Q: My son has Down syndrome and possible apraxia. Can you give me advice about this?

Many therapists today are labeling children with Down syndrome as apraxia, but this is an incorrect diagnosis. The expressive speech and language problems of children with Down syndrome are the result of dysarthria and cognitive deficit.

Dysarthria

“A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech”

Brookshire, R. H. (1992). An Introduction to Neurogenic Communication Disorders. St. Louis: Mosby.

Cognitive Deficit

Children with Down syndrome have depressed cognitive skill, or what we used to call mental retardation. Cognitive deficit interferes with the child’s development of vocabulary, concepts, imitation, questions, memory, play skills, and so forth. It also interferes with the child’s ability to discriminate small differences in phonemes.

Prognosis

In my experience, children with Down syndrome, who are doing well, speak like a one-year-old at age three, and speak like a two-year-old at age five. This means that they are using single words by age three, and they are speaking in short 2-3 word utterances and jargoning by age five.

Treatment Considerations

My advice is that therapy should include at least the following:

• Develop vocabulary and concepts through multisensory learning activities, including storybook reading and general play.
• Develop auditory attention, awareness, and discrimination for words and sounds.
• Teach the child to speak up, speak out, and punch out syllables.
• Teach him to exaggerate words for maximum clarity.
• Teach him to exaggerate the rhythm of speech to boost intelligibility and to help him maintain syllables in multi-syllabic words and phrases.
• Establish oral stability with the jaw high and the tongue inside the mouth.
• Develop lip and tongue mobility and separation of movement.
• Normalize oral-tactile sensitivity to improve oral awareness and discrimination for place and manner of phoneme production.
• Develop clear vowels and diphthongs.
• Teach him to prolong vowels and diphthongs in order to extend the full length of individual syllables. This eventually will allow final consonants to emerge.
• Encourage development of all consonant sounds over time. Don’t worry about consonant perfection.
• Don’t worry about jargon. Let him jargon if he is. Keep practicing two- and three-word combinations instead, so that he can make these as clearly as possible.
• Develop an augmentative communication system along with verbal speech to give the child an ability to express himself as words develop slowly.
• Keep the upper respiratory system clear by following doctor’s advice.