by admin | Mar 21, 2017 | news
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.
by admin | Jan 20, 2017 | news
Characteristics of Childhood Speech Apraxia
Childhood Apraxia of Speech (AHI) is a type of motor disorder that affects the production of speech. Motor speech disorders are neurological in nature. It means that a child's brain has difficulty coordinating the parts of the body that produce speech. Structures such as the tongue, lips, and lower jaw may be affected.
Researchers believe that deterioration in the speech processing system occurs between phonological coding and the motor execution phase. When children with apraxia try to communicate their ideas to us, they don't do it properly. They struggle to sequence and articulate sounds, syllables and words. This results in difficulty in moving quickly and accurately between sequences of articulatory configurations. These configurations are necessary for the production of continuous and intelligible speech.
Causes of Childhood Speech Apraxia
Children with AHI may also have a disorder in motor sensory areas, such as proprioception. We find an inability to understand the spatial position of the articulatory structures. For the most severely affected children, even initiating speech movement gestures can be difficult. Apraxia is different from other motor speech disorders because it is not caused by muscle weakness, limited range of motion, or paralysis of the muscles.
Apraxia is most often caused by nerve damage due to infection, disease, injury, or trauma. It may also be a secondary feature of other conditions such as genetic, degenerative, metabolic, and even seizure disorders. However, not all children with this type of disorder will have apraxia. There are also cases where the cause of apraxia is unknown and there is no apparent neurological indicator of why a child is exhibiting apraxia in speech.
Manifestations of Childhood Speech Apraxia
AHI is a difficult disorder to identify because of its complexity. Symptoms also vary in severity. However some of its more common features include:
- You're late. This symptom can be shared with many other disorders. However, if your child is considered a "late talker," apraxia may be one reason.
- Articulatory attempts. This is a kind of quest or fighting behavior. Your child tries several times to articulate sounds with his tongue, lips, or lower jaw.
- Inconsistent errors. The child produces different types of errors in the same word when repeating it. Depending on the level of severity, your child may be able to accurately produce the objective statement in context. But, it will be unable to produce the same objective accurately in a different context.
- Automatic speech is better than spontaneous speech. The child's automatic speech and imitated speech will be less affected than spontaneous speech. Has more difficulty with voluntary and self-starting statements compared to learned, automatic, or modeled statements.
- Difficulty in multisyllabic words. Errors increase with the length or complexity of the statements. There is more difficulty in multi-syllabic or phonetically challenging words
- Prosody affected. There is a monotonous speech or emphasis on the wrong syllable or word. Affected speed, time deficit in the duration of sounds and pauses.
- Reduced speech intelligibility. It will be difficult for unknown listeners to understand children with apraxia.
Who can help my child with Apraxia?
If you think your child may be exhibiting symptoms of AHI, it is important to be evaluated by a speech therapist. At Speech Therapist we will be able to provide you with a differential diagnosis. Currently research does not show consistency in which characteristics are most important to support the diagnosis of apraxia of infant speech. It is also unclear which or how many characteristics should be present for diagnosis. Therefore, the speech therapist must be experienced and use her clinical judgment in the diagnosis.
We don't have an easy solution for apraxia, and because it can manifest differently in every child we don't have the same formula for everyone. Rather we offer you a variety of individualized techniques. Treatment outcomes depend on the severity of the child's apraxia, as well as whether there are other associated problems.
Children with Apraxia Del Habla Infantil progress to levels of intelligible speech and effective communication. Many children can become intelligible speakers.
Consistent practice and repetition are important and necessary keys to helping children with apraxia achieve an adequate level of communication, which is why we guarantee a professional and evidence-based approach.
Visit us at our office or contact us at 70928392. We are located in Guadalupe, San José. Remember that neither you nor your child are alone!
Lic Rocío Vargas.
by admin | Apr 1, 2016 | news
Sudden infant death syndrome (SIDS) is the sudden death of a healthy baby younger than 1 year of age after being put to sleep and its cause is unknown. These deaths have decreased significantly since mothers and fathers are recommended to sleep children on their backs, on a firm surface, and offer exclusive breastfeeding for the first six months. Another recommendation currently provided by the American Pediatric Association based on several studies is the use of the pacifier in breastfed (older than one month) and non-breastfed (before one month) babies. The benefits underpinning this recommendation are as follows:
1. The pacifier prevents the baby from turning on its stomach while sleeping and thus prevents suffocation.
2. The baby still doesn't fully control his breathing so if his pacifier falls it's easier for him to wake up and remember to breathe.
3. The pacifier keeps the airway free and modifies the position of the tongue.
As I mentioned in a previous article, the pacifier is perfectly recommended for children under one year of age and for its safe use several recommendations must be taken into account:
Offer it during sleep periods and don't force the baby if he doesn't like it.
Do not put the pacifier into the mouth when the baby is asleep.
Don't put anything sweet on the pacifier.
To offer the pacifier to the breastfed babies until after the first month that is when the lactation is well established.
For formula-fed babies, the recommendation is important before one month because they have other characteristics that may increase the risk of SIDS.
In order to avoid the negative effects of the use of the pacifier it is recommended to limit its use until the year of life.
Be careful with the pacifiers you buy. Not all of them are safe for your baby, for example the one-piece ones are the safest but if necessary consult your pediatrician for advice on the right size (about 4cm) and the best brand for your baby.
The pacifier also has an analgesic effect and stimulates non-nutritive sucking.
In the end, how important it is for parents to know both the risks and benefits of pacifier use and to make an informed decision.
by admin | Feb 28, 2016 | news
I write this article thinking of all those moms who say things like this in the consultation: "to be able to rest I put her to watch TV", "see how well she behaves when she watches TV", "the nanny sleeps it like this, with the TV on" or "the grandmother takes care of it and since she is so tired, they watch a lot of TV". If your child does not yet speak and loves to watch TV, it is very likely that this is a key factor in changing the environment in which it develops. The general recommendation is to try not to expose them to it before the age of two, since it is associated with the appearance of delays in language development and neuronal alterations due to the prolonged exposure of some images and changes in light and colour; but it is also necessary to be realistic. In many of our homes young children are exposed to it for different reasons. This is why instead of totally eliminating it from our lives I recommend turning it into a tool. I explain it with a real-life example: you are tired after a day's work, you decide that you want to rest for a while and sit your child down to see something he likes. While the child is focused, you check his Facebook, answer messages, end the program and get up. This was wasted time for your son because at that time he received information but there was no reciprocity in the communication. If, on the other hand, you share what he or she is seeing and comment on things like: what is Mickey doing? Where did they go? What color is her dress? See what dinosaur is bigger! Does it look big or small to you? And a while later they comment again; at that moment television becomes a learning tool and your child will have taken advantage of the time sharing his world with you and exercising his communication skills. The same principle applies to tablets and cell phones. My recommendation is to use them with measure (less than two hours a day and in short intervals) and always supervise and accompany. If it is impossible for you to accompany your child, it is better to engage in another activity . Remember that the secret is to turn your "enemies" into friends.
