Written by Jill Hicks, Speech-Language Pathologist, November 2022

We all want our students with Down syndrome to succeed.   Every goal we choose to work on will likely require lots of practice until it is learned and carried over.  Given the intensive amount of practice required, there is necessarily a finite number of skills that can be practiced at any one time.  Choosing the right goals therefore becomes extremely important.  What we choose to work on will directly impact the student’s ability in that area.
It is well known that speech and language are an area of particular weakness for most people with Down syndrome.  We also know how important verbal communication is in numerous areas of life.  Being able to speak well enough to be understood impacts social connection, academic performance, employment opportunities, independence, and ultimately quality of life.

​This challenges us to step back and assess our goals in light of our student becoming an adult.  It is easy to choose goals based on what content is being taught at a particular grade level, and we all naturally gravitate to goals that allow us to use skills we have, and programs we’re familiar with.  However, we need to look beyond what is familiar and comfortable, and instead focus on the student’s needs, setting goals that lead to successful adulthood.
Clear verbal communication is a basic academic skill.  It is addressed in curriculum guidelines as shown in the Nova Scotia government’s document English Language Arts Primary Guide available online. 

These outcomes require a foundational level of oral language ability for communication.  And communication is successful when the oral communication is intelligible enough to be understood by the listener.
So a child with poor or reduced intelligibility will have difficulty meeting even the entry level of academic skills in language arts.  This highlights that speech is a fundamental skill.  For a child in a grade higher than Primary (kindergarten), these fundamental oral language goals are still very much applicable.
For many children with Down syndrome who have poor speech intelligibility, improving speech intelligibility should be their primary academic goal.  Knowing this should help us as SLPs and educators put a primary and weighty focus on developing the student’s speech.  This focus is reflected in a careful assessment of the child’s speech and language, setting specific articulation goals, and allotting significant time every day to practice speech skills. 
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​As we make speech development our highest priority and allot time for intensive daily practice, we give the student the highest likelihood of achieving intelligible speech.  We prepare the student for an adulthood with successful relationships, work and independence.

​As parents and professionals working with children with Down syndrome, we want to help them succeed.  In this blog post I’m going to address the reciprocal dance between skill development and support.
I like to think of skills and support as being two separate but related paradigms.  They each fit on a continuum from less to more.  And they have direct influence on each other.  Said another way, the level of a skill or ability directly influences how much support should be provided.  And how much support is provided will directly affect skill development.  So what is the optimal amount of support?  And how do we know how to adjust the amount of support we give?
Since I’m a speech-language pathologist it is most relevant for me to give an example regarding speech development.  First of all we’ll look at the Skill paradigm.  This example reflects how much ability or skill the child has producing a specific phoneme (speech sound).  

​As the above illustration shows, the child moves from the most basic level of ability, which is production of the sound in isolation (by itself).  Once the child can accurately produce the sound in isolation, we move to saying the sound in a word, then to saying the sound in a word in a sentence.  And finally, the child uses the sound in a word, in a sentence during spontaneous speech (in a real life context).   
There are often substeps to the above Skill paradigm illustration which your child’s SLP will be aware of and guide you through.  Some examples of substeps are closer and closer approximations to saying the sound in isolation, saying the sound in syllables, saying the sound in one syllable words before multisyllabic words, saying the sound in different positions in words, etc.  Moving from producing the sound in isolation to using the sound in words in sentences in spontaneous speech can take months or even years  depending on the child and the sound.  Each step is a significant achievement and needs to be celebrated.
Practice eliciting the sound in isolation, and at the word and sentence level are often initially done during “structured practice time”.  This is because it takes a lot of focus to learn a new skill.  During structured practice time, we can offer time to focus on speech work, without distractions, or time pressure.  But eventually,  and ultimately, we have to be intentional about making sure the new sound is carried over to real life speaking situations. 
 
So now let’s talk about the Support paradigm.  The Support paradigm shows how much support we need to give a child during skill development.  It’s important that the goals we choose are at exactly the right level.  A goal that’s too easy means the child already has that skill.  A goal that’s too hard means that even with support the child has a very low rate of correct responses when trying to achieve the skill.  Let’s assume our speech sound goal is at the right level.  This is what the Support paradigm looks like:

The Support paradigm moves from the child needing full support to needing no support.  Full support is when numerous supports or cueing methods are used, for example, to elicit a sound.  Full support can mean hearing the adult model the sound, seeing the Sign Sound for the sound, watching how the mouth moves, producing the sound with the SLP while looking in a mirror together, getting verbal cueing (such as “smile” or “keep your lips together”), etc. For moderate support the child still needs several cueing methods to achieve success.  For minimal support the child needs only one or two cues, or needs cues only intermittently to achieve success. And finally, Independence means the child is independent in producing the sound without any cueing required.  It is important to explicitly reduce and then withdraw support to increase independence.  Independence with a skill is our ultimate success.
 
One of the most important concepts to embrace is how the Skill and Support paradigms interact.  As you move up the Skill continuum, each new level may initially require more support, and move through the Support continuum.  For example, once a child learns to say a certain sound such as /m/ in words, it can be a significant hurdle to then ask the child to use that word in a phrase or sentence.  Instead of just having to concentrate on saying the sound in a single word, the child now has to think of all the sounds in all the words in the sentence, get the words in order, and figure out the meaning.  These “distractions” make it harder to concentrate on articulation of the target sound in the word.  But fortunately, we can provide more support at this new Skill level, so the child has a greater likelihood of success.  The amount of support we provide is directly linked to how much support the child needs.
Success is important.  We want our children with Down syndrome to practice the right way.  Each time the child says /m/ incorrectly, they are cementing a misarticulation in their memory.  Each time the child says /m/ correctly, they are cementing correct production of the sound in their memory, which makes it easier and more likely to produce the correct sound next time.  Success builds upon success.  It all starts with very carefully chosen goals, and an in depth understanding of how the Skill and Support paradigms interact to enhance learning, independence, and success :)