as signs, gestures, communication boards or books • Picture Exchange System (PECs) • Pragmatically organized dynamic display (PODD) • High tech strategies: • Speech generating systems (SGDs) • AAC is used in conjunction with intervention to maximize speech development • http://www.youtube.com/watch?v=IGKS95G4ynM
The Parent’s Role • There are several simple things that parents and caregivers can do at home to promote speech and language development for children! • Play • Matching and modeling • Reducing questions • Create a communication need • Sign language • Speech sounds
Expanding Language Through Play! • Play is a Child’s Work! • Play encourages turn taking, promotes joint attention, integrates the senses, involves repetitions, helps develop social skills and motor skills. • How to Play in your Child’s World: • Follow your child’s lead: Be flexible allowing child to change the direction of any activity • Get down to your child’s physical level • Play for fun: Think doing not finishing • Be spontaneous: Have fun and go with the flow
Modeling and Matching Utterances • Modeling is a way of teaching by “doing and saying” as an example for your child. • Model actions, gestures, sounds, words, phrases • Match your child’s utterances • Stay at the child’s language level by: • Using appropriate vocabulary- short, familiar words • Using a slower rate of speech • Using short, simple sentences • Why… • Child has a better understanding of the spoken message • Reduces child’s speaking demands
Questions • Questions are good, but avoid using too many • Use open-ended questions, rather than limiting yes/no questions • Provide plenty of wait time (5-10 seconds) for the child. • Children need time to collect their thoughts and decide how to respond • Waiting for the child shows them we are interested in what they have to say • Instead of questions, use comments
Creating a Communication Need • Children who have limited communication skills need a reason to communicate • To increase the likelihood of communication it is helpful to create a situation in which the child must communicate wants/needs • Examples • Interrupt and enjoyable activity and wait for child to respond • Use prompts and cues, such as, “ I stopped the song. Should we sing more?” • During routine “forget” a step • While putting shoes on, “forget” to put socks on.
Speech Sounds • Why did my child say that sound first? • Some sounds are easier to see (p,b,m) • Some sounds are easier to make and imitate because they require less coordination and movement of the mouth • Help your child learn speech sounds • Slowly model the sounds for your child • Emphasize the target sound by making it longer • Have your child watch your mouth • Play with sounds during interactions
Sign Language • Purpose • Children want to communicate, but often lack the ability to do so • Sign can help them express their message and close the gap between their need to communicate and their ability. • Benefits • Hand-eye coordination develops earlier than verbal skills • Gives child the ability to express wants, needs and thoughts • Enhances sound and word development. It is important to pair sign with sound! • Reduced frustrations of net being able to express wants and needs • Teaches child how to initiate and participate in conversation
Words from Self Advocates • I have dreams and if I work hard my dreams can come true. Elaine Fickenscher, self-advocate, Maryland • Please do not ever prejudge the limits of my abilities, just because I happen to have a disability. Ann Forts, self-advocate, New Hampshire • ...all of us have abilities and disabilities. Some of us have disabilities that you can see like Down syndrome. People with disabilities are proud of themselves;they can speak for themselves.Katie Maly, self-advocate, Ohio
Resources • Handout • Website resources • www.dynavoxtech.com • www.prentrom.com • http://www.mayer-johnson.com/downloads/trials/ to trial Boardmaker to make low-tech communication boards
References • Bray, M. (2008, July 15). Social and communicative functioning. Retrieved from http://www.down- syndrome.org/reviews/2073 • Bray, M. (2008, July 15). Speech production in people with down syndrome. Retrieved from http://www.down-syndrome.org/reviews/2075/ • Buckley, S. (2008, July 18). Speech, language and communication for individuals with down syndrome-an overview. Retrieved from http://www.down-syndrome.org/information/language/overview/ • Buckley, S. , & Bird, G. (2009, March 27). Speech and language development for children with down syndrome (5-11 years). Retrieved from http://www.down- syndrome.org/information/language/childhood/ • Doman, R. (n.d.). Language acquisition in children with down syndrome. journal of the national association for child development, 12(1), Retrieved from http://downsyndrome.nacd.org/language_acquisition.php • Reed, V. (1994). Indroduction to children with language disorders . Boston M.A.: Pearson Education Inc.