Causes and Treatment of Speech Impairment in Children With Down Syndrome
Speech impairment is a common challenge for children with Down syndrome. This is one of the many issues our Fort Myers speech therapists address for our Down syndrome patients at FOCUS Therapy. We encourage any parent whose child has been recently diagnosed to contact our office to set up an evaluation for speech therapy, occupational therapy, physical therapy and possibly ABA therapy. The earlier we are able to intervene, the better the long-term progress and prognosis.
Speech is the ability one has to vocally communicate by articulating sounds and using language.
To understand why children with Down syndrome struggle in this regard – and how we can help treat it – we first need to break down some of the observable symptom clusters affecting multiple body systems that are common among children with this diagnosis.
Symptoms That May Impact Speech For Children With Down Syndrome
Down syndrome is characterized as a genetic chromosomal disorder that causes developmental and intellectual delays. Among the cluster of observable symptoms:
- Short stature
- Different facial structure
- Hearing loss
- Vision loss
- Gut/digestion issues
- Low muscle tone
- Thyroid issues
- Atlantoaxial Instability (AAI), cervical spine abnormalities
- Intellectual disability
- Holes in the heart
- Sleep issues
Children with Down syndrome don’t necessarily have every single one of these, and there are others, but these are perhaps the most common and well-recognized. Each of these issues can affect speech. The four main ways they impact speech ability are: Structure, Tone, Cognition and Sensory Issues.
Let’s look at each of these more closely.
- Structure. Specific to speech, it should be noted that the shape of the child’s head and face overall is different. The middle of the face, nose, mouth and upper jaw are smaller. In turn, that means there is less room for speech. It can also impact the airway and require a person to be more precise to have the same level of clarity as a typically-developing person. The palate too is taller and narrower, which means the person has to move their tongue further to make accurate speech sounds. There are also structural differences in the tonsils, teeth and ears. For children with Down syndrome, their ears may sit a bit lower than the typically-developing person, which means they are more prone to stuffiness, frequent ear infections and hearing loss. Sometimes this is seasonal, so hearing loss can be temporary or permanent. Nonetheless, it can impact speech.
- Tone. Note: This is not about how strong a child is. Instead, it refers to how their muscles respond to gravity. Typically, a person can have their mouth closed while at rest and breathe through their nose. Children with Down syndrome, however, might have their mouth open at rest because of tone issues. In turn, this results in mouth-breathing as well as low tongue posture – both of which can make speech more challenging.
- Cognition. Most kids won’t pick up a new sound or word on the first try. They need to hear it several times. For a person with Down syndrome, however, they’re going to need more practice. Whereas a typically-developing child might need to hear a new sound two-to-six times, a child with Down syndrome may need to hear it 20 times.
- Sensory. There are two kinds of sensory issues: Hypo-aware and hyper-aware. Hypo-awareness means they cannot register sensory impact as easily (it’s why they might constantly be putting things in their mouth). Hyper-aware means that sensory input that might not bother most kids can really bother a person with Down syndrome.
Combining all these challenges, it is almost guaranteed that children with Down syndrome are going to have a speech delay. It simply is going to take them more time to develop sounds from the very first stages. It also makes them more likely to suffer a speech sound disorder. Think of speech development in terms of Legos. You need to have a strong foundation of those basic sound blocks on the bottom before you can build more complex sounds on top of that. Because of some of the structure issues, a child with this condition is going to be missing some of these fundamental sounds (often the K and the G, because of the arched palate and the way the tongue sits low in the mouth).
Co-morbidity is also more common among children with Down syndrome. They are more prone to be diagnosed with childhood apraxia of speech (a motor speech disorder), dysfluencies (stuttering, cluttering, etc.). We also sometimes see a condition called dysarthria (another motor speech disorder sometimes described as sounding like one has “marbles in the mouth”). All of these can result in speech impairments beyond just a simple delay – and it can be even more difficult if your child has an additional diagnosis of autism spectrum disorder or epilepsy or suffers setbacks due to surgery recovery.
How FOCUS Speech Therapists Treat Down Syndrome
The first thing to keep in mind is that your child is not defined by their diagnosis. They are more than the sum of their symptoms, and there are many ways we can help your child communicate clearly and effectively. We take a holistic approach with our therapy, seeing the child for who they are rather than simply their symptoms.
We offer evaluations and develop comprehensive treatment plans to address all the areas in which a child might be experiencing difficulty. That can include:
- Expressive and receptive language
- Semantics (vocabulary)
- Syntax (grammar)
- Pragmatics (using language and developing social/conversational skills)
- Classroom language skills
- Speech, oral and motor planning
- Motor strengthening
If your pediatrician has not already recommended it, it’s a good idea to meet with an ENT (ear, nose, throat doctor). This is a professional who can examine the tonsils and adenoids to determine if those need to be removed to make more room in the mouth and throat – which in turn can help with both breathing and speech. It’s also good to regularly see an audiologist who can periodically test for possible hearing loss and determine whether your child needs tubes or hearing aides.
Children with Down syndrome benefit tremendously from the team effort we have at FOCUS between our speech therapists and our occupational therapists. An occupational therapist can, for example, help with seating. This seems like a minor thing, but a child with Down syndrome may need additional trunk support, backrests, footrest or armrests. You would be amazed at how much longer a child can attend to a task – including speech therapy – when they have the benefit of modified seating. (Regular movement breaks can also really help in this regard.) Occupational therapists can also be tremendously helpful in helping make sure a child’s sensory needs are met, as well as assisting with tone, play and many other issues. Physical therapists can help build up muscle tone and practice strengthening certain muscle groups and skills. ABA therapy can help children with Down syndrome (particularly those on the spectrum) learn expected behaviors through positive reinforcement, which in turn improves their ability to learn, engage and play. Parents find having all of these services together in one place – sometimes with therapists co-treating – is tremendously helpful and results in faster progress.
In terms of cognition, because these kids need additional repetition, it is imperative that speech therapy be consistent. They are going to need more practice and they’re probably going to need it daily or at least several times a week. It’s also important that as we target each child’s personal goals that our practice is motivational. Because kids learn best through play, we commit to following the student’s interests – whatever those are – to motivate them to talk, engage, and push through the challenges that may pose more difficulty.
If you have any questions at all about how our Fort Myers speech therapy, occupational therapy, physical therapy and ABA therapy team can help, we are available to meet, allow you tour the clinic and talk to other parents about the difference our services have made for their children.
FOCUS offers pediatric speech therapy and online speech therapy for kids in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.
Speech & Language Therapy, National Down Syndrome Society
Speech Impairment in Down Syndrome: A Review, Feb. 1, 2014, Journal of Speech, Language and Hearing Research
More Blog Entries:
Parents: Get Involved in Your Child’s Speech Therapy Progress! May 15, 2020, Fort Myers Speech Therapy Blog