Running Head: SPEECH THERAPY AND INTERVENTIONS
Speech Therapy and Interventions for Adults and
Children with Down Syndrome
Lindy Cooper
Samford University
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SPEECH THERAPY AND INTERVENTIONS
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Through recent research, it has been shown that one in every 10 children will
have some kind of speech or language impairment (Wood 2009). Most people who
have Down Syndrome will encounter these communicational impairments that will
cause a lot of difficulty (Wood 2009). These speech issues are the result of the
impairments that people with Down Syndrome have in almost all of the systems
required for successful speech (Cleland 2010).
Down Syndrome is a disability that affects one out of 732 live births (Cleland
2010). It is known as the most common intellectual impairment. Down Syndrome is
a genetic disorder that is caused by an extra chromosome in the 21st pair. Down
Syndrome varies from case to case, but most people with Down Syndrome (85%)
have mild intellectual impairment with an IQ between 40 and 60 (Cleland 2010).
Many people have thought that the speech impairment and issues correlating with
Down Syndrome were a result of a cognitive disability, but a study by Dodd and
Thompson presents information that reveals otherwise. Although Down Syndrome
is an intellectual disability, the speech disorders have nothing to do with the
cognitive level, but instead the many impairments that occur in the systems that
make normal speech possible (Cleland 2010). People with Down Syndrome usually
have muscle hypotonia, craniofacial abnormalities, and even more frequently
communication disorders that include language deficits and speech disorders that
relate to the cognitive impairments (Mahler 2012). New research has found that
speech disorders in “Down Syndrome may be best conceptualized as a dysarthria,
impairment characterized by slow, weak, and/or imprecise muscle movements”
(Mahler 2012). This regular dysarthria is the cause of “included speech naturalness,
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imprecise consonants, hypo nasality, overall loudness level, prolonged intervals,
inappropriate silences, irregular vowels, aberrant oropharyngeal resonance, hoarse
voice, reduced stress, prolonged phonemes, audible inspiration-expiration and
aberrant pitch pattern,” which are all commonly seen in people who have Down
Syndrome (Mahler 2012). All of these aspects of speech associated with someone
who has Down syndrome can have a “negative influence on speech intelligibility,
naturalness of speech, and overall communication skill” (Mahler 2012). Since there
is such a large number of language impairments in people with Down Syndrome, it
is vital that researchers investigate speech interventions/therapy techniques to
maximize communication ability.
Most children at some point will be offered speech and language pathology to
combat these communication difficulties. Whether or not a child can afford speech
therapy outside of school, most public school systems now have people who work
for the schools who can offer speech therapy to children with communicational
difficulties. According to Wood’s academic journal, Speech therapists usually use
auditory-based transcriptions to identify the acoustic output of speech production
for each child that they work with. These auditory-based transcriptions can help the
speech therapists to first diagnose exactly where the speech difficulties are. This
helps the therapists to pin point the specific areas that need to be worked on each
time they meet with the child or adult (Wood 2009). Since there can be some
limitations with the auditory-based transcriptions, more recently, speech therapists
have been using instrumental techniques to fill in the gaps where mistakes could
occur, so that they can get a more accurate read on where problems are occurring.
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Some instrumental techniques that are used include ultrasounds and
electropalatography, which “visually displays the timing and location of the tongue’s
contact with the hard palate during continuous speech” (Wood 2009). After deciding
what are the specific speech impairments that each individual child has, the speech
therapist can then start using different methods and treatments (Michael 2012).
A common treatment that is used by many Speech therapists for people with
Down Syndrome is the LSVT. This treatment was also used in Mahler’s academic
journal regarding intensive treatment of dysarthria in two adults with Down
Syndrome. LSVT is a treatment that is commonly used with people who have speech
impairments associated with Parkinson’s disease and other neurological conditions
(Mahler 2012). LVST is a treatment frequently used because it “incorporates
principles of motor learning such as intensity of practice with high repetitions of
salient materials that have been identified as beneficial in the treatment of motor
speech disorders” (Mahler 2012). This type of treatment uses higher intensity
exercises and other voice techniques to increase the vocal loudness of the
participants and to ensure a normal voice amplitude. For the best results, a
participant should receive the LVST treatment four times a week for four weeks and
the sessions should be about an hour each. The first half of each session was geared
towards reading and vowel prolongation at target loudness ranges. The second half
focused on producing words and speech that was functional starting from just
words and moving to sentences and finally conversational speech. Added on to each
session, the participants also had daily homework t hat they had to complete. After
Mahler’s study was done, results revealed that LSVT had immense positive effects
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on both participants (Mahler 2012). Particularly, the results showed that both
participants showed progress in phonatory stability and their normal voice
amplitude. The researchers also stated that improvements could be made by making
the duration of the treatment longer and adding in respiration and articulation
teaching (Michael 2012).
Regarding children who have Down Syndrome, any type of early intervention
is key to increasing the ability of normal speech. Most interventions for young
children focus on “physical and motor based activities to improve the speech
production” (Bysterveldt 2010). There was an early thought that non-speech oral
motor exercises and treatments could help increase children’s ability to speak
normally, but a recent study showed that there was no increase in speech
production for children who had received that treatment. Since there were no
improvements, researchers and speech pathologists should focus on phonological
based interventions where the spoken language impairments are targeted and more
likely to change (Bysterveldt 2010).
There have been two main phonological intervention programs that have
been documented. The first study included six children who had Down Syndrome.
These ages of these children ranged from 1 to 6. All of the children started the
intervention at different levels in phonological communication, but they all still
showed positive change in the first two weeks of the intervention. This intervention
program used amplification and “focused on contrastive versus homophonic
production of the targeted patterns in words” (Bysterveldt 2010). Along with these
interventions that were implemented with a speech therapist, home interventions
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were also implemented by the parents, which involved speech target practice and
joint story reading (Bysterveldt 2010). The second program that was documented
involved nine children with Down Syndrome who were all between the ages of 2 to
6 years. This program focused on vocabulary and reducing non-developmental
errors and variability in the children’s speech (Bysterveldt 2010). The at home part
of the intervention involved the parents using corrective feedback when each child
didn’t use their target pronunciation. The results of this study showed that the
children had decreased their non-developmental errors and variability in their
speech (Bysterveldt 2010). The studies of these two interventions demonstrate that
the phonological intervention is very effective for children with Down Syndrome
and also that parents can play a huge role in the improvement and success of their
children (Bysterveldt 2010). Regarding parental influence, it is important that
parents are always looking for ways to challenge their children to correct errors at
home. Although it may seem like the teachers and therapists are the ones who
should be correcting them, parents tag team their efforts, so that improvement is
quicker and more lasting.
The second type of intervention is integrated phonological awareness
intervention, which integrates letter knowledge and achieving a precise
phonological representation of a word (Bysterveldt 2010). Letter recognition is
something that can be extremely challenging for children with Down Syndrome, so
therapists strive to help the children be able to identify the initial sound in a word
and segment words into the different phonemes (Bysterveldt 2010). New
researchers have been studying the influence of reading to increase phonological
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awareness for children with Down Syndrome. For example, two researchers
observed children ages 6 to 10 and found that there was a direct correlation
between phonological awareness and better reading fluency. Therefore, regarding
children with Down Syndrome, “phonological awareness skills play a role in
supporting reading in this population” (Bysterveldt 2010).
A large study in Bysterveldt’s academic journal combined both integrated
phonological awareness and regular phonological awareness, which were discussed
in the two previous paragraphs, to create a study of integrated interventions for ten
children with Down Syndrome. Five girls and five boys participated in this study and
they ranged from 4 years to 5 years and came from all different socioeconomic
backgrounds. The researchers hypothesized that the intervention would improve
“speech production accuracy in trained and untrained speech targets, letter name
and letter sound knowledge, and finally phonological awareness skills on untrained
phoneme level tasks” (Bysterveldt 2010). Each participant attended weekly sessions
in small groups and also regular individual sessions. The study used six highly
trained “specialists/therapists which included a physiotherapist, or occupational
therapist, a cognitive therapist, a speech-language therapist, a musical therapist, an
early childhood teacher and a computer specialist who they saw individually and
sequentially throughout the morning” (Bysterveldt 2010). Before the study started,
all participants were given an audiological assessment and the results showed that
seven of the children involved had either slight or moderate hearing loss. In regards
of eye sight, six of the children wore classes (Bysterveldt 2010). To asses Receptive
and Expressive language, researchers used the Peabody Picture Vocabulary Test-III
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where the child is asked to point to the picture named by the tester and the PreSchool Language Scale. To asses the speech production of the ten participants,
researchers used the Hodson Assessment of Phonological Patterns and assessed
them six weeks prior to the intervention. This test “is a single word articulation test
comprising 50 single and multi syllabic words elicited by naming manipulatives and
line drawings” (Bysterveldt 2010). The six therapists joined together and selected
target speech cards for each child, which the children were assessed on five
different occasions throughout the entire study. There were three components in
this integrated intervention program, which included a parent-implemented home
program, Speech Therapy (SLT) sessions, and Learning through computer (LTC)
(Bysterveldt 2010).
To ensure that the parents were able to implement the home program, each
parent attended an information and training seminar where “the parents ere trained
to use print referencing techniques at home to bring their child’s attention to
targeted letters and sounds during joint story book reading” (Bysterveldt 2010).
This home intervention was implemented by the parents four times a week for 10
minutes each session throughout the 18 week intervention. The speech therapy
sessions added up at the end of the 18 weeks to be about four hours total of
intervention. Each session included for 5 minute activities, so that the therapists
could hold their attention throughout the sessions. Each session “integrated speech
goals with phonological awareness and letter knowledge goals and was
implemented by the lead researcher, focusing on two speech targets per session”
(Bysterveldt 2010). Throughout the 18 weeks of the intervention, researchers took
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note of each child’s compliance and engagement and they found a total of 28
challenging behaviors. Some of these included biting, pinching, shouting, throwing
objects, hiding, damaging equipment and many more (Bysterveldt 2010). These
behaviors affected 25 of the 39 sessions that were reviewed by researchers
(Bysterveldt 2010). The Learning through computer sessions required that the
children attended sessions one morning each week out of the 18 week intervention.
These sessions focused on letter names, letter sounds and phoneme matching.
Surprisingly, researcher noted that there was not as much disengagement or
challenging behaviors as were in the Speech therapy sessions.
After all of these different intervention programs that each child attended for
18 weeks, “findings indicated that significant improvement in the speech
articulation of single words can be achieved after a short intervention” (Bysterveldt
2010). Regarding letter name and letter sound knowledge, researchers concluded
that it was a difficult concept for most participants to grasp and only two of the
children improved in letter sound knowledge. The children did a little better with
letter name knowledge and six of the ten children knew more letter names than they
did before the intervention. This also could have been a result of the difficulty that
children with Down Syndrome can have “transferring improvement skills from a
therapy context to an assessment context” (Bysterveldt 2010). Regarding
phonological awareness skills, the results suggest that phonological awareness was
further stimulated, but not completely mastered by the end of the intervention
(Bysterveldt 2010). Ultimately, there were definite results in all of the testing
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categories for each child showing that integrated intervention programs are key for
the improvement of speech for children with Down Syndrome.
Ultimately, “speech production errors are common in children with Down
Syndrome and these errors often persist into adulthood” (Bysterveldt 2010). The
results from all of the studies show that intervention programs that include speech,
letter knowledge and phonological awareness are effective in decreasing speech
errors and in general making speech more understandable. After looking at
research, findings suggest that these therapy programs are more successful if they
are for a longer period of time and if children receive speech therapy at an earlier
age. In conclusion, people with Down Syndrome should receive the speech therapy
they need, so that they can have the best opportunity to communicate well with
others.
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Resources
Cleland, J., Wood, S., Hardcastle, W., Wishart, J., & Timmins, C. (2010). Relationship
between speech, oromotor, language and cognitive abilities in children with
Down's syndrome. International Journal Of Language & Communication
Disorders, 45(1), 83-95. doi:10.3109/13682820902745453
Mahler, L. A., & Jones, H. N. (2012). Intensive treatment of dysarthria in two adults
with Down syndrome. Developmental Neurorehabilitation, 15(1), 44-53.
doi:10.3109/17518423.2011.632784
Michael, S. E., Ratner, N., Newman, R., Oetting, J., & Crais, E. (2012). Verb
Comprehension and Use in Children and Adults With Down Syndrome.
Journal Of Speech, Language & Hearing Research, 55(6), 1736-1749.
doi:10.1044/1092-4388(2012/11-0050)
van Bysterveldt, A., Gillon, G., & Foster-Cohen, S. (2010). Integrated speech and
phonological awareness intervention for pre-school children with Down
syndrome. International Journal Of Language & Communication Disorders,
45(3), 320-335. doi:10.3109/13682820903003514
Wood, S., Wishart, J., Hardcastle, W., Cleland, J., & Timmins, C. (2009). The use of
electropalatography (EPG) in the assessment and treatment of motor speech
disorders in children with Down's syndrome: Evidence from two case
studies. Developmental Neurorehabilitation, 12(2), 66-75.
doi:10.1080/17518420902738193