Down Syndrome Comprehensive Intervention for Children

By Libby Kumin, PhD, CCC-SLP; Cheryl Councill, MS, CCC-SLP; Mina Goodman, MS, MEd, CCC-SLP; and Diane Chapman, MS, CCC-SLP

Children with Down syndrome are at high risk for speech, language and oral-motor difficulties. Although each child exhibits a unique pattern of strengths and challenges, most children with Down syndrome will need individually designed assistance to maximize their communication potential.

Language is an area typically addressed in treatment. However, speech often receives less emphasis as part of the treatment program for children with Down syndrome.

There is a need for comprehensive speech, language and oral-motor intervention. Treatment may include the following areas: oral mas-sage/normalization, sensory integration, feeding/eating, oral-motor exercise, orofacial myology, articulation, phonological processes, fluency, voice, auditory processing, receptive language, expressive language, pragmatics, whole language and literacy.

The Loyola College Speech and Language Center in Columbia, MD, provides comprehensive speech and language intervention through an integrated program of parent training and individual therapy to children with Down syndrome ranging in age from infancy through adolescence.

The clinical intervention team is composed of a speech and language graduate student clinician, who provides direct service to the client, and a certified speech-language pathologist, who serves as parent facilitator and clinical supervisor. In addition, an oral-motor specialist and occupational therapist trained in the area of sensory integration serve as consultants to the program.

A typical treatment session, which ranges in length from 30 to 60 minutes and is held once or twice a week, contains the following sequential components:

• gross motor activity,
• oral normalization/massage,
• oral-motor treatment, and
• specific speech and language activities.

Gross motor activities are an integral part of each treatment session. These build postural tone and stability needed for speech production. Children with Down syndrome frequently demonstrate low muscle tone. The gross motor activity is designed to increase the child's overall body tone and to prepare the child's sensory systems for tasks requiring a heightened level of attention.

The following sensory systems may be addressed during gross motor activities: auditory (e.g., playing children's folk music to set the rhythm for movements); vestibular (e.g., bouncing on the ball chair, rocking inside a barrel); kinesthetic/proprioceptive (e.g., crawling through a tunnel, pulling a cart filled with weights); and tactile (e.g., ball massage to calm and focus the child who becomes overstimulated by movement).

An oral normalization/massage activity often follows the gross motor activity. The typical progression begins with massage on the arms and moves to the shoulders, cheeks, lips and then into the mouth. Specific techniques are taught to the parents and are used at home on a daily basis to decrease oral hypersensitivity as well as increase oral awareness to improve the precision of articulatory movements.

Certain types of music (e.g., Hemi-sync, classical baroque, folk music) are used during this process to enhance the learning environment.

Oral-motor exercises and activities to strengthen individual muscle groups follow the oral normalization/massage process. Depending on the age and skill level of the child, this might include food activities (e.g., holding a pretzel between closed lips); toy activities (e.g., blowing bubbles, blowing into a variety of whistles or musical instruments); oral-motor exercises (e.g., following tongue commands, producing lip prints); and myofunctional activities (e.g., button pull, marshmallow twist).

Speech and language activities target the child's individual communication needs through a whole language approach. For the young child with Down syndrome, therapy is play-based and total communication is used.

Treatment for this age group includes play activities that are designed to parallel home routines such as bathing, feeding, dressing and food preparation. The clinician is encouraged to follow the child's lead, and an imitation with expansion model is used during the session and taught to the parents.

Cueing systems such as a Pacing Board, visual cueing for speech, and motokinesthetic cues are frequently used to provide visual, tactile and motor cues to encourage articulatory precision and language expansion.

For the older child treatment might focus on auditory processing skills, vocabulary development, syntactic skills, language and literacy skills, curriculum/school-related skills, ar-ticulation skills, phonological pro-cess skills and pragmatic skills

The mission of the intervention program for children with Down syndrome at Loyola College in Maryland is to do the following:

• provide comprehensive speech, language and oral-motor assessment and intervention;
• provide advanced professional training;
• provide pre-professional training;
• provide family training; and
• conduct clinical research.

The comprehensive speech, language and oral-motor program for children with Down syndrome is based at the Loyola College Speech and Language Center. Treatment services for children with Down syndrome also are available at the Loyola College Speech, Language and Literacy Center in Hunt Valley, MD.

In addition, speech, language and hearing services are available at the Margaret McManus-Moag Speech and Hearing Center in Baltimore, MD; and comprehensive oral-motor assessments for children with Down syndrome are conducted at the Loyola College Speech and Language Literacy Center in Hunt Valley.

Workshops for professionals who assess and treat children with Down syndrome are available to provide advanced training in diagnostic and intervention techniques. The workshops address such topics as comprehensive evaluation and treatment through the communication stages and oral-motor skill development, assessment and treatment.

Pre-professional training is provided through the undergraduate and master's degree programs in the Department of Speech-Language Pathology/Audiology at Loyola.

Two research studies are now being conducted at Loyola College.

Libby Kumin, PhD, CCC-SLP, and Diane Chapman, MS, CCC-SLP, are investigating the effectiveness of oral-motor treatment for children with Down syndrome ages 2-5 and 6-10.

Participants are being sought who are not currently receiving oral-motor treatment or oral massage. Two evaluations at reduced fees will be provided at the Loyola College Speech and Language Literacy Center. A full-day parent workshop addressing oral-motor treatment for participating families will be held next year.

Dr. Kumin also is involved in a study to develop vocabulary norms for children with Down syndrome. She is conducting the study with Cheryl Councill, MS, CCC-SLP, and Mina Goodman, MS, MEd, CCC-SLP.

Participants are needed to complete the MacArthur Communicative Development Inventory and a brief parent questionnaire about vocabulary development. The researchers are interested in contacting parents of children with Down syndrome ages 16 months to 8 years. Test results will be provided to participants.

* About the authors: Dr. Libby Kumin, at (410) 617-2242 or Kumin@Loyola.edu by e-mail, is chairperson of the Department of Speech-Language Pathology/Audiology at Loyola College in Maryland, and Diane Chapman, (410) 617-2508; Mina Goodman, (410) 312-7603; and Cheryl Councill, (410) 312-7615, are on the clinical faculty at the college. Contact Dr. Kumin and Chapman at 4501 N. Charles St., Baltimore, MD 21210-2699, and Goodman and Councill at 7135 Minstrel Way, Ste. 101, Columbia, MD 21045.