Q: Do you know of any good books about remediating speech (not language) in children with Down syndrome? My client is 12 years old and I think it is time to concentrate more on intelligibility after years of language work.

I answered this question through a personal exchange with the SLP, however I thought I would say a few things about the topic here on my blog.

Always remember that with Down syndrome you always have dysarthria and that means that the main problem is that speech is distorted.

Over-exaggeration of speech is the method most often recommended in books on dysarthria.  Kids with Down syndrome tend to talk too fast and not give themselves time to sound as good as they can. Teach your client to––

• Punch out syllables.
• Make full resonance and big vowels.
• Pronounce each part of diphthongs.
• Make consonants clean, clear, and crisp.
• Make sure stops are fully stopped.
• Make sure nasals are fully nasal.
• Make sure fricatives and affricates have frication (but not too much).
• Make sure diphthongs and glides have two parts.
• Teach him to use big beautiful intonation patterns.

A final thought:  It always baffles me that therapists today think you can work on language without working on speech.  For example, if you model the word “shoe” and the child says “gotch” can you do nothing to straighten this out? I think that Van Riper is rolling over in his grave over this.

Even if the child is two-years old we can teach them a better way to say a word like that.  It will not be perfect, but it can be better and more intelligible.  For example, he could be taught to say “Thoo” or “Sh” or “Oo.” Any of these are a step toward a better production.  A child who cannot be “fixed” certainly can be made to sound better and there is no reason to wait years to do this.