Down Syndrome has unique cognitive, sensory, and physiological characteristics. Learn how to use a multi-modal approach to improve the intervention you give to children with Down Syndrome. Appropriate, successful intervention can be provided for children with Down syndrome by understanding how the disorder impacts communication. This course includes a review of language development in individuals with Down syndrome, a discussion of evidence-based treatment methods, and a modified elementary level lesson plan to demonstrate successful intervention.

1. Language Intervention
for School-age Children
with Down Syndrome
Anna Ubels, MA, CCC-SLP
Patricia Villarreal, MS, CCC-SLP

2. Learner Objectives
• Describe language development in children
with Down Syndrome
• Describe evidence-based intervention
approaches for children with Down Syndrome
• Select appropriate communication system
based on a profile of strengths and challenges
• Produce modifications for a therapy lesson

3. Disclosure Statement:
No relevant financial relationship(s) or nonfinancial
relationship(s)
I have no relevant financial or nonfinancial relationships
in the products or services described, reviewed,
evaluated or compared in this presentation.

4. Unique Characteristics
• Anatomical and physiological differences
• Pattern of strengths and challenges in
functioning across different domains of
development

5. Anatomical and Physiological
Differences
• Low muscle tone
• Low muscle coordination
• High narrow arched palate
• Large tonsils and adenoids
• Small mouth and jaw area in comparison with
the size of the tongue

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7. Hearing Development
Narrow and short ear canals
Otitis Media with Effusion
Fluctuating Conductive Hearing Loss

8. Cognitive Domain
Strengths
• Visuo-spatial
• Visuo-motor
Challenges
• Verbal Processing
▫ Memory

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10. Social/Emotional Domain
Strengths
• Desire for social interaction
• Use of facial expressions
• Reciprocal eye contact
• Interest in exploring
environment
Challenges

11. Motor Skills Domain
Strengths
• Gestures • Motor planning
• Fine motor/Gross motor
▫ Balance
▫ Posture
▫ Strength
▫ Flexibility
Challenges

12. Language Domain
Strengths
• Receptive • Expressive
▫ Vocabulary
▫ Grammar
▫ Syntax
Challenges

13. 6
12
18
24
30
36
42
48
54
60
66
72
78
marginal babbling joint attention canonical babbling using gestures first word 2 words 3+ words
AgeinMonths
Language Milestones
Comparison of Language Development
Typical Down Syndrome

14. Language Domain
Strengths
• Receptive • Expressive
▫ Vocabulary
▫ Grammar
▫ Syntax
Challenges

15. 0
200
400
600
800
1000
1200
12 15 18 24 36 48 72
NumberofWords
Age in Months
Vocabulary Development
Typical
Buckley
Kumin, Councill,
Goodman

16. 0
200
400
600
800
1000
1200
12 15 18 24 36 48 72
NumberofWords
Age in Months
Vocabulary Development
Typical
Buckley
Kumin, Councill,
Goodman

17. The Needs of an Elementary Student
Social Interaction
Time Activity
8:00-9:00 Circle Time
8:30-9:30 Math
9:30-10:00 Science
10:00-10:30 Specials
10:30-11:00 Lunch
11:00-11:30 Recess
11:30-12:00 Recharge
12:00-12:30 Reading
• Follow Directions
• Learn Routines
• Acquire Academic Knowledge
Language Skills

18. Approach to Intervention
Total Communication (TC) is:
Verbalization + Modalities of learning
-Visual
-Auditory
-Kinesthetic
-Tactile

19. Signs Visual
Manipulatives
Voice Output
Devices
Alternative Augmentative
Communication Systems (AAC)

20. Signs- Parent Concerns
• Signs can develop verbal
speech
• It is abandoned or phased
out
• Children with Down
Syndrome:
▫ Can lack the motor
control to produce
meaningful speech
▫ Can become frustrated
Signing is a natural
segway into
communication.

21. Signs- pros and cons
Pros
• Reduces frustration
• Easier to learn
• Builds on relative strengths
• Unaided
• Direct Communication
• Pragmatic skills
Cons

22. Signs- pros and cons
Pros
• Reduces frustration
• Easier to learn
• Builds on relative strengths
• Unaided
• Direct Communication
• Pragmatic skills
• Easier to physically prompt
• Grammar can be extended
• Intelligibility
Cons
• Limited to
communication partner’s
knowledge
• Ambiguous gestures

23. Visual Manipulatives- pros and cons
Pros
• Teaches persistence
• Widely understood
• Grammar extension
Cons
• Aided
• Requires additional prep
time
• Not suitable for all
environments

24. Voice Output Devices- pros and cons
Pros
• Widely understood
• Provides auditory and visual
information
• Range of complexity of
devices
• Grammar extension
Cons
• Aided
• Requires battery
• Prep time
• Not suitable for all
environments

25. Sign Visuals VOD
Builds on Relative Strengths
Unaided
Direct Communication
Grammar Extension
Intelligibility
Persistence
Widely Understood
Suitable for all environments
Provides External Auditory Information
No battery/plug required
Communication Systems Comparison

26. Intervention Aligned with Curriculum
• Base intervention on academic subject matter
▫ Increases collaboration
▫ Allows for frequent repetition
▫ Promotes generalization

27. Group Lesson Plan
Time Schedule Activity Modifications
15
minutes
Question of the Day-
Introduction
What animal do
you like best?
• Picture of deer,
rabbit and blank
card
• Sign ‘like’
15
minutes
Surprise Bag Label Animals • Visual templates
• Sentence strips
• Sign ‘see’
15
minutes
Story Animals in their
Homes
• Switch
• Communication
Board
• Sentence strips
• Sign ‘where’
15
minutes
Question Time What animal lives
in the forest?
• Switch
• Communication
Board
• Sentence strips
• Sign ‘animal’

28. Generalization
• Morning Circle Routine
▫ Names of students, age of students, day of the
week, weather
• Snack Time
▫ ‘I want,’ ‘more,’ ‘please,’ ‘thank-you’ variety of
snack options
• Story-time
▫ More specific to story content
▫ First, Second, Third, Finally

29. Putting it All Together
• Same language development trajectory, slower
pace
• Relative strengths in visuo-spatial, visuo-motor,
social interactions, facial expressions, gestures
and receptive language
• Evidence-based practice points to Total
Communication intervention approach

30. All of the documents and charts in this
presentation can be downloaded from our Free
Resource Library.
Click here to visit the Resource Library

31. Common Questions

32. How do we begin to develop therapy
materials?
Think about the Skills first:
▫ Where the child is
▫ Where the child needs to be
Then think about the activities you want to do.
▫ Activities from class
▫ What the parent wants to focus us
Finally, modify those activities to help the child
improve.

33. How do we get buy-in and support
from the professionals we want to
collaborate with?
• Work within the classroom
▫ This shows the student successes
▫ The teachers often want to be a part of this
▫ And the teachers see that you value what they also
have to focus on.
• Make time to meet with them without the
students
▫ Talk about what they are working on so you can
support them.

34. How do we support students with low
vision or low hearing?
• Low Vision
▫ Provide physical manipulatives
▫ Especially objects they frequently use in their
environment.
• Make time to meet with them without the
students
▫ Use lots of generalized visuals
Pictures
Signs

35. Click to visit www.bilinguistics.com

36. Difference or Disorder?
Understanding Speech and Language
Patterns in Culturally and
Linguistically Diverse Students
Rapidly identify speech-language
patterns related to second
language acquisition to
distinguish difference from disor
der.

39. References
Clibbens, J. (2001). Signing and lexical development in children with Down syndrome. Down Syndrome Research and Practice,
7(3), 101-105.
Early Intervention. National Down Syndrome Society. www.ndss.org
Fidler, D., Most, D. & Philosfsky, A. (2008). The Down syndrome behavioural phenotype: Taking a developmental approach.
Down Syndrom Research and Practice. www.down-syndrome.org/research
Foreman, P. & Crews, G. (1998). Using augmentative communication with infants and young children with Down syndrome.
Down Syndrome Research and Practice 5(1), 16-25.
Grouios, G. & Ypsilanti, A. (2011). Language and Visuospatial Abilities in Down Syndrome Phenotype: A Cognitive Neuroscience
Perspective. www.intechopen.com
Kumin, L. (2012a). Speech and language therapy for children and adolescents with Down syndrome. National Down Syndrome
Society. www.ndss.org
Kumin, L. (2012b). Speech and language therapy for infants, toddlers and young children. National Down Syndrome Society.
www.ndss.org
Roberts, J., Chapman, R. & Warren, S. (2008). Speech and language development and intervention in Down syndrome and
Fragile X Syndrome. Baltiomre, MD: Brookes Publishing
Romski, M. & Sevcik, R. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young
Children, 18(3), 174-185.
Rondal, J. & Buckley, S. (2003). Speech and Language Intervention in Down Syndrome. London: Whurr Publishers Ltd