The Speech and Language Deficits of Children with Down Syndrome

Years of research have concluded that children with Down’s syndrome will present with speech and language deficits. Children with Down syndrome are extremely likely to experience difficulties with semantics, grammar, phonology, and pragmatics (Martin et al, 2009, p. 113). These children are also equally likely to experience difficulties with speech intelligibility, voice and fluency due to motor impairments and muscle weakness (Kent et al, 2013, p. 178). For children with DS who are born into a bilingual home, it is possible that language impairments may be more severely affected due to an overload of syntactical differences (Pearson et al, p. 96). Research surrounding bilingual or multilingual children with DS is severely lacking (Cleave et al, 2014, p. 43). Certainly, there has been myriad research on the delays that are expected with the DS diagnosis, and those delays may be able to be generalized to that of multilingual populations of individuals with DS (Woll & Grove, 1996, p. 271). However, little research has been done on the effectiveness of dual language speech therapy in children with DS. This study aims to identify the effectiveness of implementing dual-language speech and language therapy methods with a three-year-old bilingual male (simultaneous dual-language acquired) with Down syndrome through the use of parallel talk, verbal models (in both languages), culturally appropriate intervention plans, and gestural signs.

While there is little research on the topic, there has been speculation that exposing children with developmental delays to more than one language may impact the significance of potential speech and language delays (Feltmate & Bird, 2008, p. 6). However, preliminary research has provided vague information surrounding the potential for children with DS to become bilingual in adulthood (Pearson et al, p. 197). That being said, these early findings do suggest that some children might be capable of achieving competence in receptive language in two or more languages (Bird et al, 2005).

Bird et al (2005) examined parental estimates of bilingual children of with Down syndrome regarding the amount of time children were exposed to each language in the home. Their findings suggest that there is a significant positive relationship between daily exposure and language ability. Potentially, if a child with DS is exposed equally to two or more languages from the time of birth to four years old, the possibility of language development in both languages should be comparable to that of a monolingual child with DS level of acquisition. Utilizing strategies of parallel talk in both languages (i.e., providing verbal prompts, verbal models, asking and answering simple questions, and narration during play), as well as gesture-plus-word combinations (in both languages) will assist children with DS in achieving speech and language in both languages (Bird et al, 2005, p. 51).

Dr. Fred Genesee, second language acquisition expert from McGill University has compiled the past decade of research regarding second language acquisition in children with developmental delays. Genesee has also conducted his on qualitative research regarding parents and speech pathologists responsibility in achieving true bilingualism in these children. Genesee argues that while current research trends suggest success in children with language delays to learn two languages simultaneously, it is not a skill that is acquired simply through repeated exposure. Bird et al’s study (2005) supports Genesee’s point of view that the parents of the child as well as the speech-language pathologists must take active responsibility to ensure that the child receives equal and adequate exposure to both languages in a supportive learning environment in order for them to be completely required (Genesee, 2009, p. 29). Currently, there is no research explaining the impact of different learning environments on bilingualism in children with DS. Similarly, no research has concluded an exact time of exposure necessary for equal language acquisition for children with language delays. At this stage, research trends in second language acquisition for typically developing children will have to be generalized for children with specific language impairments (Woll & Grove, 1996, p. 272). Thus, reduced exposure in one language will result in incomplete acquisition (Genesee, 2009, p. 31). Children with specific language impairments will need equal continuous and regular exposure in both languages in order to gain full competence to that of their monolingual peers with language impairments (Woll & Grove, 1996, pg 272).

Marder et al (2006) conducted research regarding the success of using gestural signs for children with Down syndrome during early language acquisition. Children with Down syndrome have a preference to visual learning styles, and this may contribute to their success with signing (p. 497). For bilingual children with Down syndrome, it may seem counterintuitive to introduce a third language when two languages are already presenting as delayed. However, gestural signs can be used to bridge the gap between two languages and enable the child to communicate wants, needs and feelings in context (Marder et al, 2006, p. 497). Exposing the child to gestural signs, and then labeling the sign verbally in each language allows the child to make a connection between verbally distinct words or phrases due to their shared gestural sign (Bird et al, 2005, p. 196).

Historically, health and education professionals such as speech-language pathologists and teachers have suggested that families with children who have DS should intend to expose them to only one language. This assumption was based on the idea that language-learning challenges would only increase with the exposure to another language (Cleave et al, 2014, p. 52). Paradis et al published a book titled Dual Language Development and Disorders: A Handbook on Bilingualism and Second Language Learning, examining potential intervention methods for children with language delays who are also bilingual. In their textbook, the authors propose the most effective speech pathology methods to implement while working with dual language learners with DS. Some of the main methods include giving the children continuous, consistent, and rich exposure to both language, using dual language models throughout therapy sessions, planning interventions that are culturally appropriate to the child’s family identity, and addressing parents' concerns by having them observe and offer suggestions for therapy activities. (Paradis et al, 2011, p.1). Much of Paradis et al’s textbook discusses the importance of Evidence Based Practice in the treatment of bilingual clients.

Through the utilization of evidence-based practice, clinicians treating bilingual children with DS will be able to provide the most effective and ethical care possible. The American Speech-Language-Hearing Association defines evidence-based practice as a combination of current, high-quality research evidence with clinical expertise and client preferences and values into the process of clinical decision-making, utilizing the three principles of individual clinical expertise, patient values and expectations, and external scientific evidence (ASHA, 2005).

Individual clinical skills and competencies are cultivated and refined by the clinician through experience in the field. Gaining insight through clinical experience with dual language learning children with DS will allow clinicians to provide effective treatment that they are comfortable implementing. Similarly, as mentioned in Paradis et al’s textbook, gathering a deep understanding of client values and expectations inevitably adds perspective to evidence based practice. When working with families who are not native speakers, the ability to recognize their needs, abilities, preferences, interests, and values is going to be essential for clinical decision-making and intervention planning. Lastly, external scientific evidence is essential for effective evidence-based practice. Gathering the most current and high quality research surrounding your client’s treatment is essential to providing good care (ASHA, 2005).

This study aims to use evidence-based practice to determine the effectiveness of providing speech language therapy in two languages for children with Down syndrome. This study specifically asks: in a preschool aged child diagnosed with Down syndrome and severe expressive and receptive language delays who has been exposed to both English and Spanish from birth, will expressive and receptive language therapy strategies (verbal modeling, parallel play, and gestural signing) presented in both languages be detrimental to overall language development as compared to treatment in only one language? Based on a review of the current literature available in this area, it is predicted that implementation of providing both equal exposure to Spanish and English will be equally effective for language acquisition as compared to providing therapy in one language. However, culturally, the child will have better communicative abilities in multiple social contexts if provided with dual-language therapy.