Down's syndrome and communication

Also called Trisomy 21 and speech, Down syndrome and language

Understanding runs ahead of speech, so a child with Down's syndrome knows far more than they can say: the case for signing from the first year, and what comes after.

What it is

Down's syndrome is a genetic condition, and the Health A-Z covers it as Down's syndrome. This entry is about communication, where the pattern is unusually consistent: receptive language, what the child understands, is well ahead of expressive language, what they can say, throughout childhood and often for life.

That gap is the whole story. A child who understands a three-part instruction and can say only single words will be underestimated by everyone who judges by speech. The task is to give them ways to show what they know while speech catches up.

Who it can help

Families from birth, because the earliest choices (signing, hearing checks, early therapy) make the biggest difference. Schools and nurseries. Adults with Down's syndrome, whose speech may still be hard for strangers to understand and who deserve the backup that makes independence possible.

It's not a guide to the medical side, and it's not a reason to lower expectations: many adults with Down's syndrome are fluent talkers and readers, and the range is wide.

How it works

Several things push against speech at once. Low muscle tone affects the tongue, lips and breath, so articulation is imprecise and speech is often quiet. Repeated glue ear muffles hearing during the years sounds are being learned. Verbal short-term memory is a specific weakness, so spoken sentences are hard to hold and grammar is slow to come. Visual memory, by contrast, is a strength.

Everything effective builds on that strength. Signing, usually Makaton, from the first year gives the child expressive language a year or two before speech, and the research is clear that signing children speak sooner, not later. Pictures and written words support understanding; many children with Down's syndrome learn to read early and reading helps their speech. Speech therapy works on clarity and on the grammar that memory makes hard.

Speech usually keeps improving into adulthood. A text or symbol backup for unfamiliar listeners keeps the person in charge of the conversation while it does.

Getting started

Start signing now, whatever the age: learn ten Makaton signs for the words your child wants most and use them every time you say the word. Sign to each other in front of the child so it's normal. Nursery and school should learn the same signs.

Get hearing checked regularly and act fast on glue ear. Ask for speech and language therapy through the paediatrician or GP and ask specifically about a Down's syndrome-focused programme.

Read together daily and put labels on things around the house. Try a symbol board for choices and requests, so the child can say the sentence they can't yet speak.

Where to get help

The Down's Syndrome Association has a helpline and detailed speech and language guidance for every age. The Makaton Charity runs parent workshops and publishes the signs. NHS speech and language therapy is via the paediatrician, GP or school, and the RCSLT explains it. Mencap supports people with a learning disability and their families across the life course.