All material Copyright © April 2009 The Down Syndrome Centre
Reprinted with the express permission of the Down Syndrome Centre as originally published on their website.
By: Marinet vanVuren
Marinet vanVuren is a South African born Speech and Language Therapist. For the past seven years she has worked with a range of Irish disability organisations including Enable Ireland, St Michael’s House and the Children’s Sunshine Home. She recently set up her own private speech and language therapy practice where she sees children of all disabilities with various speech, language and feeding difficulties.
NB: This article was written primarily for parents, but the information is nonetheless excellent for therapists.
Speech and Language Early Intervention Programmes are essential for children with Down Syndrome and should address each child’s individual areas of need through treatment. Families should not be told, “We don’t provide speech and language therapy for children with Down Syndrome until they are two”, or “we don’t provide speech and language therapy until your child begins to talk.” In the USA, such statements are against federal law. There are many areas that can be worked on in therapy with young children with Down Syndrome before they begin to talk. Speech and language therapy work needs to begin early.
Parent training programmes (e.g. the Hanen approach) are an effective way of empowering parents to use general communication strategies to facilitate expressive and receptive language during every day activities. But unfortunately, these types of language stimulation experiences are not sufficient on their own (Buckley, 2009) and need to be accompanied by specific techniques to target oral motor skills, speech sound production and specific language skills.
There are three precursors to language development. Over the next few weeks, I will discuss each precursor and provide practical guidelines for parents and therapists to help develop their child’s language skills. In brief, language precursors are the steps children need to acquire before they are able to speak. Research indicates that these precursors develop from birth and there is a critical period for acquiring these prerequisite skills that can be up to 6-7 years of age (Buckley, 2000).
This is not to say that children’s language skills cease to develop at 7 years of age, on the contrary, research indicates that a person’s language skills can continue to develop and grow even in adulthood. The difference is in whether these skills will be naturally acquired versus taught through direct instruction. The language precursors are roughly divided into three skill areas: (i) cognition, (ii) social and communication development, and (iii) sound production.
In this blog I will discuss the third prerequisite: Sound Production.
In typical development, the foundations for clear speech are being laid in the first year of life as infants babble (Buckley, 2000). Speech production is a motor skill, requiring motor planning and control, and like all other motor skills will only improve with practice. Speech requires very precise coordination, planning and programming of the muscles in the mouth along with breathing and voicing. Young children start to practice a variety of sounds from an early age onwards.
Parents and Speech and Language Therapists can target speech sounds (single sounds and re-duplicated babble) to help develop their child’s speech and auditory memory development.
Speech Sound stimulation for the Young Child (from 4 months of age onwards)
Teach your child about sounds as well as the motor speech patterns of speech through multi-sensory babbling facilitation:

• Let your child SEE the sounds: Sit very close and be face to face with your child. Let your child look at your mouth to see how you are pronouncing the sounds. You may have to put some bright red lipstick on your lips to help your child to look at your mouth.
• Let your child HEAR the sounds: Make a sound (e.g. p, b, m, ah, oo, ee) and wait for a reaction. Use a loud clear voice and over-articulate while you say the sound. It is always a good idea to wait for a few seconds after you made the sound allowing your child time to process the sound. You can also babble the different early speech sounds (e.g. bababa, mamama, pipipipi, etc.)
• Let your child FEEL the sounds: Bring your child’s hand up to your lips so that the vibrations and movements can be felt. Place your child’s hand against your throat so he/she can feel the vibrations of your voice box. Place a wooden tongue depressor between your lips. Let your child hold onto each side of the tongue depressor while you make a /mmm/ sound. Your child will be able to feel the vibrations through the tongue depressor as well as see how you close your lips to produce this sound.
• Let your child EXPERIENCE the sounds: Place your child’s hand against his/her own mouth and throat when he is making a sound e.g. crying, cooing, etc. Teach your child the different motor speech patterns, e.g.
  • Gently press your child’s lips together as you say /mmmm/.
  • Gently press down on your child’s chin to help part his/her lips while you say /ah/.
  • Push your child’s lips forward in the shape of a kiss and say /ooh/.
  • Pull your child’s lip corners in the direction of his ears to help spread his/her lips in a smile while you say /ee/.

Sound Play (Have fun with sounds):

• Sing your child’s favourite nursery rhymes and encourage them to finish a line of the song. e.g. “ee-i-ee-i-oh” in ‘Old MacDonald Had a Farm’.
• Sing with sounds instead of words, for example sing “Twinkle Twinkle Little Star” with the sounds ‘p’, ‘b’ or ‘m’ instead. Or sing “If You’re Happy and You Know It” but instead of “clap your hands” sing “say p-p-p”.
• Use items around the house to create a rhythm for sound, e.g. bang on a metal saucepan with a wooden spoon while making a sound to the beat, e.g. “d-d-d” or “b-b-b”.
• Use toy shakers or make your own shaker from a container with small objects inside (such as rice) and say “ch-ch-ch” or ‘sh-sh-sh” while you shake.
• Make noises with toys. You could say “mmm” for a car, “v-v-v” for a plane.
• Make up a surprise box with animals. Get your child to pull an animal out of the box. Say the name of the animal e.g. “dog” and make its associated noise e.g. “woof woof”. Don’t target more than 3 animal sounds in one go.
• Once your child is saying the sounds with you, play a game. Move the toy while making the sound and then stop suddenly. Look at your child expectantly and encourage him/her to vocalise before you continue the action.
• DON’T WORRY if your child doesn’t imitate the sound – they will be listening and learning from you.
• Playful sounds precede babbling sounds and are often forgotten about when we think of sounds in speech. Open vowel sounds (e.g. ah) are also early vocalisations and should be encouraged and reinforced. Reinforce any attempts at playful sounds, e.g. blowing raspberries, kissing sounds, blowing bubbles with his/her saliva, clicking tongue sounds.
• Associate sounds with actions and play. For example, when you are changing your child’s nappy, babble away to him/her, maybe blowing on his/her tummy or make sound associations as you remove the nappy or pull up his/her trousers. Consequently, your child will always be hearing sounds in all situations and he/she will begin to make the communication connection.

If your child is having difficulty saying certain words:

• Praise any attempts at trying to say the word. Try to listen to what your child is saying rather than how.
• Say the word clearly after your child, but do not ask him/her to repeat it.
• Make sure you are face to face with your child so that he/she can see your mouth.
• Because children with Down Syndrome are strong visual learners, he/she may be able to pronounce the word more clearly if reading it than simply hearing you say the word. Print is visual and many children with Down Syndrome have better visual than auditory (listening) skills. Make up a Word Book with your child containing words your child has difficulty saying. Reading enables children to practice their speech skills and pronunciation of sounds.
• Help train your child’s ear to the different sounds/syllables in words through Phonological Awareness tasks. Clap out syllables of multisyllabic or polysyllabic words (e.g. ba-na-na, e-le-phant) or sounds(phonemes) of words (e.g. h-a-t = hat). Target word categories e.g. clap out the syllables of all the zoo animals, transport vehicles, vegetables, etc.

Featured Organization: The Down Syndrome Centre
We thank the Down Syndrome Centre for allowing us to reprint their copyrighted article. For more information about this organization please visit The Down Syndrome Centre