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Language Intervention
for School-age Children
with Down Syndrome
Anna Ubels, MA, CCC-SLP
Patricia Villarreal, MS, CCC-SLP
Learner Objectives
• Describe language development in children with Down Syndrome
• Describe evidence-based intervention approaches for children with Down Syndrome
• Select appropriate communication system based on a profile of strengths and challenges
• Produce modifications for a therapy lesson
Disclosure Statement:
No relevant financial relationship(s) or nonfinancial
relationship(s)
I have no relevant financial or nonfinancial relationships
in the products or services described, reviewed,
evaluated or compared in this presentation.
Unique Characteristics
• Anatomical and physiological differences
• Pattern of strengths and challenges in functioning across different domains of development
Anatomical and Physiological
Differences
• Low muscle tone
• Low muscle coordination
• High narrow arched palate
• Large tonsils and adenoids
• Small mouth and jaw area in comparison with the size of the tongue
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Hearing Development
Narrow and short ear canals
Otitis Media with Effusion
Fluctuating Conductive Hearing Loss
Cognitive Domain
Strengths
• Visuo-spatial
• Visuo-motor
Challenges
• Verbal Processing
▫ Memory
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Social/Emotional Domain
Strengths
• Desire for social interaction
• Use of facial expressions
• Reciprocal eye contact
• Interest in exploring environment
Challenges
Motor Skills Domain
Strengths
• Gestures • Motor planning
• Fine motor/Gross motor
▫ Balance
▫ Posture
▫ Strength
▫ Flexibility
Challenges
Language Domain
Strengths
• Receptive • Expressive
▫ Vocabulary
▫ Grammar
▫ Syntax
Challenges
6
12
18
24
30
36
42
48
54
60
66
72
78
marginal babbling joint attention canonical babbling using gestures first word 2 words 3+ words
Ag
e i
n M
on
ths
Language Milestones
Comparison of Language Development
Typical Down Syndrome
Language Domain
Strengths
• Receptive • Expressive
▫ Vocabulary
▫ Grammar
▫ Syntax
Challenges
0
200
400
600
800
1000
1200
12 15 18 24 36 48 72
Nu
mb
er
of
Wo
rd
s
Age in Months
Vocabulary Development
Typical
Buckley
Kumin, Councill,Goodman
0
200
400
600
800
1000
1200
12 15 18 24 36 48 72
Nu
mb
er
of
Wo
rd
s
Age in Months
Vocabulary Development
Typical
Buckley
Kumin, Councill,Goodman
The Needs of an Elementary Student
Social Interaction
Time Activity
8:00-9:00 Circle Time
8:30-9:30 Math
9:30-10:00 Science
10:00-10:30 Specials
10:30-11:00 Lunch
11:00-11:30 Recess
11:30-12:00 Recharge
12:00-12:30 Reading
• Follow Directions
• Learn Routines
• Acquire Academic Knowledge
Language Skills
Approach to Intervention
Total Communication (TC) is:
Verbalization + Modalities of learning
-Visual
-Auditory
-Kinesthetic
-Tactile
Signs VisualManipulatives
Voice Output Devices
Alternative Augmentative
Communication Systems (AAC)
Signs- Parent Concerns
• Signs can develop verbal speech
• It is abandoned or phased out
• Children with Down Syndrome:
▫ Can lack the motor control to produce meaningful speech
▫ Can become frustrated
Signing is a natural segway into communication.
Signs- pros and consPros
• Reduces frustration
• Easier to learn
• Builds on relative strengths
• Unaided
• Direct Communication
• Pragmatic skills
Cons
Signs- pros and consPros
• Reduces frustration
• Easier to learn
• Builds on relative strengths
• Unaided
• Direct Communication
• Pragmatic skills
• Easier to physically prompt
• Grammar can be extended
• Intelligibility
Cons
• Limited to communication partner’s knowledge
• Ambiguous gestures
Visual Manipulatives- pros and consPros
• Teaches persistence
• Widely understood
• Grammar extension
Cons
• Aided
• Requires additional prep time
• Not suitable for all environments
Voice Output Devices- pros and consPros
• Widely understood
• Provides auditory and visual information
• Range of complexity of devices
• Grammar extension
Cons
• Aided
• Requires battery
• Prep time
• Not suitable for all environments
Sign Visuals VOD
Builds on Relative Strengths � � �
Unaided �
Direct Communication �
Grammar Extension � � �
Intelligibility � � �
Persistence �
Widely Understood � �
Suitable for all environments �
Provides External Auditory Information �
No battery/plug required � �
Communication Systems Comparison
Intervention Aligned with Curriculum
• Base intervention on academic subject matter
▫ Increases collaboration
▫ Allows for frequent repetition
▫ Promotes generalization
Group Lesson PlanTime Schedule Activity Modifications
15 minutes
Question of the Day-Introduction
What animal do you like best?
• Picture of deer, rabbit and blank card
• Sign ‘like’
15 minutes
Surprise Bag Label Animals • Visual templates• Sentence strips• Sign ‘see’
15minutes
Story Animals in their Homes
• Switch• Communication
Board • Sentence strips• Sign ‘where’
15 minutes
Question Time What animal lives in the forest?
• Switch• Communication
Board • Sentence strips• Sign ‘animal’
Generalization
• Morning Circle Routine
▫ Names of students, age of students, day of the week, weather
• Snack Time
▫ ‘I want,’ ‘more,’ ‘please,’ ‘thank-you’ variety of snack options
• Story-time
▫ More specific to story content
▫ First, Second, Third, Finally
Putting it All Together
• Same language development trajectory, slower pace
• Relative strengths in visuo-spatial, visuo-motor, social interactions, facial expressions, gestures and receptive language
• Evidence-based practice points to Total Communication intervention approach
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Common Questions
How do we begin to develop therapy
materials?
Think about the Skills first:▫ Where the child is▫ Where the child needs to be
Then think about the activities you want to do.▫ Activities from class▫ What the parent wants to focus us
Finally, modify those activities to help the child improve.
How do we get buy-in and support
from the professionals we want to
collaborate with?
• Work within the classroom▫ This shows the student successes▫ The teachers often want to be a part of this▫ And the teachers see that you value what they also
have to focus on.
• Make time to meet with them without the students▫ Talk about what they are working on so you can
support them.
How do we support students with low
vision or low hearing?
• Low Vision▫ Provide physical manipulatives▫ Especially objects they frequently use in their
environment.
• Make time to meet with them without the students▫ Use lots of generalized visuals� Pictures� Signs
Difference or Disorder?
Understanding Speech and Language
Patterns in Culturally and
Linguistically Diverse Students
Rapidly identify speech-language patterns related to second language acquisition to distinguish difference from disorder.
ReferencesClibbens, J. (2001). Signing and lexical development in children with Down syndrome. Down Syndrome Research and Practice,
7(3), 101-105.
Early Intervention. National Down Syndrome Society. www.ndss.org
Fidler, D., Most, D. & Philosfsky, A. (2008). The Down syndrome behavioural phenotype: Taking a developmental approach. Down Syndrom Research and Practice. www.down-syndrome.org/research
Foreman, P. & Crews, G. (1998). Using augmentative communication with infants and young children with Down syndrome. Down Syndrome Research and Practice 5(1), 16-25.
Grouios, G. & Ypsilanti, A. (2011). Language and Visuospatial Abilities in Down Syndrome Phenotype: A Cognitive Neuroscience Perspective. www.intechopen.com
Kumin, L. (2012a). Speech and language therapy for children and adolescents with Down syndrome. National Down Syndrome Society. www.ndss.org
Kumin, L. (2012b). Speech and language therapy for infants, toddlers and young children. National Down Syndrome Society. www.ndss.org
Roberts, J., Chapman, R. & Warren, S. (2008). Speech and language development and intervention in Down syndrome and Fragile X Syndrome. Baltiomre, MD: Brookes Publishing
Romski, M. & Sevcik, R. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18(3), 174-185.
Rondal, J. & Buckley, S. (2003). Speech and Language Intervention in Down Syndrome. London: Whurr Publishers Ltd
