46 Early Communication Skills for Children with Down Syndrome
Line up all of your baby’s stuffed animals and dolls or action figures.
Walk into the room, and cue your baby: “Wave hello to Bo-bear. Wave
hello to Paddington. Wave hello to Betsy. Wave hello to Pooh. Wave hello
to Raggedy Ann….”
Practice waving with a brother or sister, going in and out of the room.
Prerequisite Skills for Language
T here is growth and maturation as your child moves from learning early commu-
nication skills to being able to learn and use language. The prerequisite skills for
language are:
n attention skills,
n visual skills,
n auditory skills,
n tactile skills,
n imitation skills,
n cognitive skills, and
n referential knowledge.
Remember that language is based
on the sensory experiences in your child’s
environment. So, he needs to receive and
make sense of the information in his en-
vironment to be able to learn labels and
names for those experiences. According
to research, children learn to handle sen-
sory information in a set order. Children
progress from tactile skills to visual skills,
then to auditory skills, and only then
are they ready to master language and cognitive skills (Ayres, 1980). These tactile,
visual, and auditory skills help us move along the pathway to speech and language
(Ayres & Mailloux, 1981). They help us learn sounds and words, and enable us to set
up feedback loops between the eyes, ears, mouth, lips, tongue and jaw, and the brain.
Attention means being able to focus in on a person, object, or event. We observe
attention
this skill in an infant as he focuses in on his parent’s face and as he listens attentively
skills to sounds in his environment. We teach attention skills through sensory experiences
and play. For example, your child learns visual attention when you help him to visu-
ally explore objects and to focus on objects and faces in his environment. You teach
auditory attention by providing experiences such as listening to music and by in-
creasing the amount of time your child focuses on listening. This learning is based on
well-functioning senses. It is important to have vision and hearing checked regularly
to make sure that they are sufficient to support your child’s attempts at learning. The
goals are to teach your child to focus and to increase the amount of time that your
child attends to the task.
4 / Before the First Word—Precursors to Language 47
visual skills visual reception
Visual reception is the ability to use the
sense of vision. It depends on the physical
ability to see, as well as the ability to under-
stand what you see. As Chapter 2 explains,
vision problems are fairly common in chil-
dren with Down syndrome. This makes it
important for your child to have his vision
regularly screened by a pediatrician or oph-
thalmologist. Current recommendations by
the American Academy of Pediatrics (2011)
are for the following:
n Between the ages of birth–1
month: eye examination for
cataracts
n Between 1–12 months: refer-
ral to an ophthalmologist (physician specializing in the eye) to assess
for strabismus, nystagmus, cataracts
n From 1–5 years: pediatrician checks vision at every well child visit
n From 5–13 years: eye examination every 2 years
n Over 13 years: eye exams every 3 years
Of course, your child should see an ophthalmologist more frequently if a vision
problem is diagnosed or if you have specific concerns about your child’s eyes or vision.
reciprocal gaze
Reciprocal gaze, conversational gaze, and communicative gaze are all different
terms for what is commonly called eye contact. Reciprocal gaze means I look at you
and you look at me. In American culture, people interpret looking at them as a sign
that you are listening to them, and not looking at them as a sign that you are not lis-
tening or are uninterested. Common expressions such as “He
looked me straight in the eye” or “He was hiding something;
he wouldn’t look me in the eye” exemplify the interpretation
that American culture gives to reciprocal gaze. In some cul-
tures, such as African cultures, it is a sign of respect to look
away, and a sign of aggression to look someone right in their
eyes. So, culture has an influence on when it is appropriate
or acceptable to use eye contact.
For children to learn speech and to learn facial expres-
sions, they need to tune in to the faces of those around them.
Engaging a child’s interest and attention and increasing the
time that he will look at your face teaches and practices these
important skills. Research has shown that the most intriguing
sight to the infant is the human face. The animated face costs
nothing but your time, and is capable of providing endless
entertainment for an infant or toddler.
Because of low muscle tone, infants with Down syn-
drome may find it more difficult to lift their heads. Visual
48 Early Communication Skills for Children with Down Syndrome
difficulties may make it harder to focus on the face. So, you may have to provide more
support for your child’s head and neck, and compensate for visual difficulties as sug-
gested by your pediatrician or ophthalmologist. Reciprocal gaze is an important skill,
and children with Down syndrome can practice and master it early in development,
usually before one year of age.
home activities
Position your baby so that he is at eye level with your face and no more
than eight to twelve inches from your face. You may hold him in the air or
on your lap facing you, or sit down next to his infant seat or crib so that
you are at eye level with him. To gain his attention, put your face close
and talk to him in a high-pitched voice: “I see you now. What a nice baby
you are.” Make funny faces or smile. Make noises and move your tongue
in and out while making funny sounds. You might sing to him, too. Any
facial movements and happy sounds are fine as long as they engage your
baby’s interest. Siblings like to help with this kind of activity, especially
when the baby is old enough to react to them by laughing.
Initiate interactions with your child by physically moving closer to him or
by moving toward his face and then away from his face. Zoom in close
and then zoom out slowly.
When you are gazing into your child’s eyes, make sounds or smiling or
dramatic faces. Sing a short song or call your child’s name. Do any-
thing to get his attention. When you are finished, look away or move
your child away.
If your child doesn’t look at you or fails to make eye contact, gently direct
his face so that he is looking at you. Try to maintain his interest by sing-
ing, making funny faces, etc.
When your child looks at you, assume that this is an initiation of recipro-
cal gaze. Begin smiling or say, “I see you.”
Make your face even more interesting to look at by introducing surprises.
For example, put a sticker on your cheek or forehead. Or, put on funny
eyeglasses (such as sunglasses that are heart-shaped, star-shaped, or
have bunny ears, frogs, or other animal figures on them). Use these
props sparingly and when your child is not expecting them. This will keep
him looking. He will never know what he might see!
When your child is able to use reciprocal gaze, reinforce the learning
through play. Games such as Peek-a-Boo are especially good. For older
children, Simon Says, Hokey Pokey, and Head, Shoulders, Knees, and
Toes promote reciprocal gaze.
