If you read the book, Early Communication Skills for Children with Down Syndrome, you will read about the differences between communication, language, and speech. A child learns about communication when they figure out that they can affect their environment and people around them by what they do. That breaks down some more into language, where they are giving a message through actions and body language. Language is a shared code, and it is one that any mother can understand. This is why mommy knows what her baby needs simply by watching or hearing the type of cry. This shared code is why I can look at Kamdyn and see that she is uncomfortable or nervous when no one else can see it. I have learned to speak her language. Language also includes gestures like pointing and waving, pictures, sign language, and speech. Speech, specifically, is verbal language. Speech itself is a complex process that requires muscles, movement, and coordination, which can be worked on prior to speaking.
Before a child can speak, there are many skills that have to be accomplished. The child must have visual skills, tactile skills, imitation skills, auditory skills, motor skills, and cognitive skills. If the child cannot see properly, she will not be able to develop skills such as visual tracking, eye contact, visual attention, or imitation. Similarly, if a child has hearing loss or difficulties, learning to speak will become more difficult, which is why many children with Down syndrome have ear tubes placed at such a young age. We are hoping Kamdyn can have the procedure for tubes soon, because she has had issues with inner ear fluid and ear infections. When Kamdyn was a newborn, and I heard so many references to low muscle tone, I did not understand what that really meant. Low muscle tone. Ok. Aren't all babies floppy. But here is an instance where low muscle tone plays a part, because low muscle tone in the face will make it more difficult to control the muscles for speaking.
Lastly, a child needs certain cognitive skills before speech will occur, and even before the child will use sign language. Kamdyn is 16 months old now, and she has 4 signs: waving hello and bye bye, "dog", "more", and "all done". We have worked on others, and I believe she recognizes other signs. Brad and I are in a competition to see if she will sign Mommy or Daddy first. Yeah, Team Mommy! Anyway, she just started signing those in the last few weeks, and I was starting to wonder what the deal was, and if I wasn't doing something right. But there are skills that a child needs before they can sign:
- object permanence: knowing that an object still exists when they cannot see it. They may not be able to see any food, but if they sign "food", they will get some.
- cause and effect: knowing that their actions produce an outcome
- means-end: (cause and effect with a plan) they have to pull a string or push a button to get the song to start, or they have to do their hands in a certain way to get more food during dinner.
- words have meaning
Through play, you can practice the skills listed above, but I feel that a child can only develop these skills as they are able. We realized that Kamdyn understood object permanence, when she screamed until we gave her more french fries while we were at dinner.
Things to work on:
1. Feeding skills: Strengthening those muscles in the face will help with speech. Many parents prefer a straw cup over other sippy cups, because they feel that it helps strengthen the muscles. We have recently been working with Kamdyn on her tongue thrust while she is drinking, because it causes her to spit out a lot fluid. We use an open cup (shot glass, actually) to hold her tongue back and she takes a tiny sip. We've just started, so we'll see how it helps. Also, being able to use the jaw to chew from side to side is a good skill to develop.
2. Children who have tactile defensiveness can work with their Speech Therapist or a Feeding Specialist to overcome these issues. At a recent appointment with the Feeding Specialist, we were told that they see many children who have these tactile issues.
3. Imitation skills: A child learns imitation by you imitating them first. It may feel silly, but when they make a noise, shriek, babble, or whatever, repeat it back to them. They will start to play along, and they will keep making noises back at you. It ends up being a fun game that you can play back and forth. Eventually, you will be able to make a noise or sound, and she will repeat it back to you. The other day during therapy, Kamdyn's therapist lifted her arms up in the air, and Kamdyn lifted hers up. Then, she clapped, and Kamdyn clapped. And finally, the therapist said, "A cow says, Mooooo", and Kamdyn said, "oooooooo". The whole cow thing might seem random, but they had been playing with a cow toy. Kamdyn
4. Oral Motor skills: The best way to improve oral motor skills is to address any feeding issues with a specialist and actually vocalizing by making sounds. The more sounds the better. There are some who use Talk Tools Therapy, while others do not feel it is useful. Here's a Resource Guide to Oral Motor from the NDSC.
5. Sound production: The website Down Syndrome Education says,
Children with Down syndrome usually have considerable difficulty with speech sound production and delay in being able to say initial sounds will lead to delay in saying first words. Sound production can be encouraged from the babble stage in the first year of life and speech sounds can be specifically practised from 18 months of age or earlier.
Speech Resource Guide from the NDSC.
You can read about other speech disorders on the blog Let's Talk Down Syndrome.
Another good article from the NDSS website is Speech and Language Therapy
Hope that can be helpful.
Thank you so much for taking the time to gather all this information for us! I already feel less overwhelmed having all these resources to read and work through.
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