Down Syndrome (Trisomy 21): Speech Therapy Support
Down syndrome (trisomy 21) is the most common genetic cause of intellectual disability. Individuals present a specific language profile with strengths (social communication, comprehension) and difficulties (expression, articulation, morphosyntax). Early and prolonged speech therapy support significantly improves communication skills.
📋 Table of Contents
Specific language profile
Individuals with trisomy 21 present a characteristic language profile, with a dissociation between comprehension (relatively preserved) and expression (more difficult). This profile is linked to anatomical, cognitive, and sensory factors.
Factors influencing language
- Anatomical: muscle hypotonia, relative macroglossia, narrow palate, dental particularities
- Sensory: frequent ear infections, hearing loss (50-80% of cases), visual impairments
- Cognitive: variable intellectual disability, short-term verbal memory difficulties
- Motor: frequent speech apraxia, coordination difficulties
Strengths and difficulties
| Strengths | Difficulties |
|---|---|
| Vocabulary comprehension | Verbal expression |
| Non-verbal communication (gestures, expressions) | Articulation, intelligibility |
| Social skills, desire to communicate | Morphosyntax, complex sentences |
| Visual memory | Short-term auditory memory |
| Learning through imitation | Rapid auditory processing |
| Reading (sometimes) | Phonological awareness |
Language development
Language development follows the same stages as in typical children, but with a slower pace and an increasing gap with age.
Key stages
- Babbling: delayed, often around 9-12 months (vs 6-8 months)
- First words: around 18-24 months on average (high variability)
- Word combinations: around 3-4 years
- Sentences: slow development, often simple sentences
💡 The importance of signs
Gestures and signs (from sign language or Makaton) are particularly beneficial for children with trisomy 21. They leverage their visual strengths, support communication while waiting for oral language development, and do not delay the emergence of speech (on the contrary, they facilitate it).
Orality and feeding
Hypotonia and anatomical particularities can lead to feeding difficulties from birth:
- Weak sucking in infants
- Difficult chewing (hypotonia, coordination)
- Sometimes immature swallowing
- Drooling related to lip hypotonia
Orality support is part of early speech therapy intervention.
Speech therapy intervention
Early intervention
Speech therapy intervention should begin from the first months of life: parental guidance, orality stimulation, communication awakening. The earlier the intervention, the better the results.
Areas of work
Early communication: joint attention, turn-taking, imitation, communicative gestures, signs.
Orality: feeding, oro-facial tone, sensitivity, praxis.
Oral language: vocabulary (with visual support), morphosyntax, narration.
Articulation and speech: intelligibility, rhythm, prosody. Attention to frequent apraxia.
Written language: reading can be a support for oral language (global method, then analytical).
Pedagogical adaptations
- Systematic visual supports: images, pictograms, signs
- Short and concrete instructions
- Repetition and routine
- Manipulation and active learning
- Response time: allow time to respond
- Positive reinforcement
Our downloadable tools
Frequently asked questions
No, on the contrary. Research shows that signs facilitate the emergence of oral language in children with trisomy 21. They allow communication while waiting for speech to develop, reduce frustration, and serve as a "bridge" to oral language. Children naturally abandon signs when they can express themselves verbally.
Speech therapy support can be beneficial throughout life, with objectives adapted to each stage: early communication, oral language, reading, maintaining skills, professional communication... Intensity varies according to periods and needs. Even in adulthood, progress is possible.
Yes, many people with trisomy 21 learn to read, sometimes at a good level. Reading can even be a support for oral language (written words are stable, unlike heard words). An approach combining global and analytical methods, with many visual supports, gives good results.
