Speech & Language, Uncategorized

Understanding speech problems in children with Down syndrome

In honor of Better Hearing and Speech Month I am resurrecting and updating a series of posts on common speech disorders in children with Down syndrome. I said it two years ago and it remains today – the most frequent concern I hear is,


“I can’t understand what Joe says. He gets so frustrated because he knows what he wants to say, but it is so unclear! What can you do?”

Contrary to comments I’ve heard, there is no such thing as “Down syndrome speech.” Unclear speech is a symptom of a larger problem. It is important to mention that before your child undergoes a speech evaluation, make sure they’ve had a recent hearing test (within 12 months to the test date). Even mild hearing loss can affect your child’s ability to hear sounds and produce them accurately.

To understand how to improve speech we first need to determine the kind of speech disorder presenting itself. The most common types of speech disorders in children with Down syndrome are as follows:

  • Speech Sound Disorders  – Two types of disorders in this category include 1.) articulation disorder (problems making individual sounds) and 2.) phonological disorder (problems with groups or patterns of sounds).
  • Dysarthria – One type of motor (muscle movement) speech disorder where the muscles of the mouth, face, and/or respiratory (breathing) system may be weak or move slowly. It is important to remember not all children with low tone have dysarthria.
  • Childhood Apraxia of Speech – Some children with DS have apraxia. Like dysarthria, apraxia is a motor speech disorder. Unlike dysarthria it is not due to weakness. Instead, the brain has difficulty planning the movements of the muscles that create speech. Other signs of apraxia include limited consonant and vowels, an appearance of ‘groping’ movements when trying to say sounds, and inconsistent sound errors that are not the result of immaturity or other speech disorder.
  • Stuttering – A disorder in which the flow of speech is broken by repetitions (li-li-like this), prolongations (lllllike this), or abnormal stoppages (no sound) of sounds and syllables.

In order to determine what kind of speech problem affects your child’s speech a thorough evaluation with a speech pathologist (SLP) is necessary.

An SLP is trained to :

  1. Look at the structures that create speech. This includes watching non-speech (puckering, smiling, sticking the tongue out) movements during an oral mechanism examination.
  2. Listen to speech. An experienced clinician will be able to distinguish patterns (or lack of patterns) to understand the type of errors affecting your child’s speech.
  3. Analyze. The SLP will likely use a standardized assessment such as the Goldman Fristoe Test of Articulation to identify sound errors in spontaneous and imitated words. A speech sample during play may also be used.
  4. Diagnose. Usually a differential diagnosis can be completed in one session. However, depending upon the child’s age, cooperation, or type of speech disorder additional visits may be needed. This is especially true of apraxia, a notoriously difficult disorder to accurately diagnose.

Once a diagnosis is made the speech pathologist can help create a treatment plan that specifically addresses your child’s speech disorder.

“Why does it matter what kind of speech disorder the child has – Can’t you just fix it?”

It matters a great deal! If you take your car in because the check engine light is on and the dealer turns it off without addressing the real problem … the light will come back on. The underlying problem isn’t solved.

There are specific ways to target each type of speech disorder. While they all have similar elements, there are very significant differences. Most importantly if your child isn’t properly diagnosed this may lead to ineffective treatment (not to mention a waste of time and money).

Over the next few posts I will address each type of speech disorder as it relates to children with DS. Treatment techniques, tips, and tools will be discussed.

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