Note: October is Down Syndrome Awareness Month.

Jordon Bills

Jordan Bills, M.A., CCC-SLP, is a speech-language pathologist (SLP) at Washington Speech in Fairfax, Virginia. She works with children of all ages with various speech, language, and feeding disorders. She received her bachelor’s degree from the University of Virginia and master’s degree from the George Washington University. You can read more about Jordan’s credentials and accomplishments on the Washington Speech staff page.

Why did you become a speech-language pathologist (SLP)?

In high school, I volunteered at a center for blind and visually impaired children for three summers. I worked side-by-side with the speech pathologists, occupational therapists, and physical therapists at the center. The work they did was incredible and I knew this is what I wanted to do! One child in particular had a large impact on me. He was three years old and unable to respond to his name. By the end of our summer together, he was not only turning toward others when they said his name but also responding to their greeting. I’ll never forget the feeling when I heard him say, “Hi, Jordan!” In that moment, I understood the power of communication. Communication is what connects us to one another. It’s what makes our lives so beautiful! I feel lucky to spend my days helping children communicate more effectively.

Why do you enjoy working with children with Down syndrome?

As a pediatric SLP, I have the privilege of working with children with Down syndrome across their lifespans. This is one of my favorite populations to work with because of the great potential for growth. Every milestone is celebrated, even the small ones, as each child works so hard to develop their speech and language skills. Every child with Down syndrome has unique strengths and interests, which I use to support the development of new skills. I have targeted bilabial sounds /b, p, m/ in functional phrases while playing basketball; used a child’s desire for hugs to teach expanded question forms (Can I have a hug?); and taught subject-verb-object sentences using Disney characters.

With younger children, I spend a lot of time playing on the floor. Children tend to learn best through repeated experiences with real objects and situations. Play is their vehicle for learning. As they enter elementary school, our sessions include more structured tasks focusing on the skills they need to participate fully in the classroom and to interact with friends. My goal for all of my clients with Down syndrome is for them to be able to effectively communicate with friends, family, and professionals across environments. My hope is that improved communication will allow them to experience the joys in life that come from making connections with others.

One of my favorite events is the annual Buddy Walk in Northern Virginia. Attending this event gives me the opportunity to see some of my patients outside of the therapy room. I love watching them with their families and friends participating in a community event. It reminds me of why I love what I do!

What are some tips that you have for families with children with Down syndrome?

Parents and other caregivers are the primary communication partners in a young child’s life. Therefore, parents play a critical role in helping their children develop speech and language skills. Below are some strategies for families to support communication development from birth through early elementary school.

Strategies for Birth to First Word Users

• Focus on pre-linguistic skills. These are skills a child needs to master before words emerge. They include: joint or shared attention, social referencing (checking parents’ facial expressions to understand how to react appropriately in new situations), turn taking, pointing, sustained engagement and attention, and imitation.
• Use language stimulation techniques in everyday activities to help your child develop his/her understanding and use of new vocabulary words. Techniques include: self-talk, parallel talk, sentence completions, choices, and communication temptations (actions you can take to set up the environment to tempt your child to communicate with you).
• Consider a Total Communication This evidence-based approach incorporates speech, manual signs, gestures, pictures, and/or a speech-generating device to help children communicate as effectively as possible while developing verbal speech. This approach can reduce frustration and support long-term vocabulary development.
• Familiarize yourself with the stages of play. Challenge your child to engage in symbolic and early pretend play.
• When teaching new words, use real objects or pictures of real objects. Incorporate vocabulary learning into your daily activates.
• Don’t forget about your child’s oral-motor and feeding skills. Children with Down syndrome are at risk for feeding difficulties. A certified speech-language pathologist can evaluate your child and develop an individualized treatment program to help him/her improve oral-motor skills for feeding.

Beyond First Words: Learning to Combine

• Research shows children begin to combine words when they reach a single word vocabulary of around 50 words. Ensure your child has a variety of single words (e.g. nouns, verbs, pronouns, social words, adjectives) he or she can use to combine. Keep a record of the words your child uses to monitor vocabulary growth.
• Continue to build your child’s vocabulary during play and daily routines. Teach 2-3 word combinations and encourage imitation. Children with Down syndrome benefit from repeated experiences with the same activities and vocabulary.
• Use expansions (adding one word to what your child says) to model phrases. Do this often! It will likely take many repetitions before your child imitates your expanded phrase.
• Try a pacing board to help your child learn to combine words. Pacing boards provide a visual and tactile cue to remind your child to use two words. They are helpful for children with Down syndrome given their strengths in visual learning. A simple pacing board can be two large dots on a piece of cardboard or thick paper. Point to the first dot and say the first word, then point to the second dot and say the second word.
• Read often! Try books with repetitive phrases your child can learn and eventually fill in.

Early School Age

• As your child’s vocabulary and utterance length increases, speech intelligibility often becomes a main concern. Again, a pacing board can be a useful tool. This time, your focus will be on teaching your child to speak slowly and producing each word deliberately while touching one dot on your pacing board. Speaking with a slowed rate can help improve your child’s overall intelligibility.
• In speech therapy, your child may be working on specific speech sounds or patterns of sounds. Work closely with your child’s speech-language pathologist to continue practice at home. To increase your child’s motivation, incorporate target sounds into highly meaningful words. For example, if your child is working on the /k/ sound, “cookie” and “car” may be very motivating words. Daily practice is key!
• Use recasts to help your child develop appropriate grammar. Grammatical recasts are when you take your child’s utterance and repeat it using adult grammar. For example, if your child says, “dog eat,” you would say, “Yes, the dog is eating.”
• Consider AAC (augmentative and alternative communication) to supplement verbal speech. This may increase your child’s ability to be understood, participate in class, and engage socially. It may also decrease frustration.

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