Using See and Learn Combining Sounds

See and Learn Combining Sounds is designed to help children with Down syndrome practise putting consonant and vowel sounds together.

When to start this step

See and Learn Combining Sounds builds on the skills taught in See and Learn Speech Sounds and is suitable for use with children with Down syndrome who are beginning to say consonant sounds in imitation and in babble (from 9 to 12 months), and older children who are starting to combine sounds.

Children can start the activities in See and Learn Combining Sounds when they:

• Can say at least some of the consonants [b], [m], [p], [h], [c]/ [k], [l], [r], [sh], [t], [w], [z]
• Can say the vowels [ar] as in [arm], [ee] as in [knee], [OO] as in [moon]

Children will learn to say sounds in different orders. If your child is able to say some of these consonants you can start working on the activities using the consonants they can say with the vowels.

See and Learn Speech Sounds (the first step in See and Learn Speech) provides activities to teach children to hear and say single consonant and vowel sounds. You can continue to use this first kit to teach your child the single sounds they are not yet saying while starting to learn to put together the sounds they can say.

See and Learn Combining Sounds may also be useful for older children who are making word attempts but have very unclear speech.

Activities

There are two activities in See and Learn Combining Sounds:

• Combining Consonants and Vowels - using picture prompts to practise putting two sounds together to say syllables or words
• Saying Symbolic Sounds - using picture prompts to encourage putting two sounds together to say meaningful symbolic sounds

It takes all children a long time to say clear words. Their first attempts are often just a sound and then the first two sounds. As they use their voices more (and therefore hear themselves and practice) their ability to combine sounds improves.

Goals

The goals for the two activities in See and Learn Combining Sounds are as follows:

• Combining consonants and vowels - for your child to say the syllables or words
• Saying Symbolic Sounds - for your child to say the symbolic sounds

Saying speech sounds

When producing individual speech sounds, try not to over-emphasise or extend the sounds. For example, say [b] rather than [buh], and [l] rather than [luh].

If you are using the app edition, you can turn on recorded sound prompts and work through the cards to listen to examples. Alternatively, you can find examples of how to say individual phonemes online - for example, http://dselink.org/eng-phonemes

Hearing

If you know your child has a hearing loss, you should speak in a loud, clear voice and ensure that they are looking at your face.

Your child's hearing should be tested regularly in accordance with current medical care guidelines, and whenever you have reason to worry whether they are hearing properly.

Organising sessions

Location

Find a place to carry out the activities that is comfortable, quiet, well-lit and free from distractions. Toys should be out of sight or out of reach.

Sit with your child facing you so that they can see your face clearly. They could be in a baby chair, at a table or on the floor - whichever works best for your child.

Timing

Choose whatever time that you feel is best for both you and your child, for example, when your child is not too tired, and when you are not likely to be interrupted.

Duration

Keep the sessions short so that you can keep your child's interest. You may start with sessions lasting just a few minutes if your child is new to this type of activity.

Gradually increase the length of each session, up to 5-10 minutes. Try to always end on a positive note. Avoid carrying on for too long and losing your child's interest.

Frequency

'Little and often' is the best principle to encourage progress. Repetition is essential for your child to make progress. Complete a short activity session as often as you can. Ideally, this will be daily.

Supporting your child's learning

Helping your child to experience success

During each session it is important that your child experiences success at every stage. Some suggestions are:

• respond to all of your child's vocalisations in a positive way
• reward good focus, attention, listening and watching (these skills are important for developing speech)
• if your child signs a word to you during the activity, acknowledge the sign and their communication and then prompt them to attempt to say the target sound combination
• take turns being the speaker and the listener - some of the pressure is removed when your child is the listener but they are still listening to models of the combination
• include other children in the activity, each taking a turn with a particular combination

Following your child's lead

The activities in See and Learn Speech Sounds give your child the opportunity to practise combining sounds in a structured way. Some children will progress quickly, while others may be slower to move forward.

Please note that in everyday activities, children's early sound combination attempts can sometimes be very subtle - maybe just an attempt at a sound, so it is important to listen carefully to your child's attempts and to respond appropriately with the correct model for what you think they are trying to say.

It takes several years for children to pronounce words like adults and all children simplify words early on. All of your child's attempts to imitate and produce a sound pattern which is in some form like the target sound or sound combination should be praised. Over time, and with practice and feedback, their production should become clearer and more like the adult model.

Encouraging speech practice throughout the day

You should use the activities in See and Learn Combining Sounds to complement the speech development opportunities that occur naturally throughout your child's everyday routine. Highlighting the sounds and combinations in structured practice and then following through in everyday activities gives your child the extra practice they need to progress and generalise their speech skills.

Some suggestions that may help you support your child's speech development include:

• getting eye contact and visual attention before talking to your child
• talking to your child about what is happening, what they are seeing, and what they are experiencing throughout the day, so that they can hear the sounds of their language
• singing nursery rhymes and other familiar songs to your child, and then leaving a pause and waiting for your child to respond
• responding to all your child's vocalisations in a positive way
• 'chatting' back and forth in a conversation, allowing both you and your child to take turns at being the speaker and the listener
• interpreting your child's attempts at making sounds/words and 'modelling' or demonstrating the correct sounds/words for them to hear. Even if your child's attempts at spoken language do not sound like true words, model back what you think your child might be saying so that they can hear the correct model. This will also encourage your child to continue to use their voice
• providing opportunities for your child to use their voice throughout the day by incorporating sounds (such as 'weee', 'uh-oh') into games and activities

Asking for repetitions

As your child is just beginning to talk, do not ask them to repeat words when they are trying to communicate with you in everyday situations. This may reduce their willingness to attempt to say words and interfere with the natural flow of conversation. At this stage, you should respond to their message and not correct their speech.

As your child becomes more confident at saying words, then you can encourage their best production. Ask your child to repeat target words when they occur in conversation if you think they can do better. Some experts suggest that we may be too ready to accept poor production and that this does not help children to improve their clarity.

Signing

We recommend that you do not use gestures or signs to represent sounds while engaging your child in the See and Learn Combining Sounds activities. If signs for words are helpful for your child when communicating, you should continue to use them in these situations. However, when working specifically on speech production practice we recommend that you encourage your child to concentrate on looking, listening and speaking.

Your child should focus on the face of the speaker and see their mouth and lip patterns as they say the word. All children use these visual speechreading cues when learning to talk. We therefore recommend that you encourage your child to watch your face, mouth, lips and tongue (rather than your hands) and to try to imitate the speech movements.

There are touch cue/sign systems intended to help children see where in the mouth sounds are made, such as Cued Articulation and PROMPT. They may help, but there is no published evidence to guide us.

We think that these systems are too difficult to understand for babies and toddlers who are just beginning to copy sounds. Some therapists use Cued Articulation or PROMPT with older children to help them with speech sound production and we suggest that you follow your therapist's guidance.

Working with groups

The instructions provide guidance for using the activities on a 'one-to-one' basis. You can easily adapt the activities to include other children by giving turns to each child engaged in an activity. However, it is important that the activity is appropriate for each individual child.