Speaking through the Silence

My client, M, is a 3 year, 6 month old boy who has been diagnosed with Down’s Syndrome. He is currently nonverbal, and communicates by using a limited inventory of American Sign Language (ASL). M began therapy in June 2007, after he was discharged from the WV Birth to Three program due to his age.

M’s therapy includes a lot of play activities that are structured in ways that elicit or require a response from M in order to continue. The majority of activities included in M’s therapy are play, with signing being integrated by the clinician. The clinician models signs that M is familiar with, which he imitates and occasionally uses spontaneously in the correct context. M currently does not communicate verbally, but will occasionally verbalize “uh oh” or “wow” when excited during play. Therapy has progressed from simple play activities where the clinician models signs and M imitates, to a more sophisticated type of play where M is cued to use basic signing and guided by the clinician in sequenced activities. The social aspects of play are also considered during therapy, and the clinician frequently models appropriate turn-taking and behavior traits that typical children use during play.

The major goal of M’s therapy, is that he would being to build up a vocabulary of signs that he is able to use functionally and in the correct context, providing him the ability to communicate his needs and wants, as well as the ability to understand and communicate with others. At the beginning of therapy in June 2007, simple one word signs were introduced to M, most of which he has retained and now uses spontaneously or when cued for a response. Some of those signs include the following: want, again, more, help, open, close, more, bird, ball, play. The clinician began integrating these signs into two-word phrases in therapy, such as the following: want more, do again, help me, tell me, help open, help close, all done, let’s play. M is clearly gaining and understanding of the techniques being used in therapy and it is reported by his parents that M is beginning to show some of the same communicative behaviors that we use in therapy at home; however, his ability to communicate, even nonverbally, is obviously attenuated. Because he is unable to communicate verbally, his lack of nonverbal cues makes understanding his needs and concentrating on therapy very difficult.

Because it was difficult to find much researched evidence related directly to this topic, I turned to an article written by Mundy, Kasari, Sigman, and Ruskin. The article broadly states that several studies have reported similar findings that children with Down’s Syndrome display a deficiency in their ability to display nonverbal requests, which could later be linked to their early verbal development. They also suggest that their delay in expressive language, such as speech motor control or cognitive approaches related to speech, may be adversely related to a disturbance in behaviors related to nonverbal communication. The most likely cause of these difficulties that have been reported are hypotonia (lack of muscle tone) or neuromotor development delays.

Reference:

Mundy, P., Kasari, C., Sigman, M., & Ruskin, E. (1995). Nonverbal communication and early language
 acquisition in children with down syndrome and in normally developing children. 
 Journal of Speech and Hearing Research, 38, 157-167.