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Since 1971, I have conducted research and clinical services with over 200 children with Down syndrome and their families. The findings from this work have been very helpful in developing several tests and treatment programs for pre-conversational children. The following conclusions come from three sources. First, videotapes of over forty children interacting with their parents and clinicians before and after treatment programs; second, interviews and observations with parents concerning attitudes and practices affecting language development; and third, critical review of 20 years of developmental research.
The majority of children with Down syndrome studied interact much less frequently, for briefer durations, on fewer activities and with fewer people than children of similar age and developmental levels. Clearly, children will learn to communicate and talk to the degree that they have frequent social contacts with others. Consequently, the most important way to help a child communicate may be to make sure they are interacting for increasingly more frequent and longer times. A major goal of our work has been to focus on four consistent goals for children with Down syndrome. To increase 1) the number of interactions with people; 2) the length of the interactions in terms of back-and-forth turns; 3) the variety of activities; and 4) the number of people who deliberately interact with the child.
It is my firm belief that the task of helping a child with Down syndrome learn to communicate can be much more efficient and effective if we insure that the child has a great number of natural approaches to practice communication at any level.
While most parents believe that play is important for a child’s development, most think that playing with toys is the best kind of play. While a child will learn a lot from playing with toys alone, it is extremely important to realize that he will not learn to communicate that way. To learn to communicate and talk, a child must play regularly with people.
A common re-commendation to parents of young children is to "bathe your child with language" and "talk to your child all the time". In order for your child to communicate, he needs two major things: models of things he can now do, and time to do it. Much research and parent reports show that children with Down syndrome are often barraged by much more language than they can try to do. At the same time, they are given very little silent time to try something. Often we see interactions like the following. Charley: Points to the refrigerator. Parent: "Are you hungry? I bet you want some juice. You like apple juice best. Okay, here it is." and the child drinks the juice without having the opportunity to practice communicating about it.
We teach parents such as these to communicate once and in a way the child can soon do (i.e., matching) then wait for the child to do something, anything, at first. Let’s go back to Charley for a more effective exchange. Charley: Points to refrigerator. Parent: Points like the child and simply says juice then waits silently looking at the child expecting some kind of response. Charley: Points again and says "oo". Parent: "oo, juice"; then waits again. Charley: Points and says "oo". Parent: says "juice" and gives the child a sip of the juice then waits again. Charley: says "oo". Parent: "juice, more juice," gives the child another sip and waits again. Charley: says "mo". Parent: says "more juice," gives another sip then waits; etc. This parent is acting and communicating in ways the child can try; and the child does try. The parent rewards the child a little then waits for another communication - anything the child can do - then the parent shows the child a little next step ("more juice"). Be sure to make the most of such opportunities and not give the child the juice all at once. Operate by the rule "Keep the child just a little longer" and remember that every exchange is a chance to communicate.
Our research shows that children with Down syndrome often have the habit of popping in and out of interactions without staying long enough to learn to communicate much. We also find that parents and other adults assume that if the child wants to leave they should allow the child to do so. But, if we believe, as we definitely do, that a child will learn to communicate only to the degree that she stays interacting longer and more frequently with others, then we will get into the habit of keeping the child a little longer. Think of your back-and-forth inter-actions with your child like insulin to a diabetic child. Without more and longer inter-actions, your child will not learn to communicate.
Many parents of children with Down syndrome are so happy when their child starts communicating in any way at all - little sounds and movements - that they accept these little attempts. That is as it should be. Long before a child talks, she will need to communicate with any kinds of sounds and movements she can do. We strongly encourage this. How-ever, there is a potential problem here. We have seen many children stuck at communicating with old sounds and movements long after it is clear that they can say some words. Many, many times I have shown parents that their children actually do not need to talk, when they get attention for any old attempts to communicate. Then I have often shown parents that by simply waiting silently after a child makes an old sound or movement, the parents will see the child trying something a little more mature.
Consider your child’s job as moving from his own special language without words to your English language. Often when a child gestures, or makes a sound, he needs help to move from his language to yours. A very effective way to do this is to translate the child’s sounds or gestures into a word. For example, when a child points to her sister, Janie, say "Janie", then wait. By doing this you are translating and giving her a word to replace her old gesture. We often then play with the word back-and-forth, treating words as the child’s most important toys - as we would throw a ball back and forth.
Years of observing parents with children with Down syndrome tells us how important parents think it is to teach the child the language of school, often even before he communicates his own ideas. I have known many children with Down syndrome who can show words for the alphabet, numbers, colors, even a long list of animals they may never see; but the same children have few words for the things they are experiencing and things they want to communicate about. Be sure your child has words for communication before words for school.
Our approach, then, is to focus on helping the child learn words for two broad classes of things: their immediate experiences (e.g., fall down, hug, mommy, daddy, give) as well as words for the things they are already communicating without words (pointing to kitchen - eat, hungry; arms outstretched - up, hug or what ever you think the child means). Why are these words most important and more developmentally necessary than school words? These words are the things the child both knows and cares about. A child is more likely to use words that match his current knowledge and motivations. A child will have many more opportunities to practice talking with words that describe what he knows and wants than with words like red, three, and other words that have little daily communicative uses. Consequently, we encourage parents to give their child much more "communicative" language than "school" language.
One of the most difficult habits to change in parents is paying attention and talking to children when they are doing undesirable or immature things. A great many parents have told me that they feel it is wrong to ignore a child when he is misbehaving or communicating in some immature way. We have worked very hard to show parents that paying attention when a child does these things is much like giving the child a ten dollar bill for it, because parents’ attention and words are often the most powerful rewards for a child. On the other hand, when we ignore those behaviors we usually see the child doing less of them and more of the appropriate and mature things. We teach parents to get into the habit of asking themselves "Do I want more of what my child is doing?" Then, if the answer is yes, they should talk and pay attention; and if the answer is no, they should momentarily pay the child no attention - no talk - nothing that would tell the child he gets attention for it.