Category: Therapy

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Speech & Language Therapy for Children & Adolescents with Down Syndrome

Children with Down syndrome have strengths and challenges in development of communication skills, including receptive (understanding) language and expressive (speaking and composing sentences) language skills and reading. It takes a team to help children and adolescents progress well in speech and language; that team typically includes speech-language pathologists, physicians, classroom teachers, special educators and families. Speech-language pathologists have information and expertise to help address the speech and language problems faced by many children with Down syndrome. Physicians treat ear, nose and throat conditions and metabolic and hormonal concerns that may affect respiration, hearing, voice and articulation. School learning is language based, so classroom teachers, special educatos and speech-language pathologists help in modifying language and curriculum to help children learn. Parents play an important role in their child’s speech and language development because home and daily activities are the core of communication.

What Are the Language Characteristics of Children and Adolescents with Down Syndrome?

Research and clinical experience demonstrate that some areas of language are generally more difficult for children with Down syndrome while other areas are relatively easier. Children with Down syndrome have strengths in the area of vocabulary and pragmatics (social interactive language). They often develop a rich and varied vocabulary as they mature. They have good social interactive skills and use gestures and facial expressions effectively to help themselves communicate. They generally have the desire to communicate and interact with people. Syntax and morphology (including grammar, verb tenses, word roots, suffixes and prefixes) are more difficult areas, possibly because of their complex and abstract nature. Children with Down syndrome frequently have difficulty with grammar, tenses and word endings and use shorter sentences to communicate.

Most children with Down syndrome are able to understand much more than they can express. As a result, their test scores for receptive language are higher than for expressive language. This is known as the receptive-expressive gap.

Children with Down syndrome learn well through visual means, so often reading and the use of computer programs focusing on language skills can help them learn. Seeing words and images associated with sounds and being able to read words can help speech and language develop. For some children, the written word can provide helpful cues when using expressive language.

What Are the Speech Characteristics of Children and Adolescents with Down Syndrome?

There are a wide range of abilities that children with Down syndrome demonstrate when using speech. Speech intelligibility (speech that can be easily understood) is one of the most difficult areas for people with Down syndrome at all ages. Many children have difficulty with the strength, timing and coordination of muscle movements for speech. Speech involves coordinating breathing (respiration), voice (phonation), and the production of speech sounds (articulation). Factors that can contribute to speech intelligibility problems include: articulation problems with specific sounds, low oral-facial muscle tone, difficulty with sensory processing and oral tactile feedback, use of phonological processes (e.g. leaving off final sounds in words) and difficulties in motor planning for speech.

What Does a Speech-Language Pathologist Do?

A speech-language pathologist (SLP) can provide evaluation and treatment for the speech and language difficulties experienced by children and adolescents with Down syndrome. They can help develop a comprehensive treatment plan to address all of the areas in which the child may be experiencing difficulty, including receptive and expressive language, semantics (vocabulary), syntax (grammar), pragmatics (uses of language and social and conversational skills) classroom language skills, speech, oral motor planning and oral motor strengthening. SLPs can work with families and teachers to design and implement an effective school, home and community program to help children develop stronger communication skills.

What Language Skills Are Needed for School?

Parents can help by working as a team with their school personnel to develop an individualized treatment program. In school settings in the United States, the plan will be part of the IEP (Individualized Education Program). Speech and language IEPs may include diagnosis and evaluation, individual therapy sessions, group therapy sessions, classroom-based therapy sessions and/or outcome goals. The IEP may also include provisions for information, consultation and guidance to parents and classroom teachers.

When children are in inclusive settings, the speech-language pathologist may consult with the teacher to provide information about a child’s speech and language needs, and may suggest modifications, such as providing the student with written rather than verbal instructions or including fewer items on a class worksheet. Accommodations such as preferential seating to help problems in hearing and listening may be used. Certain skills may also help prepare a child to get the most out of classroom learning; children who have learned to follow directions, have a good grasp of classroom routine and have basic subject knowlege are well prepared for a successful educational experience. Other communication skills needed include the ability to talk and interact with other children, teachers, custodians, cafeteria staff and other school personnel such as school bus drivers.

It is difficult for children in school when their speech and language can’t be understood by the teacher or other children in the class. Behavior problems are sometimes related to frustration in not being understood and the relationship between communication and behavior should be explored. In the schools, a child can be referred for a Functional Behavioral Analysis. Based on the findings, a Positive Behavior Intervention Program can be developed.

What Can Parents Do to Help Their Child’s Speech?

Parents can provide practice in speech and language skills at home and in the community. Varied and inclusive home and community experiences help children and adolescents with Down syndrome continue to acquire and use new communication skills. Activities that involve social interaction, such as scouting or participating in youth groups, can help young people with Down syndrome develop and practice speech and language skills. When a child has more opportunities to communicate, his or her skills will expand.

The speech-language pathologist can provide information and can design a home activities program to help the child practice the communication skills being addressed in therapy. It is important that parents stay in regular contact with the speech-language pathologist so that their child can practice speech and language skills. Regular phone or e-mail contact, a journal or audiotapes can provide that continuous contact. Parents can also seek additional services as needed. Books, workshops, conferences and newsletters can provide state-of-the-art information.

How Can I Get Help for My Child?

Parents are often frustrated because they feel that their child needs more speech and language therapy than is being provided by the school. School systems are the major provider of speech-language services, but they have guidelines that determine whether a child is eligible for their services. Sometimes eligibility depends on whether a child’s test scores are below those for his or her age; other criteria include the relationship between cognitive and language levels. Parents should make sure they are aware of the eligibility criteria, as well as the federal, state or local legislation and policies that apply to service delivery in speech and language.

Although most children receive speech and language services through their local educational system, speech-language pathology services are also available in hospitals, rehabilitation centers, university clinics and private practices. Parents should seek additional help for their children when needed.

How Can I Find a Qualified Speech-Language Pathologist (SLP)?

Qualified SLPs are certified by the American Speech-Language-Hearing Association and licensed by the state. After professionals have been certified, they can use CCC-SLP (Certificate of Clinical Competence in Speech-Language Pathology) following their names. This means they have completed a master’s degree in an accredited program, completed required hours of clinical practice internship and passed a national certification examination. The American Speech-Language-Hearing Association or a specific state’s Speech-Language-Hearing Association can refer parents to local SLPs. Members of Down syndrome support groups can also often refer parents to local speech-language pathologists who have experience working with children with Down syndrome.


Ways to Manage ADHD That Aren’t Drugs

Know Your Options

If your child’s been diagnosed with ADHD, you want to know what can help him. Medication isn’t the only way to treat it. Other things can help, too. And many can be used along with medication or other nondrug treatments. Talk to your doctor to come up with a treatment plan that works best for your child.

Behavioral Therapy

This type of therapy, also known as cognitive behavioral therapy, can ease your child’s ADHD symptoms and help him feel better. Most of the time, it focuses on identifying and changing thoughts to change behavior. Research shows that it’s very good at improving mindfulness and reducing impulsive behavior. People with ADHD often have mental health problems like depression or anxiety, and behavioral therapy helps with these, too. It usually works best when combined with ADHD medication.


Behavior Therapy For Parents

As part of behavioral therapy, parents take a class or meet with an ADHD specialist to learn to help their child manage ADHD symptoms. It can help your child improve his behavior and strengthen your relationship with him, too. Ask your child’s doctor or an ADHD expert to recommend a therapist.


Behavior Therapy For Teachers

Teachers, too, learn ways to make it easier to work with kids with ADHD. Since an estimated 11% of kids in the U.S. are diagnosed with it, the training can help teachers with many students — not just your child. Schools will help support students with ADHD. If you want to see if your child’s teacher may be open to such training, meet with the teacher or principal and discuss what you’ve learned from behavioral therapy.



This is a newer type of ADHD treatment. Coaches — who are sometimes called executive function coaches or organizational coaches — aren’t the same as therapists or doctors. Some coaches may be licensed therapists or medical professionals, but they use different techniques during coaching. They help kids and adults with ADHD learn skills that help them manage symptoms. For example, coaches can help with goal setting, problem solving, and time management.



Neurofeedback — also called brain training or EEG biofeedback — involves placing headgear with sensors on your child’s scalp to monitor brain waves. While your child wears the sensors, he plays a computerized game using his brain, which helps him learn how his brain works. The idea is that learning about his brain and how to control it can help ease ADHD symptoms. The verdict is still out on neurofeedback. But it doesn’t have any side effects, and some research shows that it improves some kids’ ability to pay attention, manage time, and stay on task. It’s also shown to lower impulsive and antsy behavior.


Music Therapy

Kids with ADHD often struggle with stress and anxiety. Music can be relaxing, which is why some experts think it’s good medicine. What’s more, music has a start, an end, and a rhythm. Some experts think that structure may help kids with ADHD get through everyday activities. Music therapy isn’t supposed to replace behavioral therapy or medication. Most ADHD professionals use it alongside other treatments.


Assistive Technology (AT)

ADHD affects the brain’s frontal lobes — that’s an area that helps you get organized and plan ahead. Because of this, kids with ADHD may struggle to stay on top of homework and  tasks at home, too. Some parents find that assistive technology — like cell phone apps, online calendars, screen readers, and talking calculators — help their kids pay attention. Many kids like screens and may be more willing to use apps that involve a cell phone, tablet, or other computer. There’s no one type of AT that’s most effective, so you may have to try several tech tools to see what works best for your child. And too much screen time may make some kids’ symptoms worse.



Regular exercise eases many ADHD symptoms. It can help kids pay attention and can boost their mood, too. Exercise may even help make it less likely that your child does risky things like speeding while driving, or abusing alcohol. One reason? Even short bursts of physical activity can raise levels of brain chemicals like dopamine.

Activity also helps with sleep. If your child often doesn’t get enough shut-eye, it can make ADHD symptoms stronger.


Healthy Diet

A bad diet doesn’t cause ADHD. But experts say that a nutritious diet filled with fruits and vegetables, whole grains, and lean protein is important for healthy brain development.

A small amount of research suggests that ADHD symptoms improve in some (but not all) kids after they stop eating anything that contains artificial food dyes. (Food dye can be found in some candy, cereals, and other foods.) Healthy levels of omega-3 fatty acids and other nutrients like zinc may also help. But there’s no proof that any one type of diet can greatly curb symptoms or cure ADHD.



While vitamins and minerals in your diet can help your brain stay healthy, it’s not clear if certain nutritional supplements can help ADHD. Some research suggests that zinc supplements may help kids with ADHD be less hyperactive and impulsive. Other studies show that fish oil supplements might help with ADHD symptoms, too. But more research is needed. Be sure to talk to your doctor before your child takes any new medications, including over-the-counter supplements.


Chiropractic Care

This is a controversial ADHD treatment option. Chiropractors believe spine issues, like “misalignment,” may contribute to ADHD symptoms. One small study suggests some kids with ADHD may benefit from chiropractic care. But experts don’t know whether adjusting a person’s spine can affect brain areas that play a role in ADHD.


Reviewed by Smitha Bhandari, MD on October 10, 2016


#Tablets and smartphones damage toddlers’ speech development

Better Study Habits for ADHD Kids

Always Losing Homework?

ADHD causes problems with the ability to keep track of time and stay organized. If your child has ADHD, it may not be his fault that he spends hours on his homework and then loses it. As a parent, you can help him overcome that. By helping your kid stay organized, you’re teaching skills to last a lifetime.

Set up a Homework Station

Kids with ADHD need a predictable routine for homework. Set up a special spot where your child does homework every day. Make sure it’s away from pets, siblings, and noisy distractions, like the TV or the front door. Keep it stocked with pencils, paper, and any other supplies your child might need.


Keep a Calendar

Big, hard-to-miss reminders will help keep kids with ADHD on track. Get a giant wall calendar and put it somewhere your child will see it many times a day. Put it on the kitchen wall or near her desk. Use color-coded markers or notes to show upcoming assignments and school vacations.


Work with Teachers

Meet with your child’s teacher and principal to make a plan for your child. It’s ideal to do this before the school year starts, but you can do it at any time. Ask for a schedule of upcoming assignments, either on paper or online, and for your child to use free periods for homework. Stay in touch by email. Knowing that you have the teacher’s support will help a lot.


Stay on Schedule

Having a daily schedule is key for kids with ADHD. They need set times for doing homework, eating dinner, and going to bed. If you get off schedule, start again tomorrow. Sticking to a schedule will help your child — and reduce the pleading, nagging, and conflict.


Use Rewards

If homework is a struggle, offer rewards for finishing it. They shouldn’t be big, but they need to be immediate. As soon as your child tucks his homework in his bag, offer to read a story. Give him a sticker. Allow TV or computer time. Build the rewards into your after-school schedule and keep it consistent.


Break up Big Tasks

When your child starts getting bigger assignments — dioramas, book reports, or term papers — that can be a big adjustment. Break it up into a series of smaller tasks, each one with a due date. Even teens with ADHD may need some help with scheduling big assignments and projects.


Use Timers

Kids with ADHD often lose track of time. Use kitchen timers or alarms on watches or phones to mark time. Have your child set a specific amount of time for a piece of homework. The alarm will also help get her back on track if she gets distracted.


Get Organized

If your child forgets assignments at school or has a backpack overflowing with crumpled papers, help her get organized. Make it visual. For example, get brightly colored folders for each subject. Have a backup plan for when assignments don’t make it home. Keep a list of other kids in the class to call. Or know how to contact the teacher directly.


Praise Effort

ADHD or not, children thrive on praise. It encourages and motivates them. So notice their successes, even the little ones. Praise your kid for effort and improvement. It feels good to you both. Small wins may lead to bigger ones.


Strategies for Hard Assignments

Does your child breeze through homework in some subjects but get bogged down in others? Have him switch between them. Start with the easy assignment. Shift over to the harder assignment for a few minutes, then shift back. Alternating may help your child feel less overwhelmed.


Set Goals

Rewards are great, but if they’re too big, like offering a new car to your teen if she gets straight As, it can backfire. Long-term goals can be tricky for kids with ADHD to meet. A better plan is to set lots of little goals  to meet within a day or a week for smaller, immediate rewards.


Write Out Directions

Does your child need help understanding how to do his homework? First, explain the instructions. Have your child explain them back to you. Then, write out the step-by-step instructions and post them on the wall. For many kids, it helps to have a visual reminder.


Mention the Obvious

When helping your child do her homework, include steps that might seem obvious to you. For instance, the last two steps should always be “put your homework in your folder” and “put your folder in your backpack.” The more specific you are when giving instructions, the better.


Help During Transitions

During times of change or transition — starting a new grade, moving to a new school — your child may have more trouble with schoolwork. Plan to offer extra help during this time. Check in more often. Go over assignments together.




ADHD in Children

ADHD in Children

What Is It?

Does your child find it hard to focus? Kids with ADHD (attention deficit hyperactivity disorder) are fidgety and easily distracted. This makes it tough to stay “on task,” whether it’s listening to a teacher or finishing a chore.

Can’t Pay Attention

It’s one of the main symptoms of ADHD. Your child may find it hard to listen to a speaker, follow directions, finish tasks, or keep track of her stuff. She may daydream a lot and make careless mistakes. Or she may avoid activities that need concentration or seem boring to her.



Another sign of ADHD: Your kid just can’t seem to sit still. He may run and climb on things all the time, even when indoors. When he’s sitting down, he tends to squirm, fidget, or bounce. You also might notice he talks a lot and finds it hard to play quietly.



You’ll notice that your kid may find it hard to wait his turn. He may cut in line, interrupt others, or blurt out answers before the teacher finishes a question.


What Causes It?

Kids with ADHD have less activity in areas of the brain that control attention. They may also have imbalances in brain chemicals called neurotransmitters. It’s not clear what causes this to happen, but ADHD runs in families, so many experts believe genes play a role.


How to Get a Diagnosis

There are no lab tests for ADHD. Instead, your child’s doctor will ask her questions, listen to your description of behavior problems, and look at her teacher’s comments. To get a diagnosis, your child must show some combo of symptoms for 6 months, like not paying attention, hyperactivity, and impulsive behavior. They must have appeared no later than age 12.


Types of ADHD

The combined type is the most common, and your child has it if she doesn’t pay attention or is hyperactive and impulsive. In the predominantlyhyperactive/impulsive type, she’s fidgety and can’t control her impulses. If she has the predominantlyinattentive type, she finds it hard to focus but isn’t overly active and usually doesn’t disrupt the classroom.


Medications for ADHD

Stimulant meds help increase your child’s attention span and control hyperactive and impulsive behavior. Studies suggest these drugs work in 65% to 80% of kids with ADHD. As with any medicine, there can be side effects. Discuss these with your doctor. Nonstimulant drugs are options for some kids, too, but they also can have side effects.



It can help your child learn to handle frustrations and build self-esteem. It also teaches you some support strategies. One type of therapy, called social skills training, shows him how to take turns and share. Studies show that long-term treatment with a combo of drugs and behavioral therapy works better than medication alone.


Special Education

Most kids with ADHD go to regular classrooms, but some do better in a place that’s got more structure. If your child goes to special education, he’ll get schooling that’s tailored to meet his learning style.


The Role of Routine

You can give your child more structure at home if you lay out clear routines. Post a daily schedule that reminds her of what she’s supposed to do throughout the day. This helps her stay on task. It should include specific times to wake up, eat, play, do homework and chores, and go to bed.


Your Child’s Diet

Studies on diets have mixed results, but some experts believe food that’s good for the brain could be helpful. Things that are high in protein, like eggs, meat, beans, and nuts, may help your child concentrate better. You may also want to replace simple carbs, like candy and white bread, with complex ones, like pears and whole-grain bread. Talk to your pediatrician before making any big changes in what your child eats.


ADHD and Junk Food

While many kids bounce off the walls after they eat junk food, there isn’t any strong evidence that sugar is a cause of ADHD. The role of food additives isn’t certain, either. Some parents believe preservatives and food colorings make symptoms worse, and the American Academy of Pediatrics says it’s reasonable to avoid them.


ADHD and Television

The link between sitting in front of the tube and ADHD isn’t clear, but the American Academy of Pediatrics suggests you limit your young child’s screen time. The group discourages TV viewing for kids under 2 and suggests no more than 2 hours a day for older kids. To help your child develop attention skills, encourage activities like games, blocks, puzzles, and reading.


Can You Prevent ADHD?

There’s no surefire way to keep your kid from getting it, but there are steps you can take to cut the risk. When you’re pregnant, avoid alcohol, drugs, and tobacco. Kids whose mothers smoke during pregnancy may be twice as likely to get ADHD.


Outlook for Kids With ADHD

With treatment, a large majority of children with ADHD improve. And if your child’s symptoms continue as he turns into a grown-up, he can still get help that’s appropriate for adults.






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