Ages and Stages, Speech & Language, Therapy Activities

Teaching children with Down syndrome to ask questions

Since attending the Down syndrome Educational International Conference in Cleveland, Ohio I’ve been thinking a lot about the way we [speech pathologists] teach children to communicate. One of the things I’ve noticed is we tend to teach statements instead of questions. For instance, what is one of the first phrases help children with DS learn? “I want _____.” When a child looks at you and says, “milk,” we model back, “I want milk (please).” We are really teaching them to use statements instead of requests.

Children with Down syndrome typically use fewer requests than their language- matched peers. I have begun to wonder if this is, in part, a result of the way we are teaching them to communicate early on. For this reason I have started teaching my families to encourage use of questions.

Let’s go back to the original example. Your child looks at you and says, “milk.” This time we will model, “May I have milk?” really emphasizing with your voice (intonation) that this is a question. Also, look like you are asking – use your face to convey the message. All of these unspoken clues will help your child learn this important form of communication. Then, hand the cup of milk to them. They don’t have to imitate the question phrase right away. They are learning by watching you. And just like the “I want ______” phrase question phrases help children learn to form a question and insert the item or action they are requesting.

Once you have practiced this skill during a variety of requesting activities – meals, TV, play time, etc –  It’s time to have the child imitate your question phrase. I use a pacing board to show the children how to ask. We tap on the circles for each word (like we’ve done with other words and phrases in the past).

After they imitate me asking the question then I respond, “Yes! You may have some milk. Nice asking!”

 Questions are so important. I can’t tell you how many times I’ve heard examples like these:

  •  From a parent of an elementary school student: “He doesn’t ask for help. He just tries to get it himself.”
  • From a parent of an articulate teen: “I don’t know why she didn’t just ask her teacher?!”
  • From a parent of a young adult: “His manager wasn’t at work and he didn’t ask who he should report to for his work assignment.”

Perhaps they don’t know how to ask for more information, clarification, or assistance because they haven’t been taught to ask questions. As children age in to elementary and adolescence I use modeling, social stories, role-playing, and practice outside the clinical setting to ensure the child knows how to ask questions and follow-up if they need more information. See my post on social stories for more information.

In summary – Sometimes modeling a skill isn’t enough. Sometimes the skills need to be taught directly for the child to experience later success.

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5 thoughts on “Teaching children with Down syndrome to ask questions”

  1. Hi Jennifer, I really appreciate the extra effort you put in to inform other families and friends of great kids. My son D , was diagnosed with autism on 9-9-2010 he has down syndrome and is 14 years old. We did meet you at the down syndrome conference in Wyoming. You can look at my face book Jane Brooks. I wanted to comment that this information makes sense that D would be even more delayed than the average person who has ds. It’s like pulling teeth to get him to make eye contact. What article or jewels of trickery can you suggest that may inspire or encourage him to look at a persons face when they are talking to him. I have a IEP tommrow. They are going over the AT expert assessment . It’s greek to me. I have looked up ProLoquo2Go Version 2. But not sure if it will be right for him. Of course I’m not the expert. any suggestions? Articles on AT for speech you like>

    1. Jane, to encourage eye contact I bring highly preferred items to my eyes and give praise for looking. Assistive Technology (AT) is not my area of expertise and I am blessed to work with 3 professionals who specialize in this area. I can tell you what we do to get ready for AT in a child dually diagnosed with Autism and Down syndrome. First we use PECS. Many parents will say children are not interested in PECS, but if dont correctly, the child should be motivated since the items used for picture exchange are preferred by him/her. I encourage the SLP and parent working with the child to go to a training: http://www.pecsusa.com/.
      Once the child is able to demonstrate communication initiation (done with PECS) we work on transitioning to either a static screen device (like the TechSpeak) or dynamic screen device – like the iPad with Proloquo2Go.

      Best of luck! Jennifer

      We do things differently for children with Down syndrome who are non-verbal without Autism, because usually the intent or initiation to communicate is present (along with eye contact). When considering a device it’s important to remember most insurance companies, if funded, will only cover one every 5 years. So choosing one that will “grow” with the child is vital. Also, I like to choose phrase-based devices for children with a dual diagnosis. This means when a button is pushed it says a whole phrase rather than making the child select multiple buttons (e.g. “I want a drink” vs. “I” + “want” + “drink”).

      If you are looking for recommendations for visual supports visit: http://www.usevisualstrategies.com/VisualStrategiesInformation.aspx
      Please keep in mind, I haven’t seen D so his treating SLP would be his personal “expert” in understanding what he may need. Any AT materials need to take into consideration his level of understanding, vision, hearing, fine motor skills, etc.

  2. As the mother of a one year old with Ds, I wanted to let you know that I really enjoy your site. I always learn something and especially LOVE that you take the “long term” view on therapy (asking a question instead of a statment). This IS so important later on in school AND at work : ) ! Thank you!

  3. Excellent. Can you do another post on how to get young children (toddlers especially) to answer questions? Thanks!!

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