complex patterns of interjection of sounds, production of non-English sounds (clicks) and, in addition, changes in prosodic features such as increased durations of sounds, sudden pitch changes and numerous filled and unfilled pauses. These speech difficulties were also identified by Heselwood in a young dysfluent man with Down syndrome who used clicks (found in African languages) seemingly as a result of involuntary dorso-velar closure while attempting sonorant productions. This suggests a motor-speech difficulty rather than/ as well as a linguistic programming problem.
What could be applied in intervention?
Making direct connections between theory and practice is complicated by the complexity of the speech problems. Unintelligibility is a problem often mentioned by those who live and work with people with Down syndrome. It is related to both sentence construction and the segmental and suprasegmental levels of speech as well as to the listeners' perception and expectations. It is important therefore to (a) find ways of enhancing the message giving by the person with Down syndrome and (b) improve the 'listening' and awareness of the communication partner. There is also a growing literature showing that cognitive and affective factors have a strong influence on the planning and production of speech. This suggests that a relaxed, at ease, dialogue is far more likely to be understood by both parties than one where one or both partners in the exchange is anxious. The work of Wishart alerts us to the necessity of understanding the learning styles of children with Down syndrome and ensuring that the learning environment is facilitative. In the stuttering literature, the importance of keeping a balance between the child's capacities in language and cognition and the performance demands made on that child is seen as highly significant in maintaining fluency. This is known as The Demands and Capacities model.
Possible approaches to managing speech output difficulties therefore must include:
- A holistic approach which supports the child in any attempt at communication - thus reducing the demands on a fragile speech-motor system.
- Training in careful listening should precede any production attempts as speech perception is important in the laying down of linguistic and motor processes in the brain.
- Training of others in identifying and understanding the speech patterns of children with Down syndrome in order to enhance the message detection ability of listeners.
- The use of simple rhythms to improve both fluency and sequencing difficulties (clapping of syllables of multisyllable words or short phrases).
- The use of visual and tactile prompts for the placement of speech articulators in order to reduce the auditory memory load.
- A focus on teaching speech and fluency in single functional words or simple phrases through parent support and education.
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- Jansen W, Bray M. (ongoi