Speech Challenges

Escrito por:  Maria

Causes of Speech Challenges in People with Down Syndrome

To begin, let’s define a syndrome. A syndrome is a collection of observable symptoms or characteristics that affect multiple body systems. In the case of Down Syndrome, it arises from a chromosomal difference. Most people have 46 chromosomes, or 23 pairs. However, individuals with Down Syndrome have an extra chromosome in the 21st pair, giving them 47 chromosomes instead of 46.

There are actually three types of Down Syndrome. Two of these types result in 47 chromosomes in every cell, while one type involves 47 chromosomes in only some cells. The characteristics of Down Syndrome include traits such as short stature, distinct facial features, hearing and vision loss, digestive issues, low muscle tone, AAI (atlantoaxial instability), thyroid problems, learning and memory difficulties due to intellectual disability, heart defects, and sleep disturbances.

An individual with Down Syndrome may not have all of these challenges—usually, it’s just a subset of the ones mentioned. There are other potential issues, but these are the primary ones.

Today, we’ll explore how these characteristics impact speech. There are four main ways this happens:

  1. Structure
  2. Tone
  3. Cognition
  4. Sensory Processing
  1. Structure
  • Head shape: The middle of the face, including the nose, mouth, and upper jaw, tends to be smaller in people with Down Syndrome. This is known as hypoplasia and affects the airway. Because there’s less room in the face and mouth, greater precision is needed to achieve the same level of speech clarity as in typically developing individuals.
  • Palate: The palate (roof of the mouth) in individuals with Down Syndrome is often taller and more narrow, requiring them to move their tongue more to produce accurate speech sounds. Differences in the tonsils and teeth may also be factors.
  • Ears: Typically, the top of the ears aligns with the eyebrows, but in people with Down Syndrome, the ears are slightly lower. This positioning can lead to fluid retention in the middle ear, causing frequent ear infections, stuffiness, and potential hearing loss. Hearing issues, whether temporary or permanent, affect speech and often occur seasonally between October and May.
  1. Tone

Muscle tone refers to how muscles respond to passive stretch, such as gravity, rather than muscle strength. Typically developing individuals have enough muscle tone to keep their mouth closed at rest, breathing through their nose. In individuals with Down Syndrome, low muscle tone may cause the mouth to remain open, leading to mouth breathing and low tongue posture. This can make speech production more challenging.

  1. Cognition

Typically developing individuals can learn new speech sounds or words after a few repetitions. However, people with Down Syndrome usually need more practice and repetition to learn new things, including speech.

  1. Sensory Processing

People with Down Syndrome may experience either hypo- or hyper-awareness of sensory stimuli. Hypo-awareness may lead them to put objects in their mouth more often, as they don’t register sensory input as easily. On the other hand, hyper-awareness can cause them to be overly sensitive to stimuli that wouldn’t bother others. Both sensory extremes can affect speech.

When you combine issues related to structure, tone, cognition, and sensory processing, a speech delay is almost inevitable. It takes more time for people with Down Syndrome to develop speech sounds, starting from early stages like “ah” to more complex words.

They are also more likely to have speech sound disorders. Speech development follows a building block pattern, but due to structural and tone issues, some fundamental sounds, like /k/ and /g/, may be harder to produce. A high-arched, narrow palate and low tongue posture make it difficult to position the tongue correctly to produce these sounds.

Several speech and sound disorders may arise, including:

  • Childhood apraxia of speech: A motor speech disorder where the brain’s motor planning doesn’t always effectively communicate with the mouth.
  • Disfluencies: Stuttering or cluttering. Cluttering involves inserting extra words, while stuttering involves repeating sounds or blocking speech.
  • Dysarthria: A condition characterized by weak muscles used in speech, leading to “mushy,” quiet, or unclear speech. It’s sometimes described as sounding like “marbles in the mouth.”

Other factors, such as autism spectrum disorder (ASD), epilepsy, or post-surgery recovery, may further complicate speech development.

What Can Be Done?

The most important thing is not to panic. Instead, focus on building a team of professionals who can help address the specific issues affecting speech.

  • ENT (Ear, Nose, and Throat Specialist): An ENT can assess whether removing the tonsils or adenoids might create more space in the throat and mouth, improving both breathing and speech.
  • Audiologist: Regular hearing checks (about every six months) can detect seasonal or permanent hearing loss, and the audiologist may recommend tubes or hearing aids if needed.
  • Orthodontist: An orthodontist may suggest a palatal expander to create more space in the mouth, improving breathing and speech.
  • Myofunctional Therapist: This therapist can work on improving nose breathing and reducing mouth breathing.

Compensating for Low Tone

While low muscle tone cannot be changed, strategies can be employed to compensate. Proper seating is crucial. Ideally, the student should sit in a 90-90-90 position (90-degree angles at the hips, knees, and ankles) with feet on the floor. An occupational therapist (OT) can help decide if more support is needed, such as armrests or a footrest. Proper seating promotes focus and stamina for tasks. Regular movement breaks also help combat the effects of low muscle tone.

Addressing Cognitive and Sensory Challenges

For cognitive challenges, daily, motivational practice is key. Engage students in activities based on their interests, whether they enjoy princesses or watching YouTube videos, to make learning fun and effective.

For sensory issues, awareness is essential. Working with a speech-language pathologist (SLP) and OT can provide guidance on improving sensory integration, seating, and play. The SLP can help with developing speech sounds, introducing assistive communication devices (AAC), and troubleshooting speech difficulties.