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Speech
Goal: To gain an accurate profile of the child's communication
skills
Most
children with Down Syndrome (DS) are faced with speech and
language challenges. In order to determine an appropriate
treatment plan for children with DS, one must first consider
"normal" development and then explore how and why the DS population
differs. There are no speech and language challenges unique
to children with DS. There are however, some common areas
or difficulty that should be considered during an assessment:
- sequencing of sounds and words
- intelligibility of speech and
articulation
- fluency
- mean length of utterance (MLU)
Since
studies have shown that children with communication difficulties
perform better with familiar examiners, it is essential for
the SLP to gain a good rapport with the child and to become
familiar with the child's communication patterns prior to
assessment. The length of the evaluation can vary depending
on the child's level of cooperation and adjustment to the
setting and may take up to three or four sessions to complete
Initial Assessment
1) The Case History
- the first step in the evaluation
process, must be completed prior to the formal assessment
- the framework for the initial diagnostic evaluation
- provides clinician information
about the child's fine motor, gross motor, social, speech
& language developmental milestones as well as prenatal
and birth history
- questions address medical history,
family history, educational history, personality & emotional
characteristics and learning style of the child.
2) The Formal Assessment
- choose a test according to the
specific needs and communication patterns of the individual
child
- parents should verify whether
or not their child's performance during testing was a typical
display of their abilities
- refer to Appendix
2-A
3) The Informal Assessment
- involves observation of child
in session - paying close attention to:
a.
general behaviour performance including levels of attention
and play
- toys are pre-selected for the
child - child is observed during play, which may involve
socio-dramatic play, games with rules etc.
- paying close attention to the
child's level of attention, as well as self-stimulatory,
sensory behaviours, sensory dysfunction and level of frustration
b.
oromotor skills
- observation of orofacial mechanism
at rest, during eating and during structured oromotor activities
(ie. blowing bubbles/whistles)
- may also be asked to produce
a variety of oral movements - parent input is valuable
- refer to Appendix
2-B
c.
receptive and expressive language skills
- receptive - focuses on ability
to follow simple and complex directions, analysis of receptive
vocabulary skills, auditory processing and auditory
memory - may use crafts, cooking activities etc.
- expressive - used to determine
length and complexity of utterance, vocabulary usage and
morphological & syntactic usage - may be videotaped in natural
setting
d.
speech skills
- an evaluation of rate, fluency,
loudness, pitch, resonance, general level of intelligibility,
articulation and phonological deviations
e.
pragmatic skills
- assess interpersonal communication
including nonverbal communication (turn-taking, topic maintenance,
request for clarification, eye contact etc.)
Audiological
Assessments
1) Behavioural tests
- offer a measure of the degree
of hearing loss; aid in locating the problem; provide information
as to how the hearing loss will affect the child's ability
to communicate
- usually include: threshold testing;
word recognition testing; and middle ear testing
2) Auditory Brainstem Response
evaluation
- used when behavioural tests
do not provide reliable results
- provides information on the
type and amount of hearing loss; effect on communication
abilities; and functioning of the hearing nerve
3) Otoacoustic emissions
- measures otoacoustic emissions
-aids in determining if the child has a hearing loss
4) Vestibular evaluation
- may help confirm cause of hearing
loss as well as provide information about the development
of motor skills
[ REFERENCES
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