Language development for children diagnosed with Down Syndrome can be challenging and confusing. Factors such as cognitive and motor delays, hearing loss and visual problems can interfere with language acquisition. It’s important that a child’s caregivers provide a variety of opportunities to increase language development.
Using many normal everyday activities can enhance the child’s language and expose them to new concepts. The language you teach to your child will assist them in learning and generalizing new information.
The following are early intervention strategies that can be used to help children with Down Syndrome develop and increase their understanding of language:
Take advantage of language opportunities during daily routines:
Activities such as taking a bath, cooking, grocery shopping, changing a diaper, or driving in the car are a wonderful time for learning. Caregivers can consistently identify actions, label items, expand on their children’s utterances to facilitate vocabulary acquisition and overall language development. It takes a lot of repetition for children to learn and start to use words appropriately. Include a variety of words that include all the senses. “Does the water feel hot?” or “Can you smell the cookies?” When speaking, identify textures, colors, express feelings etc.
Read, read, read:
It can never be said enough how important reading is to children. When reading a book, it’s important to not only read the words on the page, but to talk about what is on the page, what the characters are doing or how they might be feeling. Make reading a book an interactive experience.
Incorporate play time with other kids:
Children can learn a lot just by interacting with other children as they are interested in and motivated by their peers. They imitate each other’s actions and will learn from them. Play time with other children will also help them develop social skills. Concepts such as sharing, taking turns, pretend play, creating, etc. can all be increased.
Play with them:
Children don’t know how to play with toys and games on their own, we need to show them. Get on the floor and play with blocks, balls, bubbles, sing a song, etc. During this time talk about what you and the child are doing (Ex: stack up the blocks, let’s blow more bubbles, it’s my turn) and expand on their utterances. Play time is critical for children to develop their ability to focus and attend to a task. When you are engaged together in a task, you are developing a special bond with your child and they are learning!
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Play skills are one of the most important areas that children, especially those with Autism, need to learn. These skills provide opportunities for the child to entertain themselves in meaningful ways, interact with others, and learn important cognitive skills. A successful way to teach play skills to children with autism is to initially teach the specific play skill in a very structured manner.
Break the play skill into small, discrete steps and teach one step at a time. As the child demonstrates success in learning one step, add the next step. (After the child can add eyes to Mr. Potato Head, then add ears, then arms, etc.)
Use modeling to teach the skill (e.g. the adult builds a tower of Legos as the child watches, then the child builds his own tower).
Always provide reinforcement (behavior specific praise “Nice job putting the piece in the puzzle”, immediately following the child’s demonstration of the skill.). As the child exhibits improved accuracy of the skill, reinforce successive approximations.
The child should have plenty of opportunities to rehearse the skill in a structured setting. Practice, practice, practice!
In the structured setting, have the learning opportunities be short and sweet, so the task does not become aversive to the child.
Fade the adult prompting and presence out gradually, so the child can gain more independence. Systematically fade the reinforcement so that it is provided after longer durations.
Remember to keep the activity fun and exciting. You want your child to WANT to play with the toys and games.
Once the child masters the skill in the structured environment by independently completing the play tasks for extended periods of time, he or she can then begin to practice and develop the skill in more natural settings. Bring the toys and games into other rooms of the house, to school, and eventually have peers present, so the child can use the skills learned in a social setting.
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A school speech-language screening allows a speech-language pathologist to observe the child’s language understanding and use, production of speech sounds, vocal and nasal quality, and social language skills. The screening typically follows a checklist that a speech-language pathologist administers in approximately 15-20 minutes.
Most screening tools yield a “pass” or “did not pass”. If a child did not pass the screening, then a comprehensive full speech-language evaluation is recommended. Following this process, an intervention plan is created and proposed if needed.
A hearing screening is equally important and recommended upon entering kindergarten. The screening is typically a hand raising game an audiologist administers in approximately 10 minutes. If a child did not pass the screening, a comprehensive full hearing test is typically recommended. Normal hearing in children is important for normal language development. If a child has hearing problems, it can cause problems with their ability to learn, speak or understand language.
Speech and language skills are used in every part of learning and communicating with other children in school. In kindergarten, children learn the routine and structure of a typical school day and need to be able to follow directions, understand ideas learned in class, communicate well with their peers and teachers, practice early literacy skills and use appropriate social skills within the classroom and during play.
Screenings can be a great tool to determine if a child warrants a full speech-language or hearing evaluation. A screening alone is not diagnostically reliable and should only be used as a tool to decide if an evaluation is necessary.
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Many people correlate hand flapping with only Autism, however this is not the case. All children could exhibit a hand flapping behavior when they are in a heightened emotional state including when anxious, excited, and/or upset. Many believe that children with Autism will engage in hand flapping as a self-stimulatory activity, which can be accompanied by other stimming behaviors like rocking and/or spinning.
Children with autism are often extremely sensitive to specific sensations and sounds that may not effect someone who is not on the spectrum. Environments in which there are multiple sounds, loud noises, and crowds can cause distress for some individuals with and even without autism. Hand flapping is seen as a way to escape the over stimulating sensory input present in the environment.
Other times when hand flapping can be observed in children (both verbal and non-verbal) is when they are trying to express or communicate to others around them. It is viewed as them trying to express that they are: happy, excited, anxious, or angry. In cases like these, families and professionals often feel that hand flapping should not be a concern, stopped, or corrected.
Hand flapping would be something to worry about when and if it impacts a child’s functional daily living ability, for example if it impacts their ability to navigate their environment safely.
Parents often worry when their child reaches 18 months or 2 years of age and does not talk much or at all. Some children exhibit late language emergence, also known as late talking or a language delay. Approximately 10-20% of 2-year-old children exhibit late language emergence. A late-talking toddler is typically defined as a 24 month old who is using fewer than 50 words and no two-word combinations. While research shows that late talkers catch up to peers by elementary school, approximately one in five late talkers will continue to have a language impairment at age 7. For some children, the late emergence of language may indicate a persistent language disorder, also called a specific language impairment. For other children, late language emergence may indicate a related disorder such as a cognitive impairment, a sensory impairment, or an autism spectrum disorder. Many parents wonder if their late-talking toddler will catch up naturally or whether speech-language therapy is recommended.
The following signs may indicate that a child will not naturally “catch up” in language and therefore may require therapeutic intervention:
Language production: The child has a small vocabulary and a less diverse vocabulary than peers. A child who uses fewer verbs and uses primarily general verbs, such as make, go, get, and do is at risk for a persistent language disorder.
Language comprehension: The child has deficits in understanding language. The child may be unable to follow simple directions or show difficulty identifying objects labeled by adults.
Speech sound production: The child exhibits few vocalizations. The child has limited and inaccurate consonant sounds and makes errors when producing vowel sounds. The child has a limited number of syllable structures (e.g., the child uses words with two sounds, such as go, up, and bye instead of words with three to four sounds, such as down, come, puppy,black, or spin).
Imitation: The child does not spontaneously imitate words. The child may rely on direct modeling and/or prompting to imitate (e.g., an adult must prompt with, “Say ‘dog,’ Mary” instead of a child spontaneously imitating “dog” when a parent says “There’s a dog”).
Play: The child’s play consists mostly of manipulating or grouping toys. The child uses little combination or symbolic play, such as using two different items in one play scheme or pretending that one item represents another.
Gestures: The child uses very few communicative gestures, especially symbolic gestures. The child may use pointing, reaching, and giving gestures more than symbolic gestures such as waving or flapping the arms to represent a bird.
Social skills: The child has a reduced rate of communication, rarely initiates conversations, interacts with adults more than peers, and is reluctant to participate in conversations with peers.
The following risk factors exist for long-term language disorders:
Otitis media (middle ear infection) that is untreated and prolonged
Family history of persistent language/learning disabilities
Parent characteristics including less maternal education, lower socioeconomic status, use of a more directive instead of responsive interactive style, high parental concern, and less frequent parent responses to child’s language productions
For children displaying any of the above signs or risk factors, a comprehensive speech-language evaluation is recommended.
Paul, R. (2007). Language Disorders from Infancy through Adolescence: Assessment & Intervention. Elsevier Health Sciences.
Motor speech disorders are neurologically-based speech disorders that affect the planning, programming, control or execution of speech. In order to produce speech, every person must coordinate a range of muscles and muscle groups, including those controlling the vocal cords, the lips, the tongue, the jaw and the respiratory system. Movements must be planned and sequenced by the brain and then carried out accurately to create speech! A child with a motor speech disorder may be learning to understand and use language, but is constrained in the ability to plan, sequence and/or control movements of muscle groups that are used to generate speech due to neurological and/or neuromuscular impairment. Motor speech disorders include apraxia of speech and dysarthia.
What is apraxia of speech?
Apraxia of speech (AOS) is a neurogenic speech disorder in which an individual has difficultly moving his/her lips or tongue in order to say sounds correctly, despite no presence of muscle weakness. This may be due to a disruption in the message form the brain to the mouth when speech is produced.
Two main types of apraxia of speech include acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment in existing speech skills. AoS may include co-occurring muscle weakness that negatively affects speech production, as well as language difficulties that result from brain damage. Causes of AoS include stroke, head injury, tumor or illnesses affecting the brain.
Developmental apraxia of speech, or childhood apraxia of speech (CAS), is present from birth and occurs in the absence of muscle weakness or paralysis. There is no known cause for CAS, however, some researchers suggest it is related to overall language development, some say it is neurologically based and others reference a genetic component.
What is dysarthria?
Dysarthria is a neurologically based motor speech disorder, caused by damage to the central or peripheral nervous system that results in impaired muscular control of the speech mechanism. These disturbances of control and execution are due to abnormalities in the muscles used for speech that can include weakness, spasticity, incoordination, involuntary movements or excessive, reduced or variable muscle tone. Dysarthria specifically affects face muscles, vocal quality and breath control. Causes of dysarthria include stroke, brain injury, brain tumors, conditions that cause facial paralysis, as well as tongue or throat muscle weakness. There are five categories of dysarthria that include flaccid, spastic, hypokinetic, hyperkinetic and ataxic.
Children with motor speech disorder demonstrate neuroplasticity for speech learning. Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience or following injury. Therefore, early intervention for treatment of motor speech disorders in children is critical. Consistent treatment frequency and opportunities for repetition are important to fully develop the child’s neural connections in order to change speech sound input (from the brain) into actions of the speech mechanism in order to create meaningful speech!
If you believe that your child shows signs of a motor speech disorder, do not hesitate to consult with a speech-language pathologist.
https://nspt4kids.com/wp-content/uploads/2017/07/Blog-Motor-Speech-Disorders-FeaturedImage.png186183Megan Siekkinenhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngMegan Siekkinen2017-07-17 05:30:552019-09-04 21:43:18What Parents Need to Know About Motor Speech Disorders
Auditory processing refers to what we do with the messages we hear. An auditory processing disorder occurs due to an auditory deficit that is not the result of other cognitive, language, or related disorders. However, children with an auditory processing disorder may also experience other difficulties in the central nervous system, including learning disabilities, speech-language disorders, and other developmental disorders. Auditory processing disorder may also co-exist with other diagnoses, such as ADHD or Autism.
10 Signs of Auditory Processing Disorder
Difficulty understanding speech in noisy environments
Inability to consistently and accurately follow verbal directions
Difficulty discriminating between similar-sounding speech sounds (i.e., /d/ versus /t/)
Frequently asking for repetition or clarification of verbally presented information
Poor performance with spelling or understanding verbally presented information
Child typically performs better on tasks that don’t require or rely on listening
Child may not speak clearly and may drop ends of words or syllables that aren’t emphasized
Difficulty telling stories and jokes; the child may avoid conversations with peers because it’s hard for them to process what’s being said and think of an appropriate response
Easily distracted or unusually bothered by loud or sudden noises
Child’s behavior and performance improve in quieter settings
How is Auditory Processing Disorder Diagnosed?
An initial diagnosis of auditory processing disorder is made following a comprehensive audiological evaluation, which is completed by a licensed and ASHA accredited audiologist. Following the diagnosis, the speech-language pathologists at NSPT work closely with the audiologist and collaborate on an ongoing basis. Children with an auditory processing disorder benefit from working closely with both speech-language pathologists, as well as occupational therapists. Professionals at NSPT can collaborate with teachers and other professionals to provide recommendations to help set up a successful learning environment for your child. Therapy will include activities to increase auditory closure skills, vocabulary building, discrimination skills, grammatical rules, and auditory perceptual training.
Bellis, Teri James. Understanding Auditory Processing Disorders in Children. American Speech-Language-Hearing Association.Retrieved from http://www.asha.org.
Potty training is a big milestone for any child. It definitely is an important milestone for parents as well! No more diapers!! However, there are some things to keep in mind prior to considering potty training as well as during potty training.
When should you consider potty training?
On average you would consider potty training when the child is around 2.5 years of age and above, can hold urine for 60-90 minutes, recognize the sensation of a full bladder, and show some form of awareness that they need to go to the bathroom.
Do at a time when you can spend large amounts of time at home! Some parents find it best to do in the summer (less clothing!).
What schedule should you use when potty training?
You want to take your child to the bathroom every 90 minutes, if your child urinates then you wait for the next 90 minute interval, if not you reduce the time by 30 minutes.
Consistency is extremely important to ensure success.
While on the toilet what should we do?
Praise your child for sitting appropriately on the toilet.
You can do activities with them as long as they are not too engaging or involved.
If they do urinate you want to CELEBRATE!
You need to wait up to 15 minutes if there is still no urination, then you let them get off and bring them back after 60 minutes (this keeps decreasing by 30 minutes each time there is not urination).
What should you do when there is an accident?
It happens! Make sure you have your child help you clean it up, this is not meant to be punishing but more a natural consequence of having an accident. Keep a neutral tone and assist your child if needed to clean up the mess.
If your child is having too many accidents you may need to shorten the intervals of going to the toilet, or it may be that your child is not ready to be potty trained yet. Always rule out any medical reasons as well!
Things to remember!
When starting potty training you want to make sure you child can sit on the toilet for up to 15 minutes with minimal challenging behaviors.
The goal is INDEPENDECE, you want to work towards your child walking to the bathroom on their own and removing and putting on their underwear and pants independently as well as washing their hands.
Make sure you child is in underwear throughout potty training! NO DIAPERS/PULL UPS!
Diapers and pull-ups are okay during nap time and bed time.
Number one thing to remember is PATIENCE, try to be consistently upbeat and encouraging to your child and deal with accidents as calmly as possible!
It is important to ensure that potty training is as positive an experience as possible for your child! Maintain your positive energy and constantly praise appropriate behavior seen throughout the potty training process! This will encourage your child to become more independent as well as want to go to the bathroom more often on their own!
https://nspt4kids.com/wp-content/uploads/2017/04/Blog-Potty-Training-FeaturedImage.png186183Parineetha Viswanathanhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngParineetha Viswanathan2017-05-02 05:30:332019-09-19 13:45:065 Things to Keep in Mind When Potty Training a Child with Autism
This guest blog was written by Sandra Strassman-Alperstein.
As a special education attorney, I am often asked by parents of children with autism about their children’s legal rights at school. Fundamentally, children with autism are entitled to the same educational rights as other children with disabilities, namely FAPE (free appropriate public education). What constitutes “appropriate” education is at the crux of many special education disputes regarding students with autism as well as other students with disabilities.
Let’s take Michael, a boy with autism severe on the spectrum. Michael is 10 years old. He is not yet toilet trained. Michael demonstrates unsafe behaviors at school, such as self-injury, violence toward peers and staff, and elopement (running). Michael is rapidly becoming a danger to himself and others at school.
At Michael’s IEP meeting, the district recommends Michael’s current self-contained life skills classroom with a student/teacher ratio of 6:1. While many of the goals appear to be appropriate, Michael has made no progress this year. But we know Michael can learn in a 1:1 setting because he has made good progress with a private tutor at home. Also, the proposed IEP contains no goal for toileting skills, which are critical life skills, and no behavior intervention plan (BIP) to keep Michael and others safe when he displays unsafe behaviors.
What types of questions should Michael’s parents be asking at the IEP meeting? I’d suggest questions designed to elicit how the team proposes to educate Michael safely and appropriately, and how the proposed IEP is designed to accomplish this.
Let’s start with Michael’s present levels of performance in the IEP. Are they based on current data, and are they accurate reflections of Michael’s current abilities? How about his goals: do they address all areas of deficit? (For instance, the proposed IEP does not address Michael’s lack of toileting skills and unsafe behaviors – goals will need to be added to cover these areas.) Are the proposed goals reasonable given Michael’s present levels of performance? Are they SMART goals? (SMART goals, according to Pete Wright, are goals which are specific, measurable, use action words, are realistic and relevant, and are time-limited. (See http://www.wrightslaw.com/info/iep.goals.plan.htm#sthash.HUUaBQ3V.dpuf.) What about the proposed services – are they sufficient to allow Michael to achieve his IEP goals?
Now let’s examine Michael’s proposed placement (the 6:1 life skills classroom). Is this classroom appropriate for Michael, or does he need a smaller class setting with more adult supervision and structure? Michael clearly needs a BIP – can an appropriate plan be implemented in the proposed placement, or should the team be recommending a therapeutic day setting or even a residential placement for Michael?
Now take the case of Michelle, a 10 year old girl with what used to be called Asperger’s Syndrome (AS), a form of high-functioning autism (AS was eliminated as a separate diagnosis in the DSM-V that was recently released; however, it remains a useful descriptive term). Michelle can read and write, her grades are good, and she does not display unsafe behaviors in school. However, Michelle demonstrates social skills deficits that impact her in school: she sits alone at lunch, does not seek out friends or engage in reciprocal conversations, and often misreads social cues, causing conflicts with both peers and staff. Other students are starting to tease her and call her “weird.” This causes Michelle to withdraw socially, and sometimes to shut down and refuse to do her work in class. Michelle is beginning to develop a negative self-image, as she has been observed to say “I am dumb” or “I am weird” at least several times a day in school.
Because Michelle – like Michael – has autism, the team proposes the same self-contained life skills 6:1 classroom. However, it should be clear that while both children have autism, their needs are nothing alike.
Both Michael and Michelle have the right to be educated in the LRE (least restrictive environment). However, what that will look like is very different for each of these children. For Michael, it is very possible (even likely) that the self-contained public school classroom will not be restrictive enough; for Michelle, it is likely to be too restrictive. (The LRE is the setting in which the student has maximum access to typical peers, but in which the child can be appropriately educated. Thus, what constitutes the LRE will vary from child to child.)
So in Michelle’s case, the parents should be asking similar questions regarding present levels (are they accurate?), goals (do they cover all areas of deficit – such as social/emotional needs – and are they SMART goals?), services (are they sufficient to enable Michelle to meet her goals?), and placement (is the self-contained classroom the LRE for Michelle when she is able to progress in the general education setting?).
What these examples demonstrate is that different children have different needs, regardless of an autism diagnosis/label. The fact is, as the saying goes, if you’ve met one kid with autism, you’ve met one kid with autism.
For each child, parents should critically examine the key elements of the proposed IEP, namely:
Present levels of performance (are they based on data and do they accurately reflect the child’s current performance?);
Goals (are they SMART goals that address all areas of deficit?);
Services (are they sufficient and tailored to meet the child’s unique needs to enable the child to progress toward the goals?)
Placement (is it the LRE?)
Parents are their children’s best advocates. They are the experts on their child and have much to contribute to the IEP team. Hopefully this information will help parents fulfill their critical roles in their children’s education.
Sandra Strassman-Alperstein holds a B.A. in English from the University of Florida and a J.D. from the University of Chicago Law School (cum laude 1990). More importantly, Sandy is the mom of four wonderful kids, three of whom have received special education services in the public school setting via IEPs and 504s. Sandy has been practicing special education law & advocacy for the past 15 years and is an active volunteer on the national, state, and local levels. Sandy’s website is http://www.spedlaw4kids.com.
What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation of
functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.
Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.
A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.
To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.
Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.
Other populations where PECS might be appropriate (to name a few):
-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)
-adults with aphasia
-Childhood Apraxia of Speech (CAS)
-children with reduced speech intelligibility
-verbal children with reduced social language and initiating
Myth #2: Using PECS will deter my child from communicating verbally
For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.
Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:
“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)
The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.
If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.
Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.
PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.
Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.
Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.
Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.
If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.
https://nspt4kids.com/wp-content/uploads/2017/04/Blog-Picture-Exchange-Communication-System-FeaturedImage.png186183Lauren Kastanhttps://nspt4kids.com/wp-content/uploads/2016/05/nspt_2-color-logo_noclaims.pngLauren Kastan2017-04-19 05:30:372019-09-04 21:40:17Common Misconceptions About Picture Exchange Communication System