Ages and Stages, Birth to Three, Parent Resources, Speech & Language, Uncategorized

When to Start Speech Therapy for Children with Down Syndrome

I am asked frequently, “When should my child start speech therapy?” This is a great question! Usually parents are asking, “Is my child old enough to improve how they sound when they talk?”

Many times infants or young children with Down syndrome (DS) will start language therapy at before speech therapy. There is a difference between the two types of therapy, although we commonly refer to visits with a speech-language pathologist as “speech therapy.”

Children with DS typically have delays acquiring speech sounds and words (Stoel Gammon, 2001). The process of gaining sounds in children with DS goes like this*:

  • Early infancy: cooing
  • Mid to late 1st year: babbling
  • 18 months: average 1st word
  • 36 months: combining words into phrases, using common phrases with multiple words like, “I did it!” or “1, 2, 3…go!”

Providing children with DS language-rich experiences during the early years of life will not only support learning, but also speech development. Activities that nurture communication include:

  • Reading books together. Don’t worry about reading every word on the page. Take time to look at the pictures with your
    Attribution: Nationaal Archief/Willem van de Poll
    Attribution: Nationaal Archief/Willem van de Poll

    child. Comment and let them show you what’s interesting to them.

  • Engaging in turn-taking games. Roll a ball back and forth. Play peek-a-boo. Alternate between peeking and allow your child to “peek” too.
  • Playing with toys that start/stop manually like rolling cars down a ramp or a jack-in-the box. This allows natural opportunity for you each to take turns as you play together.
  • Singing songs with hand motions like Itsy Bitsy Spider or finger plays such as “Open, Shut Them.
  • Being silly together. Children pay attention when adults behave in ways that are unexpected. In my sessions I place toys on my head like a hat and then say, “Ah – ah – ah – Chooooooo!” sneezing them into my lap. It’s usually good for a laugh AND the child tries to imitate my actions and sounds.

While clear speech is important, it’s equally important to allow opportunity (and time) for sounds to develop. Therapy goals targeting speech sounds and clarity are appropriate when:

  • The child has a variety of spoken words or approximations
  • He/she consistently tries to imitate sounds you make

Most children with DS are in preschool or kindergarten when goals for articulation are established. Until then, therapy focuses on the child’s ability to understand and use words and gestures to communicate.

Three of my favorite resources for early communication are:

1. It Takes Two to Talk from Hanen

2. Communicating Partners, by Dr. James McDonald

3. See and Learn Language and Reading from Down Syndrome Education International

When did your child’s therapy start to focus on speech sounds? I’d love for you to share your experience in the comments section.

*Ages represented are averages for children with DS as reported in research literature. The range of acquiring first words in children with DS is very large!

12 thoughts on “When to Start Speech Therapy for Children with Down Syndrome”

  1. When should we test for Apraxia or other speech disorders? Troy will be two in a week and is saying a handful of wordbut seems stuck on some sounds like “d”. He even says “dubbles” for bubbles, etc. Is this ok? He seems to have a difficult time saying letter sounds like “m” “b” and “p”, which I thought were the first sounds for typical babies.

    1. I like to do an assessment of the words a child uses freely rather than a standardized assessment when they are 2-3 years old. This means I transcribe their words phonetically and analyze them for patterns. At this age children, even those without DS, are still developing many sounds including /p/ /b/ and /m/. Mastery for these 3 in particular can happen into the early 3rd year for a child without speech delays.
      More formalized speech sound testing occurs once a child has transitioned from using gestures and signs to speech. The exception is when I am considering apraxia as the child may use many signs and only have a very limited number of sounds, of which vowels are predominant.
      Troy’s substitution of “dubbles” for bubbles is developmentally appropriate for his age. Just continue to model the correct production.

  2. We had speech therapy start around 9 months when my daughter’s spoke her first word, “up”. The speech therapist pushed Signing Time (what a gift!) and she entered preschool with a 400 word expressive sign vocabulary, which was a bit of a challenge for her teachers.

    One thing I always hated was the early intervention evaluations. Some days, she just didn’t want to perform. For example, at one eval, the speech therapist couldn’t get more than two words out of her and put that down in her notes. At one point my daughter got sick of the whole process and signed, “want more fish there, please.” (pointing to Goldfish crackers). Yyyyeahh, just a few more than two words.

    Hard to believe that was so long ago – she’s now in 5th grade – still doing speech and language.

    What we find frustrating at this point is that she gets lazy – she’s figured out that a lot of people won’t demand a lot from her so she doesn’t have to bother working. She tried to pull that on us and we very quickly put an end to it. We don’t accept the request “I push cart?” but will accept, “Daddy, may I push the cart please?”

  3. Speech and language therapy was a part of Carrie’s life from two months old in Early Intervention until her graduation from high school @ age 21. Those first days were centered on feeding plus her tongue thrust issues. Helps for her speech became a natural and daily part of our family life. Her medical blueprint (always remember each child’s being unique) has enabled her to respond well. She spoke last week to 385 administrators in Florida advocating for those with special Down syndrome and other needs. She continues to work hard on her articulation and pre-stuttering skills at age 38 but in general speaks clearly and spontaneously. Speech intervention formally and informally is a lifelong process!

    1. Peggy, Thank you for sharing your experience! I love the term “medical blueprint” – it’s the first time I’ve heard it used to describe the unique combination that is each person.

  4. Hi Jennifer,

    We started EmC with ST at ~6 months old. This was mainly to coach us as parent to know about turn taking and books. Since we excepted the speech delay we wanted to encourage any form of “meaningful” communication. Thankfully baby sign (ASL) worked.

    We started teaching EmC ASL at ~8 months. Her first sign was “milk” at ~11 months. By 16 months she knew 5 signs, and by 30 months she knew ~60.

    In your post you mentioned that combining words happens at ~36 months. Here is a video of EmC demonstrating understanding and combining signs at ~22 months.

    EmC also tried to mimic sounds with most of her signs. Here she is at ~28 months.

    We have since stopped teaching new sign as she is trying hard to say words. She consistently uses 2-3 word sentences “I want please” “more (water, beef, banana, etc)” and is becoming more and more clear everyday.

    ASL gave EmC the tools to show that was thinking in “complex” sentences before she was expected to. As well, We feel that ASL helped EmC develop her communication skills so that she is ready to “speak” when her speech catches up.

    Sean @TheEmCEffect

    1. Sean, Way to go EmC! While 36 months is average for combining multiple words, I certainly have seen earlier. I too encourage sign language to support pre-talkers although not every child takes to it as beautifully as your little one. Thanks for sharing!

  5. We started speech therapy when Juliet was one and she’s had it ever since. She would receive weekly sessions through our early intervention program, then she received it through the public school system upon entering pre-K. We supplemented with private speech sessions of between 4 to 2 times per month through Kindergarten. She receives free speech therapy once a week through our local support organization, but that’s when our schedules work out to attend the sessions. Turn-taking was an “a-ha” moment for me, learning that simply by teaching Juliet the act of taking turns would prepare her for taking turns in having a conversation.

  6. My son Jadon started ST a little over a year old. Although, I have worked on it with him prior to that. He is very vocal and says a few words. He will say “dop” for pop (pop pop) He says TT for his daycare teacher Miss Tina, yeahhhhh, Ha for hi. He’s doing good with certain signs too. He currently has ST every other week, but his ST is pushing for weekly sessions at our 6 month eval with Early Intervention! Patience is critical. Every child is different, but will get there!

  7. Owen started when he was a little over 2 years old. He has been diagnosed with an articulation disorder and apraxia, so speech has taken a long time to come for him. He is just now babbling like a young baby/toddler and getting sounds out. I often wonder if we had started speech services when he was an infant if that would have changed things. I don’t know but I can’t change that now. He works hard and hopefully one day we will have bonafide words and a conversation together.

    1. Thanks for sharing Stephanie! It’s natural for parents to wonder “if only I’d started xyz earlier.” However, speech therapy (focusing on fixing/adding sounds) won’t prevent a speech disorder. It’s more likely you did all the right things!
      Babbling like a toddler is okay – it is a natural step to talking. It means Owen really wants to use sounds to talk and his body is figuring out how to make them. Babbling or jargoning (speech that sounds like his own language) is an important part of learning words much like crawling is to walking.
      Hang in there!

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