Transcript Sue Madraszek 2012 Talk - Towards a Positive Future

Developing communication skills of pupils who
have Down syndrome
June 16th 2012
Sue Madraszek
Speech and Language Therapist
Symbol UK Ltd
How can we assist children to reach their
potential?

Minimise the effect of the syndrome - lots is known about the
syndrome and there are many helpful resources available. Early
Intervention is important to maximise the development of
communication skills.

Have high expectations - redress historical focus on ‘won’t’ with
a focus on ‘can’! People with Down syndrome make significant
progress in all areas of their communication skills, given support
and opportunities to do so.

Have information - this presentation shares information about
the profile of communication strengths and needs associated
with DS, and strategies to use to overcome difficulties and
develop skills.
How can we assist children to reach their
potential?

Understand strengths and needs - use areas of strength to
support learning and address areas that are more challenging

Realise the value of targeted intervention - people who have
Down syndrome require support and programmes of activities
that take into account what is known about the syndrome and
individuals’ strengths, challenges and needs.
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.’
Children are developing their communication skills in many
activities and situations.
Key elements include:




Having reasons and motivations for communication
Experiencing opportunities to communicate
Access to a means of communication
Support to ensure that communication is successful
Something to talk about
Specific issues associated with Down
syndrome impact on communication
Health and
Medical issues
Expectations
and
opportunities
Learning cognitive skills
Speech and
language
impairment
Motor
development physical skills
Sensory
issues-vision,
hearing,
sensory
processing
Down syndrome: a specific profile of strengths
and weaknesses
Areas of strength
 Strong motivation to interact and orientation to people
 Visual processing skills
Skills in line with non verbal mental age
 Motor skills (see below)
 Information processing
Weaknesses
 Vision and hearing
 Speech and language skills
 Verbal/Auditory short term memory - phonological loop
 Motor skills (see above)
Speech, language and communication profile
associated with Down syndrome
A specific profile of communication impairment over and above any
speech/language delay associated with learning disability and
hearing loss:
Not just following patterns of typical development at a slower rate!
Summaries of research findings
Major communication challenges that children with Down
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 syndrome (Robin S. Chapman,
Adolescents with Down’s Syndrome, 1997)
Some implications of key research findings
‘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
‘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
‘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 syndrome
 Use shorter average length of sentences compared to ‘mental
age’ matched controls.
 Omit grammatical words more frequently than pre-schoolers
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.
Some implications of key research findings
Great social sensitivity, appropriate non-verbal communication
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
‘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

Development of ability to produce speech sounds is delayed.

School age children with Down syndrome show many more
speech errors and inconsistencies than either other children with
‘mental retardation’, or children of similar ‘mental 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.
Some key research findings
Short term memory will not develop as rapidly as the other
cognitive skills of children with Down syndrome:
children with Down 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.
Areas addressed at each stage of
language development

Interaction - making choices, being part of a group taking turns

Social language

Expressive language

Vocabulary

Speech production

Management of associated issues

Specific strategies to support speech and language
development: reading, signing, auditory memory training.
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

Targeted Intervention at each stage of language development
‘Intervention might work better when….professionals try to tailor
intervention to specific etiological groups’ (Jean Rondal)

Facilitative Communication Environments
Speech is an
auditory signal
and more
difficult to
process
Visual signals
are more
powerful
Using visual representations…

To support understanding of information and language

To support memory, learning and verbal reasoning

For communication - to get a message across

To learn and rehearse spoken language
Visual communication
Pictures
Objects
Demonstration
Signs
Symbols
Written words
Gestures
A facilitative communication
environment…

Makes extensive use of visual strategies to support both
understanding and expression

Allows children plenty of time to process information and respond

Presents information in meaningful and manageable steps

Uses vocabulary that individual children can understand or are
learning to understand

Avoids use of grammatical structures that individual children cannot
understand or are likely to misinterpret

Makes communication successful, and fun / useful.
Signing

Makaton (01276 681368) www.makaton.org and Signalong
www.signalong.org (01634 819915) produce A4 ring bound
reference books of signs that can be used to look up signs.

You can learn lots of signs and improve your signing skills with
the Makaton Nursery Rhymes DVD and Something Special
children’s programmes with signing on BBC.

Learning to sign several signs per sentence in songs like “Baa
Baa Black Sheep” and “Miss Polly had a dolly” will help you and
your child to develop you skills in signing sentences.
Reading: Why?

Down Syndrome Education International (now located in
Cumbria) recommends that reading activities are
introduced when are children are around 2 ½ years old.

We use flashcards and word matching to teach children to
read by whole word recognition (not by sounding out the
words).

Reading sentences helps 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 children.
Further reading for families and
others
Modules from the Down Syndrome Issues and Information Series:
 Speech and language development for children with Down
Syndrome - An overview
 Speech and language development for children with Down
Syndrome 0-5 years, 5-11 years and 11-16 years
Book:
 Early Communication Skills for children with Down Syndrome: A
guide for parents and professionals (Libby Kumin, 2003)
Both are listed in “resources” section of Down Syndrome
Education International www.dseinternational.org
See also Down’s Syndrome Association website –
www.downs-syndrome.org
Feeding

Aim for children to “move on” with feeding skills around the
same age as other children: if it doesn’t happen, seek support
to identify and deal with underlying difficulties.

Support children to take drink from spoons/cups/straws,
initially in small amounts, and in play.

Alongside routines that ensure your child gets enough food and
drink, give opportunities to try new experiences.

If you encounter difficulties, try moving on in “smaller steps”.

Bringing food/drink to mouth may be a challenging task, aside
from dealing with food/drink in the mouth. So treat this as a
separate task.
Feeding

Feeding issues are often related to sensory processing,
so helpful strategies can include:

Touch experiences in messy play: progressively
increasing messiness!

Opportunities for messy play with food.

Routines to deal with hyper/hypo sensitivity.

Seek specialist advice where needed: dietician,
GP/paediatrician, occupational therapist, speech and
language therapist.
Speech skills
Control of mouth, lips and breathing

Work towards your child tolerating touch on his/her face. We
start off just stroking hair and pressing ears, and work towards
rubbing cheeks, patting chin and lips, and stretching lips. You
can do this when having a cuddle, putting on cream or washing
faces, or sing a “touch on face” song.

Keep working towards eating a good range of food textures:
biting, chewing, dealing with lumps, and drinking from an open
topped cup and straw. Ask a speech and language therapist for
advice.
Speech skills
Control of mouth, lips and breathing

Support your child to practise biting: once children are happy
to put things in their mouths, they usually enjoy biting chewy
toys (with supervision!!).

Play with toys that you blow: whistles, kazoos, bubble blowers
that you put in your mouth. Search out ones that your child can
use, and nearly use, and then play with these.

When you give your child an ice cream or spoon to lick, hold it
still so your child has to move his/her head or tongue, rather
than wiping the food against his/her tongue. Start off with big,
flat wooden spoons, and work towards using spoons with deep
bowls (plastic measuring spoons or Chinese soup spoons are
good), so that your child has to move his/her tongue.
Speech skills
Support children to learn to say words:

Clap the syllables - this is the first step towards marking the sound
structure of words.

Practice saying single speech sounds with sound cards such as
Jolly Phonics pictures. Use pictures, actions (sound cues) and
sounds. Make transition to letters when children are ready.

Practice identifying which sound you hear: hold up two sound
cards, say one sound, and support the child to find the matching
sound card. Then practice identifying the first sound in short words:
car, door, bee, shoe.

If you are concerned that your child is not using the sounds that
he/she can say in words, then write down the words that your child
says, and how he/she would say the word (e.g. “rin” for prince). A
speech and language therapist can advise on which sounds and
words to practise next (“phonology”).
CONTACT DETAILS
Symbol UK
Newington Manor
Callaways Lane
Newington
Kent, ME9 7LU
Tel: 01795 844440
Email: [email protected]
Web: www.symboluk.co.uk