Within the framework of the International Down Syndrome Day I would like to share some information that I consider valuable. My work focuses on enhancing language development in children with Down Syndrome. However, I am not limited to just working in this area.
Characteristics of Down Syndrome
The language development of a child with Down syndrome goes through the same stages as the language development of any other child. However, the physical and cognitive characteristics of the child with DS make speech and language more likely to be difficult.
These difficulties are diverse and some may affect one child more than another. Recurrent ear infections, fluid accumulation in the middle ear and hearing loss of different intensity can be found. Also in some boys we see a low muscle tone in orofacial structures, a small mouth compared to the size of the tongue, a tongue with little coordination, malocclusions or a narrow palatal arch. There may be difficulties in cognitive aspects such as auditory memory, attention, information retention and other health disorders such as heart disease.
Like all other children, all children with DS are different. It is not possible to pigeonhole them, label them or assume what they are capable of before they are even evaluated. Although there are similarities between them because of their genetic condition, no two children are alike. There is also no such thing as the talk of a child with Down Syndrome. This is why no two interventions are the same.
Language development in the child with Down Syndrome.
It is important to know what communication skills are expected based on the child's age and where the main difficulties lie. This is important to give parents peace of mind. Many times when not seeing immediate results, parents lose hope in therapy. We must keep in mind that this is a long process.
Dr. John F Miller of the University of Wisconsin has for many years studied the language development profile of children with DS and its challenges. Next we will take a look at the language levels and the expected age of appearance of some of the most important aspects in a regular child vs. a child with DS, according to this research.
Prelinguistic Stage in the Baby with Down Syndrome
In the prelinguistic stage (from 0 to 12 months) there is crying, social smile, first vocalizations, reduplicative babbling until reaching the first words around the year of age. In the SD child the development follows this same pattern but the speed is slower. The visual contact is less frequent, the social smile takes longer to appear as well as the vocal games and babbling. In the first year, the first signs may appear. The first word usually appears in some children between the ages of two and three, and in other children up to the age of five. It is therefore very difficult to establish an exact age range for the emergence of many of these skills.
Remember that before speaking the child must understand. The vast majority of children with DS understand more than they are able to express. We notice this expressive comprehensive gap by observing its behavior. If they follow instructions and respond appropriately to the questions they are asked with signs or gestures. In this way we can be sure that your understanding is adequate.
Semantic Level
Regular children start expressing themselves at 9 months. Around 18 months we find the first words with semantic function. At 24 months the child acquires about 50 words. The same happens in a child with DS but at 36 months. In the child without DS the vocabulary increases rapidly between 24 and 36 months and they have between 300 and 400 words. In the child with DS the increase is significantly lower (100 words) and much later (4 years). At 4 years old a regular child will dominate 1600 words and a child with DS at 5 years old will dominate between 200 and 300. I remind you that these data were published by Miller but we will always find children who go ahead or behind these averages.
Phonetic Level
The appearance of the first words is also delayed because the articulation ability of the speech sounds is affected by the state of the phonoarticulatory organs. When you have a high palate, tongue with poor muscle tone, poor occlusions, etc. it is obvious that the joint will be difficult. However, once again, not all children have such complicated anatomical structures.
Morphosyntactic Level
As far as sentence construction is concerned, we find that children of 24 months make combinations of 2 words and at 24-36 months they present sentences of up to 5 words. At age 4 they use verbal nexuses, subordinate sentences and more elaborate constructions. Meanwhile in the child with DS two-word productions may appear by the age of 4 or 5. In some even up to school stage and are usually simple productions. This happens because the morphosyntactic area, because of its abstraction, is particularly difficult for children with DS. Some flattering areas are those that can be acquired by visual methods (such as vocabulary) since the vast majority have a very good visual memory.
Pragmatic Level
In the pragmatic area in the child with DS there are difficulties especially because they often find it difficult to understand the social rules of communication. For example, greetings, rules of courtesy, taking turns, etc. are properly acquired but with the help of your family, teachers, peers and therapists.
The work of the Language Therapist.
The evaluation and intervention of the speech and language of a child with DS goes far beyond numbers, statistics, and ages of acquisition. It is rather aimed at identifying what difficulties are delaying the child. The aim is to bridge this gap between understanding and expression by intervening in each and every aspect that affects speech and language.
I place special emphasis on this aspect because what may serve one, may not serve another child. The patient and his environment must be known. In the consultation I have come across children with incredible advantages, both environmental and cognitive and anatomical that are completely out of that unpleasant mold in which they have wanted to stereotype.
It is here where the work of the speech therapist becomes indispensable to guide the parents and above all to work together with the teachers and other professionals involved according to each specific case.
Speech therapy is often recommended from the age of 3. It is thought that a child who does not speak cannot be evaluated. There's nothing further from the truth. As I mentioned earlier, the child's communication does not begin at that age, it begins from the pre-linguistic stage. It is for this reason that the start of therapy is recommended as early as possible. While speech certainly cannot be evaluated, all aspects of communication are evaluated and involved, as well as the receptive language or communication system the child uses.
Some love stories
Day by day I have had the joy of meeting professionals who are truly committed to their students and patients and who really make a difference in the lives of these families.
I'm also a witness to the struggle of and admirable parents. One of those is Don Gabriel who, besides being the one who accompanies his son to most of his therapies, has created together with his wife the LAM Foundation. The goal is to help other children with fewer opportunities to receive the same therapies as your child.
I have also had the good fortune to share many therapies with dona Dannia who has been struggling since her son was diagnosed with a gastric disease a few days after birth. After 30 surgeries, he is now a pupil integrated into the regular system and a potential pianist.
I have been able to accompany Doña Eugenia who tried to get her daughter into several schools where they put a thousand obstacles until she found a place where both of them are happy.
International Down Syndrome Day
Today, 21 March, is International Down Syndrome Day. This day was set up to raise awareness of all those who still feel doubt, fear or ignore aspects of this condition. Also to promote the inclusion of boys in all areas of society. In the educational system, in the workplace, in the health system and in recreational activities.
I celebrate all the parents and children who have achieved their goals despite the ignorance and prejudice that still exist in our society. To all mothers and fathers, who feel in doubt, remember that they are not alone, there are many professionals who are committed to our vocation.
I thank my patients and their parents for choosing me to accompany them through this process.
If you would like to talk, learn more about the support we provide and get to know our team and facilities, do not hesitate to contact us at 70928392. We are located in Guadalupe, San José.