Transcript Document

Including Children with Down’s syndrome
Presented by
Cecilie Mackinnon
Training Officer
DSA
A specific communication profile
•Research shows a profile of communication skills and
needs common to people with Down’s Syndrome.
•These affect a child’s ability:
– To understand language
– To produce and use speech,
– To put thoughts into words.
– Use sentence structure and grammar
• Specific
difficulties in developing spoken language over
and above any language delay associated with learning
disability and any hearing loss that may be present
Difficulties
So we notice difficulties in:
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Saying what we want
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Talking about things that have happened
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Following rules of conversation and interaction
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Using language to learn, to sort out problems, to plan
and to deal with emotions.
Communication Profile 3a
15 yr old with learning disability
10 yr old with learning disability
5 yr old with learning disability
A specific communication profile 3b
15 yr old with DS
10 yr old with DS
5 yr old with DS
A specific communication profile 1
• Significant Expressive – Receptive gap
• Knowing this means that we can work on narrowing
the GAP
• Significant delay relative to non verbal abilities
Able to use sign, gesture and body language
• So….an uneven profile
• Smaller vocabulary = less general knowledge.
• Vocab. learned slowly & steadily – esp. nouns
• Sentences and grammar more delayed
A specific communication profile 3
• Early grammar delayed learned slowly & paced by size
of vocab. (250/300 word)
• Spoken grammar lags behind nouns & verbs &
understanding
• More complex grammar specifically delayed
• “telegraphic” 2 – 4 keyword phrases. “sit chair”
• Lack confidence in initiating speech but usually good
communicators & keen to socialize
• May self-limit as a result
• Speech probs affect written work
A specific communication profile 2
• 5 – 6 yrs, most but not all have spoken vocab. of
approx 300 words. ( Buckley)
• Typically developing child = 2,000 words.
• 8/9 yrs spoken vocab 450 -500. Range 100 – 600.
• 11 yrs 600 words larger comprehension.
• Grammar approx 5/6 yrs.
• Receptive grammar up to 7 yrs +.
HUGE RANGE
Speech clarity
• May have difficulty making speech
sounds
– Low muscle tone in the tongue and the lips
making their speech imprecise and slurred.
• A smaller than average oral cavity
– less room for the tongue which may appear
to be too big for the mouth, thus impeding
speech production
Speech Articulation
Speech:
• Oral motor skills movements of mouth, tongue
other structures used for speech
• Articulation of speech sounds and combinations
of sounds in words
• Dyspraxia: problems planning and carrying out
sequences of movements
• Learning to use sounds in words (phonology)
• Hearing and reproducing the sound structure of
words (phonological awareness)
Sensory System
• Difficulty with sensory integration
– Vestibular - balance
– Proprioception - sensing where my body parts are
without looking - multitasking difficult
– Touch - predict feel, weight, how to handle
• Control of mouth, lips and breathing
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
– Hypersensitivity - dislike of touch
• Increase toleration
– Hyposensitivity - seeking stimulation not aware of
gentle touch
• This is the way we touch our……
• Supporting putting things in the mouth, lumps in food
• Chewy tubes talktools.net
Additional Diffficulties
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Hearing impairment
Visual impairment
Motor skills development
Short-term auditory memory
Hearing Impairment
Storing the wrong words
• Children may only hear APPROXIMATIONS of
words i.e., ‘ an’ ‘ed’ and ‘orse’
• Levels of hearing loss associated with conductive
loss experienced by majority of Under 5’s with
Down’s syndrome is 35-45 decibels
• Can’t hear to discriminate consonants for words
which rhyme
• If they don’t hear it, this means they will not
STORE it accurately
Fine and Gross Motor Skills 1
• Motor-neuro pathways inefficient
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Slower reaction times
Problems adapting movements/timings
Muscles make the movements but slower/clumsier
Processing sensory info & coordinating movements
• Sitting, crawling, walking, handling objects
feeding
– Increase opportunities to explore environment
– Develop cognition, receptive language
Short-term Auditory Memory 1
Working memory
• The working memory is the ‘mental workplace’
• For children with DS it is the gateway to the
world..
• Short term memory and processing skills are
needed to:
Learn to talk
Process spoken language
Undertake mental arithmetic
Support everyday tasks e.g., telephone, making
choices
Learning new vocabulary from listening is
difficult
Short-term Auditory Memory 2
The phonological loop for consists of two parts:
A short-term phonological store with auditory
memory which fades rapidly. It holds briefly the
sounds patterns for words
An articulatory rehearsal component that can
revive the memory traces -the brain talks to
itself needs language
When learning language the child must:
1.
Be able to store accurate representations of
the sound patterns
2. Link them to meaning
3. Copy or produce the word when talking
Short-term Auditory Memory 3
• In children with Down’s syndrome, there is a
basic impairment in phonological loop function
• This affects their ability to process spoken
language and carry out cognitive tasks
• It is possible to improve STAM using memory
activities and prompts but the biggest gains
come through READING and interaction in
MAINSTREAM environments
Short-term Auditory Memory 4
Digit Span
• We measure the phonological loop by digit span
• Typically developing children - 3 at ages 4/5
years, 7/8 at 16 years
• Young children with DS significantly less 1-2
• Teenagers with DS, will have digit span of
about 3-4
Short-term Auditory Memory 5
Affects pupil’s ability to:
• Listen, understand and respond to
speech.
• Cope with info directed to whole class.
• Remember auditory sequences
• Learn to read and write sequences .
• Learn new vocabulary
Learning new vocabulary from listening
is difficult
Phonological Errors
What you might observe
• Inconsistent word reproduction
• Doggy, goggy, soggy
• Using the same sign/word for
• ‘ran’ and ‘van’
• ‘red’ and ‘bread’
• ‘sauce’ and ‘horse’
EVEN THOUGH they point correctly to
examples of the two different items
Memory Activities
Kim’s game
Pairs using action and describing words
Barrier games
Sing word sequences, lists
Recall lists of words - do and say activities
QuickTim e™ and a
TIFF (Un co m press ed ) de com pres so r
are n eed ed to se e this p ictu re .
train
bricks
dolly
Signing 1
• Children with Down’s syndrome DO NOT learn
words easily from speech alone.
• Signing is a BRIDGE for spoken language –
KEYWORD SIGNS augment speech.
• Signing NOT an alternative.
• Signs dropped as child learns the word.
• Reduces frustration – helps communication
Signing makes speech visual
VISUAL LEARNERS!!!!!!!
Signing 2
• All benefit from up to 100 signs with spoken
word.
• Children have larger vocabularies when in sign
supported environments
• 25% of 4 year olds still need to use sign as
major means of communication
• Teach new signs alongside speech and reading.
Signing can:
• Makes speech visual
• Focuses the child’s attention to listen to what is
said
• Support children to understand what is said, by
SHOWING as well as TELLING
• Help children to learn and remember new words
Enable the child to:
• Use signs for words s/he cannot yet say
• Organise words into sentences
• Get the message across when speech is unclear.
Visual prompt cards
Allow the child to communicate visually before
they can verbally..(www.howitis.org.uk)
Developing Speech & Language 1
• Use gesture & sign with spoken word.
• Surround by good language models.
• Simple & direct language.
• Clear, concise instructions.
• Give extra time to respond
• Support language visually – objects,
photographs, pictures, photos, text, drawings,
symbols.
• ‘Teach reading to teach talking’
• Work on speech sounds
Phonics - Letter Sound Awareness
• Sound awareness requires a sizeable spoken
• Use to develop develop awareness of sounds in
spoken words
• Single sound work should include awareness of:
– Initial sounds -
– Final sounds – Medial sounds – Onset blending -
cu p
be d
b
bed bag
bun ban
bit bar bog
bat
bad
t
bit set fat hut lot
a
cat sad dad mad
ba
bat bag ban bar
fi n
ro t
sa d
How you can help in school
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Work in collaboration with SALT
Assessment and monitoring by SALT
Programme designed by SALT
Staff training by SALT
Daily sessions speech sound production
Activities involving
– Blowing, making mouth shapes, stimulating the lips,
face and tongue
– Using voice practising production of single speech
sounds
• Narrative skills, using visual prompts to give
accounts of events etc.
How you can help in school
• Group activities, with structure and
feedback
• Puppets, Barrier games
– Develop attention, listening and turn taking
• Rehearsal of social communication skills:
– Extending repertoire of language and social
routines
– Greeting and saying goodbye, starting a
conversation, taking notes, relaying simple
messages
Putting ideas into sentences
• You hear “Dinner. Chicken tatoes”
• You remodel “You had dinner. You had
chicken and potatoes.”
Always use open questions
Avoid:
“Did you have dinner at home?”
Instead say
“Tell me where you ate dinner.”
Model the sound structure of words
• You hear “ I went to the the si’pool”
• You say “You went to the swimming
pool”
• You add “I went to the swimming pool
on Saturday.”
Positive feedback
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“Good talking!”
“Good looking!”
“Good listening!”
A running commentary..
– “ You’ve got a book.”
– “You’ve got The Hungry Caterpillar.”
• Describe each step as you see it
happen in simple sentences.
Now we’re talking