If your child has Down syndrome, you've probably heard a lot about heart checks, muscle tone, and milestones. Questions about talking often come a little later: When will my baby say a first word? Why does my child understand so much more than they can say? Should we use signs? This post summarizes what public health agencies and researchers have published about speech and language in children with Down syndrome, so you can walk into conversations with your child's care team feeling more prepared.
Is it common for children with Down syndrome to talk later?
Yes. The CDC calls Down syndrome "the most common chromosomal condition diagnosed in the United States," and notes that "People with Down syndrome often have developmental challenges, such as being slower to learn to speak than other children."[3] The National Institute of Child Health and Human Development (NICHD) lists "Delayed language and speech development" among the common developmental differences.[1]
NICHD also offers an encouraging perspective: "Most children with Down syndrome develop the communication skills they need, although it might take longer for them to do so compared with other children."[1] And it stresses that "The symptoms of Down syndrome vary from person to person."[1] Your child's path won't look exactly like anyone else's.
Why does my child seem to understand more than they can say?
Many parents notice this, and researchers have noticed it too. A review in Topics in Language Disorders summarizes it this way: "Despite considerable individual variability, receptive language is typically stronger than expressive language, with particular challenges in phonology and syntax."[4] In plain terms, receptive language (understanding) is often ahead of expressive language (talking), and two areas that tend to be harder are speech sounds (phonology) and putting words together into sentences (syntax). The same review adds that "vocabulary is stronger than syntax."[4]
NICHD puts it from a parent's point of view: "In many cases, children with Down syndrome understand language and want to communicate before they can speak."[2] If the difference between understanding and talking is new to you, our post on receptive vs. expressive language explains it in more detail.
The review also describes relative strengths alongside the challenges, including "the ability to stay on conversational topic, content-related narrative skills, and the ability to respond to requests for clarification."[4] Areas that may be harder include "initiating and elaborating on conversational topics."[4]
Why can my child's speech be hard to understand?
How easy someone's speech is to understand is called intelligibility. A research review in the Journal of Speech, Language, and Hearing Research reports that for intelligibility, "Studies consistently show marked limitations in this area."[5] The earlier review notes that "nearly all individuals with Down syndrome may be difficult to understand at least some of the time."[4]
Researchers think several things can play a part. According to Kent and Vorperian, speech difficulties "may be related to peripheral factors such as anatomic differences in the vocal tract, impaired hearing acuity during recurrent otitis media, and impaired motor function (dysarthria and/or apraxia) or to central factors such as language and cognitive dysfunctions," and they add that "It is likely that several factors interact."[5] They also describe speech sound patterns as "a combination of delayed development and errors not seen in typical development."[5]
Some children with Down syndrome also stutter. The same review reports that "Stuttering and/or cluttering occur in DS at rates of 10 to 45%, compared to about 1% in the general population."[5] Research on voice is less settled: the authors write that "major questions remain about the nature and frequency" of voice differences, and that results "have been mixed."[5]
What does hearing have to do with it?
A lot. The CDC lists hearing loss among the common health problems in people with Down syndrome.[3] The Topics in Language Disorders review reports that "Approximately two-thirds of children with Down syndrome experience conductive hearing loss, sensorineural hearing loss, or both," and that children with Down syndrome "may be particularly susceptible to otitis media" (middle ear infections and fluid).[4]
Because of this, the review notes that "routine screenings in these areas are recommended," and that "speech and language should be monitored while OME is being medically managed" (OME is fluid in the middle ear).[4] Your child's pediatrician and audiologist are the right people to set a hearing schedule. Our post on hearing and speech development explains more about why hearing matters for talking.
Should we use sign language or pictures before my child talks?
This is one of the most common questions parents ask, often with a worry that signs might replace words. NICHD describes how a speech-language therapist "can help a child use alternate means of communication, such as sign language and pictures, until he or she learns to speak."[2]
The research review notes that "children with Down syndrome commonly use sign language to communicate," and that "there is general agreement that AAC use does not hinder the development of spoken language but may actually promote its development."[4] (AAC stands for augmentative and alternative communication: signs, pictures, or speech-generating devices.) Every child is different, so it's worth talking through options with your child's speech-language pathologist. Our post on common myths about AAC covers this topic more broadly.
From NICHD: "Learning to communicate is an ongoing process, so a person with Down syndrome may also benefit from speech and language therapy in school, as well as later in life."[2]
When can speech-language support start?
Early. NICHD explains that early intervention "refers to a range of specialized programs and resources that professionals provide to very young children with Down syndrome and their families," that it "can begin shortly after birth and often continues until a child reaches age 3," and that "After that age, most children receive interventions and treatment through their local school district."[2] NICHD states that "Research indicates that early intervention improves outcomes for children with Down syndrome," and that "Early, ongoing speech and language interventions to encourage expressive language and improve speech are particularly helpful."[1, 2] As with any therapy, how much and how quickly a child progresses varies.
According to NICHD, a speech-language therapist working with a young child "can help them develop the early skills necessary for communication, such as imitating sounds," and with older children "may help with conversation skills, pronunciation skills, understanding what is read (called comprehension), and learning and remembering words."[2]
In Arizona, early intervention for children under 3 is provided through AzEIP. Our parent's guide to AzEIP walks through referrals and what happens at age 3. If you're thinking about private support in addition to school or early intervention services, you can read about our early intervention and speech therapy services.
What about reading?
Reading is worth keeping in mind from the start. The Topics in Language Disorders review notes that "Many individuals with Down syndrome can achieve some level of literacy competence given exposure and instruction," and that individuals with Down syndrome "have relatively strong whole-word recognition skills, despite impairments in phonological awareness."[4] The authors also say that "Literacy assessment should not be delayed until the school years, as foundational literacy skills begin to develop at birth."[4]
The bottom line
Many children with Down syndrome talk later than their peers, often understand more than they can say, and may be harder to understand when they speak. Hearing problems are common and worth checking regularly. Signs and pictures are widely used, and researchers generally agree they don't get in the way of speech. Support can begin in infancy and continue through school. Every child is an individual, so bring your questions to your pediatrician and a speech-language pathologist who can look at your child's own strengths and needs.
Sources
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (n.d.). What are the symptoms of Down syndrome?. NICHD, National Institutes of Health.
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (n.d.). What are common treatments for Down syndrome?. NICHD, National Institutes of Health.
- Centers for Disease Control and Prevention (n.d.). Down Syndrome. CDC, Birth Defects.
- Martin, G. E., Klusek, J., Estigarribia, B., & Roberts, J. E. (2009). Language Characteristics of Individuals with Down Syndrome. Topics in Language Disorders (via PubMed Central).
- Kent, R. D., & Vorperian, H. K. (2013). Speech Impairment in Down Syndrome: A Review. Journal of Speech, Language, and Hearing Research (via PubMed Central).
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.