Einstein Syndrome: Down Syndrome with a Positive Attitude

The teaching of individual signs to replace delayed speech is very popular among therapists and parents of children with Down syndrome.  In fact, this has become the normal therapeutic route in Early Intervention. In my opinion, this focus on sign language is a mistake.

Now, before you berate  me for my misguided view, hear me out.  I’ve been following this sign language question for years, and seen quite a bit of  heated discussion.  The controversy comes because of the phrasing of the question,   “Should parents teach sign language?” A better question is, “Should parents pursue speech or pursue sign?”

The sad fact is that Parent Professors have limited time to pursue therapy options. So, my advice is to put that limited time into the interventions which will give the best result. There are, in fact, a number of interventions toward pursuing speech which give excellent results.

Before we begin, realize that this choice of speech vs. sign is a question of expectations. Do you want normal speech and language? Do you believe it is possible? Are you willing to do the extra work to reach those expectations? This seems so obvious as to be almost insulting, but just having this out on the table is very helpful, in my opinion. Most DS parents are working with speech therapists who have very low expectations, and their treatment recommendations are determined by those expectations.

In this post, I’ll discuss four developmental skills that are necessary for good speech and language.  These are auditory tonal processing, auditory sequential processing, social turn-taking, and oral-motor skill.

Auditory Tonal Processing

For good speech, the child needs to have good auditory tonal processing. The brain needs to learn to process the various frequencies in the sounds that the ears hear. If the brain cannot distinguish those frequencies, then the child will not be able to reproduce them in speech. For this reason keeping the ears free of fluid is critical. But there is more to developing good tonal processing.

Exposing the child to lots of good classical music and a rich (but not cluttered) auditory environment will help. This means, play lots of Mozart.   Sound therapy programs such as  SAMONAS  address poor tonal processing in a therapeutic program. If the ears aren’t working because of fluid, then the tonal processing will be poor. If the ears have been full of fluid for intermittent periods in the past, then there may be remedial work that needs to be done to correct poor tonal processing.

Few speech therapists will specifically address auditory tonal processing in their clients. Neurodevelopmentalists from ICAN and NACD do this routinely.

Auditory Sequential Processing

Beyond tonal processing, the child needs to have good auditory sequential processing. Auditory sequential processing is a measure of the auditory short term memory. It is sometimes called the auditory digit span.

A ten-year-old child with everything else in place, but with auditory processing of two will still carry on conversations at a two-year-old level. If the auditory processing level is one, then the speech you can get is one word at a time.  The level of language development cannot progress beyond the level of auditory sequential processing.

If the processing level is at one or two, then even with sign language, all you will see are single and paired signs.  You don’t have much “language” and you certainly don’t get the rich syntax of ASL.

Again, speech therapists don’t specifically address auditory sequential processing. For those children who work on this, the results can be profound in the level of language development. The best work here is done at home, during the day, throughout the day. It is accomplished through the normal day-to-day interactions that the parent has with the child. There are several articles on this site which address and explain how to work on processing.

Neurodevelopmentalists include work on auditory sequential processing in their programs routinely.  If you want your child to have abilities of conversational language, then spend plenty of time working on auditory sequential processing.

Social Turn-taking

In addition to auditory processing, good speech and language requires social skills in communication and turn-taking. Our kids spend their lives with others being in control of every interaction. They are almost never an equal partner in a social setting. This one-way direction in interaction leaves our children with incomplete skills in speech and language. It eliminates training in social communication and turn-taking.

The child can only become a social person by communicating with people. He needs to learn to stay in social interactions for several turns.  Think of how you converse with a peer:  you say something… he says something…you say something…he says something.  We call it conversation.  This simple skill of turn-taking has not been learned by most people with DS with whom I’ve tried to have a conversation.  Think of it like a game of table tennis with your child.  In this game, however, you are not playing to win, but to see how long you both can stay in the game.   You both play in such a way that the ball can be easily returned.

Both a game of ping-pong and a conversation are frustrating if one side always drops the ball. This is where the techniques developed by James D. MacDonald, affectionately called Jimplay by parents, are so helpful. His methods are second nature to mothers–usually– if we just give in to our intuitive leanings. I’ve written in greater detail about MacDonald’s methods in How Not to Be a Therapy Mom.

Unfortunately, what happens with special kids is that we spend our time trying to teach our child or do therapy on them and we neglect the simple fun of playing with and relating to them as a person. It is in the playing that social turn-taking and two-way communication is learned. Dr. McDonald does us a favor. He says that simple interaction and relationship is actually important therapy and thus gives us permission to get down on the floor and play.

Speech therapists do not routinely include Jimplay in their programs. But you can easily learn these techniques and incorporate them into daily life.

Oral Motor Skill

The final developmental skill necessary for good speech and language is oral-motor. For proper speech, the child needs to have the skill and strength to move those mouth muscles with precision and without tiring.

Sara Rosenfeld-Johnson (SRJ) has demonstrated that a big piece of the problem of speech in DS is poor muscle strength and control in the tongue, lips, jaw and breathing apparatus. Obvious, right?

Rather than teaching sign as a way to compensate, SRJ decided that the solution to weak muscles was to isolate them and exercise them. She developed a set of easy-to-use tools and protocols to move these individual muscles from weakness and poor motor control to strength and precisely graded use, plus she has made her techniques and tools entirely available to parents.  These techniques and tools are changing speech profoundly for the kids whose parents know about this.

But, once again, the oral-motor techniques and tools are not even taught in the training programs for speech therapists. It is highly unlikely that your son’s speech therapist through Early Intervention will be trained to assess and address oral-motor issues.

But What about Sign?

Auditory tonal and sequential processing, social communication and turn-taking, and oral-motor skill are the pieces necessary for development of good speech and language. Can sign language help here? Yes, if it is used to enhance one of these pieces. Signed gestures can be used to encourage social communication, for example. Or they can be used so the child can play sequential processing games. Can sign language hurt here? Yes, if it interferes with or replaces the time spent teaching and developing the necessary pieces for spoken language. Yes, if it allows the parent to settle for low expectations. Yes, if it removes a child’s need to speak.

My recommendation would be to focus the limited time you have on these four pieces necessary for speech and language. If sign helps you accomplish these, then great. If sign distracts from these, then put your time in on oral-motor, good tonal processing, auditory sequencing, and Jimplay.

Filed under: communication, development, Down Syndrome, interventions, oral motor | Tagged: apraxia, communication, digit spans, Down Syndrome, Jimplay, oral motor, SAMONAS, sign language, speech, SRJ | 8 Comments »