Persistent Articulation Errors and Down Syndrome: Should Therapy Continue?

Question

I am working with a child with Down syndrome who is presently in the 7th grade. This child has a fluctuating hearing loss and is unaided at this time. The child has persistent articulation errors on the s, z, sh, ch, and j phonemes. I did not write goals

Answer

Hearing Issues must be addressed first:

Typically, we know that 60-85% of individuals with Down Syndrome have some level of a hearing loss. Even a mild loss can have an effect on articulation training. You mention it is fluctuating, which makes me conclude it is a conductive loss, however, we first need to determine whether there is a sensori-neural component as well.

Individuals with Down Syndrome are at an increased risk for otolaryngological and audiologic disorders. These otolaryngologic concerns may include narrow ear canals that can become blocked with cerumen, frequent recurrent otitis media with middle ear fluid (which results in fluctuating loss') tympanic membrane dysfunction, etc. In addition, upper respiratory, ear, nose and throat infections can all be compounding factors as well. Therefore, the most important issue to address for this young man is.... what is the current status of his hearing and are there medical intervention strategies that can be discussed with his parents to eliminate this intermittent hearing problems. The family needs to see an otolaryngologist first and determine if this issue can be resolved. If this can be managed successfully, I would attempt articulation training.

Articulatory Issues specific to individuals with Downs Syndrome

He is having difficulties with the lingua-alveolar strident and palatal sounds which tend to be more difficult for individuals with Down Syndrome. Factors that need to be considered include:

• Is there good postural alignment of the body (is there hypotonia)
  
  
• Is there good jaw-tongue separation for independent movement of the tongue
  
  
• How is his tone in the lips, face and tongue

There are progression therapy techniques that can facilitate jaw stability, grooving of the tongue and lifting of the tongue tip along and with improving of the respiration/breath support. Treatment is possible and with the parents support and carryover of specific techniques it is feasible to work on these issues. A phonological approach may be very useful, as these are the most persistent errors we see in the older child with DS.

Additional Information that is needed:

I hate to answer a question with more questions, but there is more information that is needed to make an appropriate decision by looking at the big picture.

• Is this young man motivated to work on these issues?
  
  
• You mention "unaided" at this time. Does he have a hearing aid?
  
  
• Has he worked on these sounds previously?

Concluding Thoughts:

1. Hearing must be addressed first, or you will not be able to be successful.
   
   
2. If hearing is no longer an issue and is resolved I would attempt progression therapy techniques: movement and positioning techniques to strengthen muscle tone and postural stability (speak with OT/PT); respiration and breath control techniques, body positioning and oral motor stimulation and speech strategies.
   
   
3. One other issue to be aware of: Many of our older children with DS will also have auditory processing and language processing issues, especially when they have had fluctuating hearing loss throughout their lives. Visual supports and multi-sensory teaching strategies should also be incorporated as part of his learning experiences, in the classroom and in the treatment environments.

Bonnie Lisbona, M.A., CCC-SLP, has 25 years experience as a speech language pathologist, with emphasis on serving individuals with developmental disabilities. She is the owner of a company which services habilitative supports to adults with developmental disabilities.