Conversational skills

[TODO] This topic offers guidance on how to ..

Initiating and responding

As children become talkers and use their spoken language more confidently, we need to consider the way they are joining in and also starting conversations. If you ask a question, does your child respond? Does your child comment on things that they see when you are out? Do they ask questions? Do they join in family conversation at the meal table? In school, does your child ask questions, contribute in class or start conversations with friends.

If not - is it possible to think of ways to include your child in school and family conversation and encourage them to ask questions. Initially, you may need to draw them into conversations by asking questions and then giving your child time to answer, followed by comments like ‘that’s interesting - and what else happened?’ or ‘can you tell me more?’ You may need to take turns around the table, as this will provide your child with model sentences to copy and support them in taking a turn in the conversation.

You may also need to model, expect and prompt socially appropriate language at a level your child can master, for example “leave me alone, please” instead of “go away” or pushing. Some of the behaviours that seem inappropriate in young children at preschool are often used because the child cannot say what they want or what the problem is.

Be a good listener

Being interested in your child’s activities and being a good listener really help in encouraging your child to talk and to share their experiences. However, it is not easy for children with Down syndrome to become fluent and confident in social situations and this issue will be addressed further in the module for 5-11 year olds.

Speech

From infancy activities that will lead to clear speech need to be a priority. Many aspects of the babies’ development will have an influence on later speech skills, including breathing, feeding and drinking skills and general motor control.

In infancy

It is important to encourage good feeding, sucking, chewing, drinking and breathing habits from the first months of life. The coordination and control of the movement of lips, tongue and breathing needed for chewing and swallowing develops similar actions that are needed for making clear speech sounds. Therefore it is important to steadily move your baby on to chewing lumpy foods, just increasing the texture a little at a time until they can chew ordinary pieces of food. At the same time, move your baby forward from drinking from a bottle to a cup in stages, using a cup with a teat, then a spout, then a recessed lid and finally an ordinary cup. Some babies may not go through all these stages and find it easier to use a straw. Watch that you baby keeps her/his tongue inside the mouth when drinking, and does not put her/his tongue down the outside of the cup. Encourage your baby to learn to drink from a straw. The special straws with built-in valves, sold in the pharmacy, for those with difficulties such as stroke patients, can help. Encourage bubble blowing and whistle blowing games to get your baby to make a round lip closure.

Some babies seem to be hypersensitive and to dislike touch around the mouth area or the feel of things in and around their mouths and these children need help to tolerate these sensations. A specialist speech and language therapist can provide advice but if this is not available, gently massage your babies face with fingers, a face cloth, or a soft brush for a few minutes several times a day. Encourage the baby to try different tastes and textures and sometimes eating with fingers is more acceptable to the child than the feel of a spoon in their mouth.

Encourage mouth closure and nose breathing (use of dummy may help, but only when baby is not socialising and wanting to babble). Your baby’s gross motor development, including head and trunk control and muscle tone, will also influence your baby’s ability to control breathing and face, mouth and tongue muscles. Massaging you baby and encouraging her/him to enjoy kicking and splashing, during nappy changing and bath times, for example, will help to build up muscle tone and control.

A note on tube feeding

If your baby has been tube-fed during infancy, this may have affected the development of breathing, swallowing, chewing and muscle control. For this reason, tube-feeding should not continue for any longer than is absolutely essential. If your baby was tube-fed and you are concerned about her/his ability to chew or make sounds, seek expert help from a specialist in early oral-motor development through a paediatric or speech and language therapy service.

Encourage smiling and babbling

Smiling, babble games, and engagement with others will all keep the face mobile and active and exercise oral-facial muscles. Auditory discrimination training for speech sounds can begin early, in babble games and then in specific sound practice activities. Try to work on sounds, encouraging babies to copy sound and gesture from as early as possible, especially in babble games. Encourage babies to watch your lip movements - they can do this in face-to-face play and will copy the mouth shapes that they see. (Later you can do this sitting side by side in front of a mirror or when using sound cards). Singing games, working on words and sounds, can be fun and a good way to engage babies and toddlers.

Babble is important and sets the stage for later speech development. Babies practice speech sounds in their babble and they tune their babble to the particular sounds of the language that they are hearing by twelve months of age. The sounds that are contained in babies’ babble lead to the first words that they will attempt to say. Interventions with sound work, which should later improve speech clarity, can therefore begin from the first weeks of life. This is the rationale for a system developed by Professor Irene Johansson in Sweden. [TODO: references 3] Parents can follow the programme themselves, although they will be helped greatly by an experienced speech and language therapist. This programme encourages parents to repeat different rhythms of sounds and syllables from early babyhood, with games and activities to teach children to make sounds, understand and use simple language and gestures. Some parents may find the full programme too intensive, but they may be able to adapt it and use the activities that they feel fit comfortably into their daily routines with the baby.

Natural play with your child will also encourage babble and copying, if you do not want to follow a programme. Imitation seems to be an important milestone, in gesture and in speech. Imitate your baby’s sounds and babble, as well as encouraging particular new sounds, taking some of the initial sounds from the speech sounds checklist and introducing them to your baby.

Babies move from babbling a variety of separate vowel and consonant sounds to producing repeated sounds such as ‘baba’ or ‘dada’. This is setting the skills in place for trying easy words like “daddy” and “ball”. Repeat and expand babble and first attempts at words. This is rewarding for the baby as they are taking part in a ‘conversation’ that they have initiated. The baby is also hearing a more accurate version of the sound or word they are trying and you are giving it meaning. Once the child begins to imitate, you can encourage practice. This will often lead to their first meaningful words as you respond to babble as if it is a word and the baby realises the noise they are making does indeed mean something specific like “Daddy”.

[From 5-11]

Initiating and responding

As children become talkers and use their spoken language more confidently, we need to consider the way they are joining in and also starting conversations. If you ask a question, does your child respond? Does your child comment on things that they see when you are out? Do they ask questions? Do they join in family conversation at the meal table? In school, does your child ask questions, contribute in class or start conversations with friends?

If not - is it possible to think of ways to include your child in school and family conversation and encourage them to ask questions? Initially, you may need to draw them into conversations by asking questions and then giving your child time to answer, followed by comments like ‘’that’s interesting’’ - and ‘’what else happened?’’ or ‘’can you tell me more?’’ You may need to take turns around the table, as this will provide your child with model sentences to copy and support them in taking a turn in the conversation.

Be a good listener

Being interested in your child’s activities and being a good listener really help in encouraging your child to talk and to share their experiences. However, it is not easy for children with Down syndrome to become fluent and confident in social situations and they do need thoughtful and sensitive encouragement in order to join in and initiate conversations.

Increasing the quality and quantity of language experience

Increasing the quantity of language use and experience as well as the range of useful phrases that your child can use is important. If you observe your child at home, in a social situation or in the classroom, how much does they talk compared to other children of the same age in these situations. It may not be easy to increase this, but it is important to try. At school, make sure your child takes full part in ‘news times’, taking their turn with whatever support is necessary, such as a holiday picture or object to help the children to understand or the use of a conversation diary for support (see the [Conversation diaries] section for more details). At school, make sure your teenager takes full part in ‘social times’, taking their turn with whatever support is necessary, such as the books and photos suggested to help the other young people to understand, or the use of a conversation diary for support (see later in this document for a description of conversation diaries).

Include the child in answering questions during lessons and in conversations during group work around the table. Remember that the other children will act as models for the language needed to talk in the classroom, so turn taking with other children will be valuable. It is important that the other children fully understand the difficulties of the child with Down syndrome in the class, and in the school, and that they are encouraged to be sensitive, to listen and to include the child in their activities. Explain to the other children how they can help by taking turns, modelling sentences, being sensitive and taking time to listen. Even five year olds are well able to understand and to help if they are asked to. It is important that both adults and children do not become too helpful and talk for the child or jump in to prompt them too quickly. Remember, it will take your child with Down syndrome longer to organise what they want to say.

The social use of language

Children with Down syndrome may need help to learn the language for opening a conversation such as ‘’Hello, Mrs Andrews’‘,’‘Hello Susie, where have you been/did you have a good time?’’ ‘’This is a delicious cake Gran’‘,’‘May I have a drink/watch TV please?’‘,’‘Thank-you for a lovely party, I’ve had a great time’‘,’‘Thank-you for having me to play/for sleep over’‘,’‘Where’s the toilet’‘. Meeting strangers for the first time phrases such as’‘Hello, I’m Julie. What’s your name?’‘,’‘Hello, Have you come to see Mr Green? Can I show you the way?’‘,’‘Hello, I’m Julie and this is my sister Sally’’. The most effective way to learn these social sentences may be to write them down on cards, which can be used to support practice and used in the real situations while the child is learning.

Behaviour and communication

School communication in lessons and elsewhere can be a problem and lead to behaviours, often disruptive behaviours, as the child’s only means of communicating. Some of the behaviours that seem inappropriate in young children at school are often used because the child cannot say what they want or what the problem is. In the playground, other children crowding a child or being over anxious to ‘mother’ the child can lead to the child with Down syndrome pushing or seeming to hit out at children. In the classroom, a child may slide under the desk or become ‘stubborn’ because they cannot say ‘’This work is too difficult, can I have some help please?’‘, or’‘I am hot/thirsty/have a headache’’.

If a teenager has only limited speech and language, then they may not always be able to explain their difficulties in words, so ‘act them out’. For example, other teenagers crowding them in the breaks, or being over anxious to help them can occasionally lead to a teenager with Down syndrome pushing or seeming to hit out at their classmates. In the classroom, a teenager may become ‘stubborn’ because they cannot say ‘’This work is too difficult, can I have some help please?’‘, or’‘I am hot/thirsty/have a headache’’.

You may need to model, expect and prompt socially appropriate language at a level your child can master, for example ‘’leave me alone, please’’ instead of ‘’go away’’ or pushing. Sometimes, other children lead the child with Down syndrome into trouble by encouraging them into naughty behaviours but the child cannot say ‘’Terry pushed me’’ or ‘’Sally took that pencil, not me’’.

In the classroom phrases such as ‘’I need help please, Mrs Jones’‘,’‘Can I go to the toilet, please?’‘,’‘What are we going to do after play?’‘,’‘Where is my book?’‘,’‘I cannot do this, it is too hard’‘,’‘I do not understand this’‘,’‘May I work on the computer please?’‘,’‘Can I read a book now?’‘,’‘I have finished my work’‘,’‘Is it dinnertime/playtime yet?’‘,’‘When do we go home?’‘,’‘Where are my shoes?’‘,’‘Please help me with my shoes/coat’‘,’‘I’m too hot’‘,’‘I’m cold, may I get my coat/jumper/sweater please?’‘,’‘I fell ill/poorly/sick’‘,’‘I have an earache/tummy ache/headache’‘,’‘My head/leg/arm/hurts’‘,’‘I’m tired/thirsty’‘,’’I’m thirsty, may I have a drink please?

Some of these sentences may seem much too difficult for your child at the moment but write them on cards and help them to use them. At first your child may be able to choose the right card because they can recognise one keyword on it or you could put cartoon drawings to help - but this might deter your child from learning to say the words, so only use pictures to get started. Remember to model the sentence so that your child can copy you, both at home and at school.

Social scripts or stories [TODO: references 1] can help children to understand what is expected of them in social situations and at school. For example, ‘’In assembly, a Year 2 pupil is expected to sit and listen quietly. First we sing and then the Headteacher will talk to us. After that we go back to our class’‘.’‘When the bell rings, a Year 1 pupil lines up by the red door. If you can do this on your own, Mr Brown will be very pleased’’. Sometimes we forget that, although we tell children off for behaving inappropriately, no one has actually made sure that they know what behaviour is actually expected of them. This issue is discussed in more detail in the social development module, with further examples of social scripts.

Expressing emotions and feelings

Teenagers with Down syndrome are usually socially sensitive; they understand other people’s emotions and show appropriate empathy. However, they may be picking up mainly the non-verbal cues we all use to identify emotions, and they may not have an adequate vocabulary of emotion words to be able to explain how they feel or to ask others about their feelings. It is therefore important to ensure that vocabulary targets include words for everyday emotions such as happy, sad, excited, frightened and angry. In teenage years, relationships with special friends and boy/girl friends become important. Teenagers experience strong emotions and sexual feelings during this time and it is important that they are helped to understand these. They will need to learn appropriate vocabulary and appropriate ways of expressing themselves. Parents and teachers need to look for suitable picture materials to aid the understanding of young people and they should not shy away from this area of development. Teenagers need to know what behaviours are appropriate and how to handle ‘crushes’ and ‘rejections’. These experiences may be more painful in inclusive school settings, if there are no other disabled peers to share ‘growing up’ and to provide reciprocal, mutually supportive, close friendships,