One step at a time...

My client, M, is a 3yr., 6mo. old male with Down Syndrome diagnosed with delayed speech and language. During the semester, we have continued to work on building up M's functional vocabulary of signs. Two of M's most important goals at the beginning of the semester included communicating functionally with signs and learning basic social skills regarding play.

Because M has not really communicated independently in a functional way during the semester, my supervisor and I began to keep track of M's vocabulary, as well as talking with M's mother about words that he uses at home and not in therapy.

Independently, M produces the following signs on his own in the correct context, without cueing:
eat, drink, bath, help, more (pertaining to crackers), sleep, and book.

M is able to imitate the following signs in the correct context, with cues:
more ball, more eat, all done (2 word phrases), ball, again, bird, play car, open, book.

M is able to vocalize the following words as approximations:
"muh" (mom) "da" (dad) when in distress.
"bub" (bubbles)
"buh" (bye)
"ak" (quack)
"uh" "oh" "ow" (uh-oh, wow)

Although M has made considerable progress during the semester, my supervisor and I are beginning to realize that M's primary mode of communication may be signing for much of his life. After analyzing his vocabulary, my supervisor and I determined that M's language level was approximately at the level of an 18 month old, although he is over 3 and a half years old.

M's mother is working with him wonderfully on carrying over signs that are used in therapy, introducing new signs, reinforcing good behavior, and communicating with myself and the supervisor about her concerns for M during his treatment. We have continued to target the signs and words that M understands, introduce new signs, and hope for generalization in the home. Because M is so impaired, it will take a lot of dedication on behalf of M's parents and the clinician that is working with him in therapy in order for M's language to develop on a level that is functional for communication--especially since children with Down Syndrome typically display a delayed language system. I have referenced the following article as a resource for planning activities and homework assignments for M throughout the course of the semester:

Reference:
Berglund, E., Eriksson, M., & Johansson, I. (2001). Parental reports of spoken language skills in children with down syndrome. Journal of Speech, Language, and Hearing Research, 44, 179-191.