According to the National Down Syndrome Society, 1 in every 691 babies in the United States is born with Down syndrome, making it the most common developmental disability resulting from a chromosomal disorder. This translates into approximately 600 births a year. Individuals with Down syndrome have three number 21 chromosomes, instead of two, in some of the cells. This additional chromosome alters typical development which results in physical and cognitive challenges. When you see how one difference in a chromosome can make such a difference in how a person develops, you realize human development is truly complex and how miraculous it is that each aspect of development and neurology work correctly in many individuals!
Children with Down syndrome, like all children, have unique strengths and weaknesses. Members of this population typically share some or many common characteristics:
- Generally has mild to moderate cognitive impairment which may result in shorter attention span, and impulsivity, as well as delays in learning, speech, and language development.
- Physical differences such as low muscle tone, upward slanted eyes, smaller facial features and stature along with slower physical development (which is often related to low muscle tone). This can lead to delays with learning activities of daily living and articulation challenges.
- More likely than the general population to have some level of hearing loss associated with anatomical differences which can lead to outer, middle, and inner ear problems.
There are many unique aspects of this population as can be surmised by this very general introduction. Speech & Occupational Therapy of North Texas provides pediatric speech therapy for many children with Down syndrome so the focus of this article will be on the anatomical and developmental differences in this population and how these differences, and in particular, how hearing impairment, may impact speech and language development.
According to Pueschel, 60 to 80% of children with Down syndrome have some level of hearing loss. This is due to orofacial and craniofacial differences related to this diagnosis. These developmental differences can lead to inner, middle and outer ear problems:
- Stenotic (arrow) outer ear canal – may occur in up to 50% of infants with Down syndrome. Narrow canals can make it difficult to clean the ear and diagnose ear infections. By age 3 year, the ear canals have grown, making this less of an issue.
- Large adenoids – enlarged adenoids can interfere with middle ear air ventilation. This can result in fluid collection in the middle ear. Fluid in the middle ear can cause a temporary hearing loss.
- Small nasopharynx – results in reduced airway size due to soft tissue encroachment.
- Narrow, more horizontal Eustachian tube – the Eustachian tube connects the middle ear to the back of the noses. It typically opens when we swallow or yawn, acting as a pressure equalization valve. This tube also functions as a drain for mucous produced in the middle ear. Blockage can lead to short term hearing loss.
- Possible missing hair cells in the cochlea may be missing which can result in a sensory neural hearing loss.
Most of these anatomical differences can lead to conductive hearing loss. Children with Down syndrome may have impacted ear wax (cerumen) due to a harrow external ear canal. This blockage will muffle the sound waves coming into the ear. These children produce more mucous than is typical and have a higher incidence of upper respiratory infections. These factors predispose this population to having chronic ear infections (also known as chronic otitis media). Fluid in the ears and otitis media typically cause temporary hearing loss.
If a child with Down syndrome has missing hairs in the cochlear, this will result in a sensorineural hearing loss. The type and degree of loss will depend on which and how many hairs or damaged or missing.
Children with Down syndrome should be closely monitored for ear infections that could lead to hearing loss. If a child has fluid draining from their ears, a running nose, or any symptoms that might signal a cold or infection, it is wise to have the pediatrician check for otitis media. The American Academy of Pediatrics recommends audiological testing at birth (typically auditory brain stem response test – ABR) and then auditory testing every six months up to age three. At age three, it would be wise to continue annual testing if the child has any history of chronic otitis media. Otherwise, testing should continue as recommended by the pediatrician or ENT.
Impact of Hearing impairment on Communication
Children learn language primarily by hearing the speech and interactions of others. So good hearing is important for speech and language development. Speech Therapy is important for a child with Down syndrome regardless of hearing deficits since cognition and processing are impaired. However, since there is a high risk for temporary or some degree of hearing loss, receptive and expressive language can be further delayed. A speech pathologist would use different strategies if there is some degree of hearing loss. A speech language pathologist would focus on strengthening receptive understanding of speech and expressive abilities, which can include articulation and functional use of verbal language. Sometimes, children with Down syndrome are good candidates for augmentative communication, if intelligibility is significantly impaired. Technology has been helpful with many cognitive and communication challenges, since children seem to be drawn to Tablet devices, which afford many interesting applications and also provide more independence for children with motor challenges. A speech language pathologist can also help with drooling, feeding and swallowing challenges sometimes associated with Down syndrome.
Children with Down syndrome can make tremendous progress with treatment, education and a supportive family. There are ample ways each individual can contribute to the community and have meaningful lives. Speech and Occupational Therapy of North Texas is happy to be a local treatment resource for children with Down syndrome in Murphy, Frisco and McKinney. For more information about how speech therapy can help your child, please contact us at 972-424-0148.
A Few Client Testimonials
Catherine Molder – My son has gone to this facility for nearly ten years. In that time he has gone from almost completely non-verbal to a chatterbox. Now his little sister goes to work on articulation and has become much more intelligible in less than 3 months, distinctly so in 6 months at the age of four. I recommend Speech and Occupational Services of North Texas to parents facing similar issues frequently.
Notably, I have also not had an insurance billing issue in years. The staff has worked to resolve all insurance issues in a timely manner and has managed to stay on top of things very well.
Ali Ackles – My son has been receiving services from Speech and OT of North Texas for about three years and we have never regretted our decision to make them a part of our family. The therapists are so knowledgeable and helpful. They are willing to talk with me after my son’s session, explaining what he accomplished and what we can do at home.
Even though the office staff doesn’t necessarily work with my son, they are just as caring and supportive to our family as the therapists. They say “hi” and talk with him when he comes into the office. They are so willing to help when the insurance is being difficult or I am having a hard time understanding something.
Speech and OT of North Texas has been and will continue to be a wonderful place that can help my son accomplish his goals!
Christa Stevens – We have been so pleased with the therapists at Speech & OT of North Texas, Frisco. They have increased my daughter’s skills so much and honestly I have been shocked by how much progress my daughter has made since her start with them last year. Also, the office staff is top notch and works hard to manage our complicated scheduling and insurance issues. I strongly recommend Speech & OT of North Texas!