Mini-Workshop with LIBBY KUMIN, Ph.D., CCC-SLP

author of Helping Children with Down Syndrome
Communicate Better   
 

Dr. Libby Kumin, professor at Loyola University in Maryland and the founder of the Down Syndrome Center for Excellence, shares her expertise about Down syndrome and communication in this mini-workshop for parents of children ages 6-14. Drawn from her new book, Helping Children with Down Syndrome Communicate Better, the information presented here encourages parents to take an active role to reinforce and enhance their child’s communication skills throughout the day. What follows are a few easy-to-follow activities to practice language and speech skills. Have fun!

Attention Down Syndrome Support Groups: 
If you’d like to reprint all or part of this Q&A in your newsletter or post it  to your website, please feel free to do so with proper attribution to Dr. Kumin, her book, and Woodbine House.

Home is at the Heart of Communication 

Communication is part of daily life. We awaken to a new day, say “Good morning,” and start our day. While eating breakfast, we might talk about the weather, and what coat would be the right one to wear (expressive language). We listen to the radio and watch tv (receptive language). We smile and frown, laugh and groan, to show how we feel (nonverbal communication). We talk about projects to be completed, what we will eat for dinner, the movie we just saw or the book we just read. Real opportunities for communication present themselves throughout the day. That’s the major difference between therapy sessions and real life. In therapy sessions, situations designed for practice are simulated. We create a game to practice the final /sh/ sound. We use a toy fishing pole with a magnet on the end. We have pictures of fish swimming in a simulated lake or ocean attached to magnets. The child fishes with the pole, and says the name of the fish he catches—swordfish, jellyfish—to practice the /sh/ sound. How much more exciting is it to talk about fish when you are fishing with grandpa, or going to the aquarium with your family? Or even when you are at home, feeding your goldfish, and talking about buying more fish food?

Home is at the heart of communication. Home is the best environment for learning communication skills and for practicing communication skills. The best situation is when you have a speech-language pathologist guiding you, and demonstrating how to teach new skills. But, parents and siblings and grandparents and classroom teachers and day care providers are truly the best communication teachers. The speech-language pathologist may be with your child 2 hours a week or less. You and your family are together many more hours. That’s why I think it is so important to have a good communication system between the SLP and parents, and why I write books and give talks to provide information that enable parents to help their children learn to communicate better. If your child with Down syndrome is not your first child, you helped your older children with language and speech. You can help your child with Down syndrome with communication, too. Take advantage of the communication moments that occur throughout the day, at breakfast, while dressing, in the car, at community activities, at dinner, talking about the day at school or camp or work, exercising, watching tv or videos, and winding down to go to sleep. The following activities will help you practice specific language and speech skills with your child.

LANGUAGE SKILLS PRACTICE ACTIVITIES

Scripts

During the day, we use many of the same phrases over and over which we repeat when appropriate. For example, when we answer the telephone, we don’t think long and hard about what we are going to say. We say, “Hello,” or “Hi there,” or “How’re you doing?”  Usually we say the same phrase each time as our greeting. When we are talking with someone in person, and we turn to leave, we use our usual parting expressions, “See ya later,” “Catch ya later,” “Bye now,” and so on. These useful repetitive phrases are known as scripts, that is, “automatic pilot” expressions that we use when appropriate but we don’t need to think about once we decide to use them. Scripts can be practiced very effectively at home. Here are some ideas of home activities to practice scripts. What makes practice fun for your child is using “props” and making the role playing into “rehearsal time” with a real “show time” or a real field trip to follow.

Ordering in a Restaurant

One script that works well for older children and adolescents is ordering in a restaurant. Usually, you can also get copies of or download menus for many restaurants. Talk with your child about what goes on in a restaurant. How does the waiter know what you want? What does the waiter say?  What does the customer say? Depending on your child's language and speech ability that might be, “I'll have a hamburger and fries, please,” or “hamburger, fries,” or pointing to the items on the menu.

Set up the scene, involving siblings and friends, if appropriate. Once the scene is set, rehearse the lines. What does the waiter say? What does your child say? Then, get the props ready and start role playing. When you, the director, feel your child is ready and the scripts have been learned, it's time to go out to eat and try out the script. In the real setting, you will be able to see which scripts have been learned and what may need revision and more rehearsal.

Other community activities where your child can learn to communicate effectively through scripts and role playing and then practice in the real situation include:

• buying shoes (how can your child indicate that the shoes don’t feel right or that she would prefer a different style or color?)

• visiting the doctor or dentist

• going to the movies and buying tickets

• visiting a friend’s house or attending a party (to include situations that arise when eating a meal or sleeping over)

• getting a hair cut

• buying a music CD or DVD

• ordering photos or prints

• ordering an ice cream cone where there are many possible choices and combinations

Auditory Memory

Taking Ice Cream Orders

How about ice cream cones for dessert? Ice cream offers possibilities for language practice. It provides excellent motivation because everyone likes ice cream. Use it to practice auditory memory (receptive language skills).

Remembering flavors of ice cream in the sequence ordered is good practice for auditory memory. Your child can take the orders while you scoop the ice cream into the cone. If your child is at the level where he can remember one flavor, you make single scoop ice cream cones. When your child can remember 2 or 3 items, you can move on to double and triple scoop cones.

If your child is ready, get started. If it would make it more fun for your child, get a cap for the order person (your child). Family members and friends line up and slowly say their choices, for example, vanilla and strawberry cone. Your child needs to repeat the order, and you then scoop the ice cream as you repeat the names of the flavors (to provide additional practice in remembering). You or your child then serves the ice cream cone to the person to complete their order.

If your child is not ready for this activity, you can help him learn the skill by:

• watching and listening to you repeat the names of the ice cream flavors as family members order their ice cream cones.

• practicing the memory skill through role playing using only 2-3 different flavor names, and making one choice. For role playing, use paper ice cream balls and a paper cone. Practice takes time, so you don’t want real ice cream that can melt. If your child can read, write the name of the flavor on the ball, if not just use appropriate colored paper. You order the ice cream cone, and your child has to repeat the order, and then “make” the cone with the paper ice cream balls. You can staple the ball into the cone. The reward after practice can be a real ice cream in a cone.

Clarification and Repairs

Making an Ice Cream Sundae

Ice cream can also be used to practice conversational skills, such as clarification and repairs—providing or requesting more information to aid in comprehension. A good way to teach and practice clarification and repair skills is through the use of barrier activities. In a barrier game, there is a physical barrier—a piece of folded cardboard, a manila folder, a screen, or a stack of magazines between the two participants. Anything that will prevent each player from seeing what the other person is doing is fine.

In the barrier game activity, one person gives the instructions and the other person follows the instructions. The person who is listening needs to try to follow the instructions and ask questions when he doesn't understand the instructions. The person giving the instructions needs to make repairs when her communication is not clear to the listener. You can use a series of barrier game activities, and the listener and speaker can change roles.

The activity can be a food activity, such as making an ice cream sundae, decorated cookies, or a sub sandwich. An art activity, such as making a sports poster or a greeting card would also lend itself to a barrier activity. The important thing is that you (or a brother, sister, grandparent, babysitter) and your child communicate by speaking, listening, and asking questions. No peeking to see what the other one is doing!

Let's say you are going to make the perfect sundae. First you put the barrier up. Then your child needs to describe to you what to do. For example, "Put vanilla ice cream in the dish." "Put chocolate syrup on." The first couple of times you try a barrier game, you can ask questions to clarify: “How many scoops of ice cream?” “Lots of syrup or a little?” On the first or second try, you may need to teach your child how to ask questions or what questions to ask.

Once you've done this several times, try to get your child to include the details. At the end of the sundae construction, you remove the barrier. Ask your child, “Is this the sundae you wanted?” If not, find out how it doesn’t match your child’s ideal. More syrup? No cherries? Discuss giving instructions. What should he ask for the next time if he wants more syrup?

Once your child can give the directions, change roles. You give the directions and your child asks the questions for clarification and makes the sundae. The bonus to this activity is each time you practice you get to make a sundae!

Other ideas for barrier games include:

• Make tacos

• Build with Legos or other blocks

• Make a picture or design with Colorforms or construction paper shapes

• String a necklace with different colors and shapes of beads

• Decorate a cupcake

• Color a map with markers

• Draw a face on a pumpkin with markers

If you’re making a craft or building with blocks, it is helpful for both the speaker and the listener to do the activity. That is, both players sit on opposite sides of the barrier with a matching set of ingredients or supplies. In this scenario, the players can compare the finished products when they are done and see where they went wrong.

What is important is that there are lots of pieces with lots of choices, so that the speaker has to be specific in describing how to use the materials, and the listener has to choose from the materials and use them based on the instructions given. The idea is to have items that can be confused if detailed instructions are not given, and items that lend themselves to simple questions to clarify the instructions. Barrier games can be used for children and teens with a wide range of language and speech expertise (three-word phrases to sentences).

SPEECH SKILLS PRACTICE ACTIVITIES

How about practicing speech at home? For speech, as for language, there are receptive (comprehension) skills (such as hearing differences between sounds) and expressive skills (saying a sound, speaking loudly or softly, speaking slowly or quickly). Here are some home activities for speech.

Sound Awareness and Sound Articulation

Singing Along

Most children and adolescents with Down syndrome love music. Sound awareness and sound production can be practiced when you are listening to your favorite songs. Here is how you might use a song for sound awareness practice.

Let’s say that your child is listening to songs from High School Musical. There are several popular songs with repeating phrases. Your child happens to be listening to “We’re All in This Together” (which repeats “we’re all in this together” many times). Your child has trouble saying the voiced /th/ sound (as in the). He says “togeda” instead of together. First, you can sing the repeating verse, “We’re all in this together” while looking in a mirror with your child. Clue her into your tongue movement when you are making the /th/ sound. Your tongue is out of the mouth and between the teeth, and then you quickly retract it. Next, you make up a sign, such as putting your thumbs up in the air, when you hear the /th/ sound. First let her listen and watch for the sound as well as hear it while you both sing the song. Then take the focus off the visual and ask her to listen for the sound. You might lie on a beanbag chair or turn your back or begin dancing, any position so that your child cannot focus on watching your face, only on hearing the song.

You can also use songs for sound production and practice. When a song has a predictable repeating phrase, you can practice that phrase with your child. For instance, if your child is working on the /g/ sound, you might encourage her to sing “Get Your Head in the Game” from High School Musical. Once your child is able to sing that phrase, whenever it comes up in the song, she can sing it loudly. This is a painless, enjoyable way to practice sounds.

Rate of Speaking

Many children with Down syndrome speak rapidly, especially when they are excited or upset. Sometimes, children may speak slowly because they are having difficulty with word finding, or having difficulty formulating what they want to say. This type of difficulty relates to language. Other times children are able to speak at an appropriate rate, but they are just not aware of how slowly or quickly they are speaking. They need help in becoming aware of rate, and learning how to control their rate of speaking according to the needs of the situation. Here are a few home activities for bringing rate into awareness, and practicing rate.

Reading, Listening, Watching, Reciting, and More

• Make sure your child understands the concepts of fast and faster, and slow and slower. You might read the story of The Tortoise and the Hare, and talk about slow and fast. Or you might demonstrate (or let your child demonstrate) fast and slow with your VCR or DVD player. When you fast forward, everything moves faster; when you let the movie go at its normal speed, it is slower. If you have a tape recorder that will allow you to adjust the speed of playback, you can demonstrate clearly what fast and slow speech sounds like.

• If you have the opportunity to attend an auction or watch one on TV, let your child experience what very fast speech sounds like and then talk about whether it would be a good idea to talk that fast in daily life.

• Have fun saying a rhyme or singing a song very fast and then very slowly.

• Set up a race course and race a toy car and a very slow moving animal. The person operating the race car must talk very fast while the person with the animal must talk very slowly.

• Talk about situations where slow speech is better and situations where fast speech is better.

• Come up with some kind of discreet visual signal to let your child know when she needs to slow her speech down.

I hope you have found these home activity suggestions useful and helpful. You deserve applause for your efforts to help your child with his or her communication development. Your daily life together affords countless opportunities to practice language and speech skills. Remember, home is at the heart of communication.