Speech therapy work with children with Down syndrome

Socialization is very important for children with Down syndrome, and speech plays a big role in this process. Problems may lie in the length of time it takes to accumulate vocabulary, children understand words much faster than they pronounce them, speech may not be very intelligible with distorted pronunciation of sounds, and there may also be problems with articulation and phonetics. Speech therapists should work with this, as well as parents, who should learn speech therapy techniques. In developing speech, the main thing is to be patient and talk a lot with children, correcting their mistakes. Patience and perseverance should lead to improved speech so much that the child will be able to express his thoughts without problems and communicate freely with peers. Correct speech will help you make new acquaintances and open up new horizons in learning and professional growth.

Tasks

Objectives of speech therapy work:

a dictionary must be formed that will include basic concepts that are often used in communication;
attention and auditory perception should develop to a level at which communication becomes effortless, the child will not need to think for a long time about what he heard and how he should express his thoughts;
improved pronunciation, increased clarity of conversation;
development of articulatory muscles;
improvement of visual perception and visual memory allows you to better describe from memory the object or phenomenon you saw;
memory development will allow you to better replenish your vocabulary, short-term memory helps in the perception of long sentences;
the development of fine motor skills of the hands will expand the child’s range of movements, which has a positive effect on speech development;
to increase the clarity of speech, you can adjust the structure of syllables in a word;
training in sound analysis;
improving coherent speech.

To implement these tasks, you must first perform a speech diagnosis and listen to the child. At the second stage, the information received must be compared with modern speech therapy techniques. The speech therapist can make a decision on how the child will learn independently, or consult with other doctors if options for eliminating the problem are possible. The next stage involves the implementation of the assigned tasks, during which it is necessary to record the dynamics of speech development.

It must be remembered that a child can improve any skill through repeated repetition and systematic practice. You can strive for the child to receive the same level of development as ordinary children, but a more correct tactic would be work that in the long term will help the child surpass his peers who do not have Down syndrome. If you try to improve the average statistical indicators on individual children, then some things may turn out worse, and some abilities may well develop much better than in ordinary children. To identify factors that will help a child achieve success, at the first stage you need to try to work in different directions - the development of oral, written speech, sound perception, and other skills.

Mental development

There are also peculiarities in mental development: eye contact is established later, social smiling is less frequent and not as intense as that of peers, they react more slowly to external stimuli.

At the same time, complex behavior patterns, such as protest against separation and wary attitude towards strangers, are formed in the same way as in normally developing children. Among children under 3 years of age who are diagnosed with Down syndrome, there are those whose development corresponds to age norms in all indicators, except for the level of active speech.

Sound pronunciation

Development of sound pronunciation and perception, this stage includes the development of attention, the formation of clear pronunciation, and increased attentiveness. Visual memory improves through the use of visual aids.

First you need to work on the sounds that come out better, then you need to move on to more problematic areas of speech. First you need to practice open syllables, then work with words that will form small sentences of up to five words. Speech therapy training in its stages is similar to teaching reading to a first-grader.

You need to do articulatory gymnastics, repeating (or trying to repeat) sounds that are difficult to pronounce over a certain period of time. Of course, it is better to conduct such classes in the form of rhymes or tongue twisters, in which attention is concentrated on one sound.

You can also do breathing exercises, but not so much for the effectiveness of training, but for relaxation, because the respiratory organs and sound pronunciation are subjected to increased stress during training. Breathing exercises can be done in the form of games, for example, blowing on rotating blades, or organizing competitions to see who can bring a ball or ball from one end of the table to the other to the other the fastest. You can also blow soap bubbles - who will have more bubbles, or who will have a larger bubble.

You can also do finger gymnastics, because it is accompanied by rhymes and games. In addition to articulation, finger gymnastics is also accompanied by the development of fine motor skills. There is no need to concentrate too much time on finger exercises, because they can easily be replaced by more practical activities - for example, making dumplings, sewing, embroidery, even if it is a simple activity, but with a practical result. And having a result is the best motivation for both the child and the parents.

Conversational skills

Children may have weak short-term memory, and they do not understand long sentences and phrases very well. But this can be fixed; we need to work on developing our understanding of spoken language. It is better to do this by memorizing short phrases that need to be gradually turned into short poems. Memory in children with Down syndrome can develop quite well, and this should be used to improve speech perception.

Vocabulary without reading skills can be expanded through descriptive lessons, in which the child needs to tell a lot, confirming his words with illustrations, visual aids, or simply objects discussed in the lesson. It is advisable to conduct part of the lessons on the street; you can talk about everything that comes across on the road, pointing to the named objects. Housework, such as cooking, can also be commented on.

Such seemingly simple activities in a relaxed atmosphere have a very great effect, because it is much more interesting for a child to communicate with a loved one than, for example, to watch a themed cartoon or a children's program on a TV or computer screen. The baby will try to ask something, and this will develop his thinking and language. Vocabulary will not only be replenished, but also used immediately; intensive lessons conducted in a practical atmosphere (for example, communication while cleaning the house) do not cause fatigue and provide a positive educational effect that will influence the child’s entire life.

After learning to perceive information, you need to teach the child to reproduce it - you need to teach children to tell what is shown in the picture. First, you can take pictures with individual objects, groups of objects, then you can go on to describe the home environment from the picture, or simply describe what is in the classroom or room. The most difficult thing is to describe industrial landscapes, for example a city street, where there are many cars, shops, people, and buildings. Describing ordinary, natural landscapes is a simpler task, so it is better for the child to draw and describe all the elements of the drawing himself.

The next stage of learning is communication in the form of dialogue. At first, you can simply communicate on the question-answer principle. Then dialogue communication can be reproduced in the form of small scenes and performances. The main thing is that it is not for show for adults. There may be spectators, of course, but it should be interesting for children.

Ways to Improve Speech Understanding in Down Syndrome

Review of foreign publications

Probably everyone who knows people with Down syndrome notes with disappointment the difficulties in communicating with them. What complicates contact most of all is the lack of understanding of what the interlocutor is saying. Speech unintelligibility for a person with Down syndrome often becomes a barrier to socialization and inclusion in the life of the wider world. There is no doubt that activities aimed at developing speech in early and preschool age play an important role in overcoming these difficulties. However, as experience and research conducted abroad show, speech therapy classes are indicated for people with Down syndrome both at school age and later. It is natural to wonder whether there are specific developments in the field of improving the speech intelligibility of adolescents and adults with Down syndrome that could become the basis for the intervention of specialists who are ready to address this problem. We tried to analyze a number of foreign publications devoted to this issue.

What is known about the state of speech therapy support for adolescents and adults with Down syndrome abroad?

Professionals working with children with Down syndrome are aware of serious delays in their speech development and that their active (expressive) speech lags significantly behind their ability to understand the statements of others. The main difficulties faced by most of them are related to articulation disorders and speech unintelligibility. It was illegibility that was identified as the main concern during an analysis of the results of a survey of 937 parents of children with Down syndrome [7]. These difficulties continue to accompany people with Down syndrome throughout adolescence and adulthood. Susan Rvachew and Marla Folden write in the preamble to their article: “With adequate support, people with Down syndrome can achieve full participation in society, but surveys of families indicate that the provision of appropriate services is generally inadequate to meet the needs of them.” [10, P. 75-76]. The authors note that older children are often considered poor candidates for speech therapy because of their cognitive limitations, although research shows that children with Down syndrome may improve their speech intelligibility when exposed to the right environment. Speech therapy services are often cut during adolescence due to beliefs about a critical period for speech development, but researchers who have studied this issue say that expressive language development continues into later years, and they recommend that young people continue to attend.

What causes speech difficulties in Down syndrome?

The speech characteristics of people with Down syndrome are influenced by various factors. A well-known specialist in the development of speech in children with Down syndrome, Libby Kumin, recalls that these are both anatomical and physiological characteristics of the vocal tract, in particular the small size of the middle and lower parts of the facial part of the skull with an average size of the tongue, a high, “Gothic” palate, reduced muscle tone lips and tongue. The combination of these factors can lead to articulatory errors and reduced speech intelligibility due to difficulties in making precise movements of active speech organs [8]. Thus, the tongue has to move in a smaller oral cavity relative to its size; it is often protruded, and this is with low muscle tone. In addition, children with Down syndrome have a high incidence of conductive hearing loss and phonemic hearing impairment, which makes it difficult to differentiate the pronunciation of similar phonemes.

It is also important to note disturbances in the control system of the motor mechanism of speech and articulatory capabilities. These are problems with programming, combination, organization and sequence of movements necessary for the implementation of speech.

According to Libby Kumin, assessing the severity of speech intelligibility problems in general is a real challenge, but it is impossible to effectively correct it using a single, universal approach. A specialist’s conclusion “reduced speech intelligibility” does not provide us with information to determine what an adequate intervention should be, she notes. We will return to this thesis later.

What do foreign studies say?

Let us turn to the literature on the problems of oral speech of people with Down syndrome to better understand what is known today on the problem of interest to us. In 2013, the periodical international publication Journal of Speech, Language, and Hearing Research published a comprehensive review of the literature on the problems of oral speech of people with Down syndrome [6]. Taking the 1950s as a starting point, Kent and Vorperian, employees of the Weisman Center at the University of Wisconsin (USA), found that a certain increase in the number of scientific publications on this topic occurred starting in the 1970s, and since 1990, the number of studies in particular has increased significantly. areas of speech intelligibility (Fig. 1).

Rice. 1. Number of scientific articles on speech production in Down syndrome

The authors of the review summarize the data of the analyzed works on the following aspects of oral speech: 1) voice formation, 2) sound pronunciation, 3) fluency and prosody, and 4) intelligibility. Let us present their general conclusion.

Voice . Although many researchers have reported voice disorders in Down syndrome, questions remain regarding the nature and frequency of the voice disorder. The results from acoustic and perceptual studies have been mixed, scientists say, making it difficult to draw any firm conclusions or even identify metrics on which to focus future research.

Speech sounds . Articulatory and phonological studies indicate that speech patterns in Down syndrome are characterized by a combination of developmental delays and errors that are not observed in typically developing individuals. By age 3 years, disrupted patterns become apparent, although abnormalities due to Down syndrome may appear earlier, even in infant babble.

Smoothness and prosody . Stuttering and/or hesitation in speech with Down syndrome occurs in 10-45% of people, in contrast to 1% in the general population. Research also indicates significant impairments in prosody.

Legibility . All publications state noticeable limitations in this area, but scientific work has gone beyond rating scales only recently. Intelligibility can be considered a joint product of the three previous categories of impairments and is at the core of the ability or inability to communicate.

Childhood apraxia of speech: is it an obligatory component of the speech development profile of people with Down syndrome?

This is the question asked by some researchers, whose work is also analyzed in the review by Kent and Vorperian. They cite the work of Barbara Dodd, who in 1976 postulated that articulatory disorders in Down syndrome are at least in part due to difficulties programming the motor mechanisms of speech. This implies that they are associated not only with dysarthria (usually defined as “a violation of the pronunciation aspect of speech caused by insufficient innervation of the speech apparatus”), but possibly also with apraxia (defined as “a violation of purposeful action while maintaining the elementary movements that constitute it”). . Later, L. Kumin suggested that children with Down syndrome may have apraxia of speech [1] (Child Apraxia of Speech, or CAS) [8]. This assumption was based on similar manifestations of speech behavior in Down syndrome and CAS. Apraxia of speech can be difficult to diagnose, especially when it occurs in combination with other speech abnormalities associated with Down syndrome. The authors of this review note that there are only three distinctive features of apraxia that have widely accepted diagnostic validity: 1) making inconsistent errors in both vowels and consonants when repeating syllables and words, 2) stretched and impaired coarticulatory[2] transitions between sounds and syllables, 3) inadequate prosody. The diagnosis of apraxia is usually made in the absence of abnormalities in the speech muscles, craniofacial structure, or neurological disorders. However, it is hardly possible to consider speech apraxia as one of the symptoms of Down syndrome, since the significant factors of this chromosomal anomaly are sensory and motor disturbances in sound pronunciation, and not the actual algorithmic functions and programming function. In itself, the authors note, this does not mean that apraxia is unlikely, but rather that an accurate diagnosis must take into account the combination of articulation errors, abnormal muscle tone, and speech fluency that are often present in people with Down syndrome. . According to the study by Kent and Vorperian, there is evidence in the literature of a general deficit in the ability to perform goal-directed actions in Down syndrome. The vulnerability of the ability to perform goal-directed actions is evident throughout life. Thus, observations show that disturbances in this area in older people with Down syndrome are becoming more noticeable.

Interest in the topic of speech intelligibility in people with Down syndrome and the definition of this problem, taking into account the existing classification of speech disorders, continues. In 2016, 3 years after the publication of the review by Kent and Vorperian, the International Journal of Speech-Language Pathology published an article by American scientists Veini Rupel, Shelley Velleman and Mary Andrianopoulos, talking about their descriptive study of the speech motor skills of children with Down syndrome [9 ]. The authors write that historically, children with Down syndrome who had specific motor speech disorders were diagnosed as having dysarthria. Meanwhile, specialists could miss the symptoms of speech apraxia, based on the assumption that children cannot have both disorders at once. This study refutes this opinion. Scientists assessed the motor component of speech in a group of children with Down syndrome, comparing it with the results of assessing the speech of typically developing children. They also analyzed the articulatory and gross motor skills of the corresponding muscle group in all study participants, using checklists of characteristics of apraxia, dysarthria and other disorders of unknown etiology. The results supported the initial hypothesis that children with Down syndrome who exhibit symptoms of both dysarthria and apraxia may actually have overlapping symptoms and need to work on all of them. Objecting to the common view of speech problems in children in this category, one of the participants in the study discussed, Shelley Velleman, in a message she gave to Neuroscience News, says: “Typically children automatically fit into one of these boxes, when the reality is that that many people have a combination of symptoms characteristic of these disorders, so we will have to take into account all the symptoms and treat the child accordingly. Otherwise, things won’t go as they should” [3].

The results of the above study are especially significant because speech therapists use different methods when working with children diagnosed with apraxia and children diagnosed with dysarthria. Therapy for dysarthria is most often compensatory, because with this defect the connection between the central nervous system and the speech apparatus is disrupted and cannot be restored. Speech therapists focus on techniques that can improve speech clarity. Conversely, children with apraxia often benefit more from therapy that focuses on motor planning rather than compensation. “If you take a child with apraxia, and you work as if he has dysarthria, trying to get him to make a nice strong 's' sound,” Velleman continues, “that's not bad, but he won't be able to do it when he needs to. The most important thing is to identify the symptoms. If, for example, you identify three symptoms of dysarthria, three of apraxia, and three of something else, such as a phonological disorder, don't worry about an official diagnosis: go ahead and work on all the symptoms." A new test, which the authors of the article developed specifically for the study and called Language - Neutral Assessment of Motor Speech for young children , abbreviated LAMS .

What approaches do experts offer to improve speech intelligibility?

To date, publications devoted to approaches to improving the speech intelligibility of people with Down syndrome and descriptions of specific techniques are mainly of a research nature only. “Suggestions for practicing speech-language pathologists, especially those that are empirically based and bring at least some benefit to people with Down syndrome, are extremely limited today,” notes Michelle Lee Easter from the University of Texas at Austin [5]. The authors of various studies often recall the observation of Libby Kumin, who writes that speech disorders in Down syndrome are persistent and relatively difficult to intervene. Therefore, any attempt to apply and explore some new method that mitigates the impact of these disorders is probably worth celebrating. Easter provides a brief description of the few promising approaches whose effectiveness has been assessed in recent years by scientists from different countries, including herself. Among them she identifies two:

intervention aimed at developing phonemic awareness;
a method of increasing the intelligibility and consistency of pronunciation of the same word from an active dictionary.

We provide brief information about these approaches.

Method for developing phonemic hearing

The development of phonemic awareness was an integral part of the project, which was based on an integrated approach to the formation of skills in speech, reading and understanding of texts [11]. This approach was proposed by New Zealand scientists A. K. van Bisterveldt, J. T. Guyon, S. Foster-Cohen and is generally presented in our journal [1]. The intervention they developed aims to achieve a range of goals. An integrated approach in this case involves classes to improve the pronunciation side of speech, mastering letters and correlating them with the corresponding sounds, as well as developing the ability to identify the initial phoneme in a word. Let us recall that the participants in the experiment described in the article were preschool children (from 4 years 4 months to 5 years 5 months). This forces us once again to pay attention to the importance of the most effective intervention during preschool childhood, which is likely to influence more favorable outcomes with schoolchildren and adults. The study authors mention the fact that, in addition to the general delay in speech development, children with Down syndrome have phonetic impairments that include significantly more atypical patterns of speech errors and greater instability of these errors compared to the speech of typically developing peers. Biesterveldt and her colleagues note that what is new to experts is that interventions aimed at improving elements of phonemic awareness and the ability to associate sounds and letters may also be effective in reducing speech errors in individual words.

The article describes the format of the experiment. The entire course lasted 18 weeks and consisted of two 6-week cycles, separated by a 6-week break. It provided three types of classes. The children worked with a speech therapist at the early intervention center twice a week for 20 minutes; once a week, in addition, the center held classes using computer programs aimed at forming both individual sounds and sentences. At home, 4 times a week, parents had 10-minute sessions with their children while reading books together. Classes with specialists, as well as lessons at home, were planned individually in each case.

The authors of this study, in addition to practicing articulation, paid special attention to the development of a conscious idea of the sound composition of words. The classes involved learning the ability to identify individual phonemes within words, recognize initial phonemes, etc. Parents were given an active role in conducting the experiment.

The results of the experiment confirmed the hypothesis that the developed training system (with an emphasis on sound analysis) really improves the correct pronunciation of words. The authors' main conclusion is that training that integrates multiple goals can be a valuable alternative to traditional techniques aimed at improving only one aspect of speech development.

Increasing the intelligibility and consistency of pronunciation of the same word from the active dictionary

The use of an approach to improving the intelligibility of active vocabulary words ( Core Vocabulary approach , abbreviated as CVA ) has been described and evaluated in a number of works in recent years [2, 4, 5, 10]. When dealing with children and adolescents with Down syndrome, experts chose this method based on its effective promotion of greater consistency in speech production when the pronunciation of the same words is unformed, which is typical for people with Down syndrome. In addition, the authors of these studies take into account the opinion that the basis for the speech production deficiencies of people with Down syndrome is a violation of the planning of movements of the speech organs, mainly difficulties in building a sequence of sounds that form the desired word, which leads to unpredictable differences in the pronunciation of one and the same word. The intervention, the object of which is the active dictionary, is aimed at stabilizing the phonological system, which ultimately contributes to the stable production of speech within the word. This method does not involve working on the characteristics of specific sounds. The focus here is on the production of whole words or short phrases, which are identified in each individual case as functional and frequently used. The overall goal of using this approach is to achieve improved speech intelligibility by improving the consistency of word production.

The authors of studies of the effectiveness of this approach in their experiments rely on the scheme proposed by Barbara Dodd and her colleagues [2, 4]. Based on it, Michelle Lee Easter, mentioned above, developed her own experimental design [5]. It involves 30-minute sessions twice a week for 8 weeks. A list for practicing the 70 most frequently used and functional words for the client is compiled by the teacher together with the client and his parents or people replacing them. The authors define the first goal of the intervention as “achieving a positive impact on each selected word based on the student’s phonological system and phonetic inventory.” Therefore, during the first session of each week, 10 words are randomly selected from the list, they become objects of influence, and the child persistently practices sound by sound to obtain the most accurate and consistent pronunciation of each word. Training was carried out using prompts, such as breaking words into syllables, visually represented on cards, and gestures indicating articulation. The use of pictures and picture books was also practiced.

Figure 2. Examples of words divided into syllables

Figure 3. Examples of gestures indicating articulation (top – “p” sound, bottom – “t”)

Then, during the remaining time of each first lesson of the week, the teacher introduces words - objects of influence into various types of activities, during which their development continues. At home, parents encourage the child to use an active vocabulary and participate in the process of practicing words. The second lesson of the week is devoted to checking the pronunciation of 10 words taken into work in the previous lesson. After this, the ability to pronounce each word used in the work three times in a row is assessed. Words pronounced the same way three times (regardless of the accuracy of pronunciation) are considered practiced. They are removed from the list. And words that are pronounced differently three times are considered unpractised and remain on the list. Another goal of the course is to ensure that the student consistently uses his best established pronunciation. The overall goal, as already stated, is to improve speech intelligibility by improving the regularity of word production.

M. L. Easter, in the course of her research, was able to identify potential opportunities for adapting this method in working with children and adults with Down syndrome and evaluate its effectiveness in cases of monosyllabic and multisyllabic words. She also noted difficulties in conducting classes associated with attention and memory problems.

Broadly targeted intervention by reshaping a child's utterance as a method of improving speech intelligibility

Analyzing the publications of recent years, it probably makes sense to pay attention to another type of therapy that American scientists Paul Yoder and his colleagues from Vanderbilt University propose for working with school-age children with Down syndrome [13]. They gave their approach a long (especially in Russian translation) name: “Broad Targeted Speech Recast , abbreviated as BTSR . ”

From the very beginning, the authors insist on replacing the term “speech intelligibility” with the term “understandability.” They justify this by the following circumstance. If the corresponding characteristic of speech is assessed in the context of a laboratory, where the listener must understand the words with which the subject names pictures, answers simple questions, etc., then the result will be better than in a conversational situation, when the meaning of the statement is not known to the listener in advance. They also argue that for students with Down syndrome, speech intelligibility is an ecologically valid [3] and functional outcome of speech therapy.

To give the statement a new, corrected form, the child is first encouraged to speak by involving him in familiar games and asking questions about his actions. Then, when he, having become conversational, utters some word that can be understood, but it sounds unclear, the teacher presents him with his own statement, but in a corrected form. The adult's utterance is given immediately after the child's utterance, and is an exact or abbreviated imitation of the word (or words) that the child tried to pronounce, but in the adult's pronunciation. Thus, the corrected form of a speech utterance provides a model of accurate pronunciation, pitch, stress and intonation. The authors call it a “sound template.” For example, if a child says, “I want juice,” then the corrected form would be “I want juice.” “Broad focus” is that the teacher uses the presentation of corrected forms of statements in relation to any word that the child tries to pronounce, but pronounces incorrectly, although he is able to produce a sound that corresponds to the level of his development.

It is important to note that one of the hypotheses, which was generally confirmed, was the assumption that this method would be most useful to those schoolchildren with Down syndrome who can retain in memory the corrected statement of an adult and their own statement (“platform”, as it is called authors) long enough to compare them. Such students must also have a good ability to control the movements of the speech organs in order to reproduce, or at least bring their utterance closer to the adult model in subsequent conversations. Thus, scientists believe that in order to receive real benefit from undergoing this course of therapy, short-term verbal memory and motor control of the child’s speech organs must be above some threshold that they have not yet identified. The authors believe that a certain degree of ability to imitate words may reflect these properties. It was this ability that was assessed at the stage of selecting participants in the experiment and was the subject of attention at the pre-therapeutic stage of the study.

51 schoolchildren took part in the experiment; the duration of the course was 6 months; Classes were held 2 times a week for 1 hour. A distinctive feature of the method was also the intensity of the impact: at least 4 statements by an adult per minute. Two groups were formed: one used the described method, and the other used standard, well-known key components of speech therapy work aimed at increasing the accuracy of speech production (such as hints, training in articulatory positions and complexes, the method of repeating sounds, syllables, words, etc. .d.).

In conclusion, the authors of this study note the positive impact of their proposed therapy on the speech intelligibility of school-age children. The authors believe that the study has made an important scientific, practical and methodological contribution to the collection of speech development methods, especially for students who already have fairly good word imitation skills at the start of classes.

The use of electropalatography to improve articulatory patterns and speech intelligibility in children with Down syndrome

The final approach in this review to improving speech intelligibility in people with Down syndrome relies on advances in computer technology. This is electropalatography ( EPG ) - a method for recording articulatory indicators, providing biofeedback and visualization of dynamic processes in the oral cavity - contacts of the tongue with the palate and teeth [12]. The method involves the use of an artificial palate with a large number of electronic sensors, which is fixed on the palate of the speaker (Fig. 4-6). For each client, such a “prosthesis” is made individually using means similar to those used in dental prosthetics.

Figure 4. Artificial palate

Figure 5. Standard articulatory pattern for pronouncing the consonant sounds “k” and “g”

Figure 6. Student during class. The correct articulation of the sound being practiced is displayed on the right side of the screen. On the left, the boy’s successful attempt to match his articulation to the given one is demonstrated.

Interest in this method and its application in the practical activities of speech therapists appeared back in the 1960s and 1970s. However, companies that have tried to put such a tool into production, making its production efficient, have so far failed due to the high cost of the product.

Let us briefly present a report by scientists from Queen Margaret University of Edinburgh on a study on various aspects of the use of the EPG method for diagnosing and improving the speech of people with Down syndrome. Their arguments in favor of this method are as follows: firstly, during a speech therapy session, the child’s attention is focused on the connection between the movements of his speech organs and their visual display on the screen; secondly, when the child learns to produce correct articulatory patterns, this method allows one to avoid complex explanations of the task. Additionally, children with Down syndrome benefit particularly from visual feedback, as they respond better to visual stimuli than to verbal instructions, and the ability to process visual information is considered a strength. There is also evidence that children with Down syndrome, like all children, enjoy interacting with computer-generated images.

It should also be added that university specialists have developed a portable EPG device, which, in their opinion, can be used both at home and in classes with specially trained school personnel, for example, a teaching assistant. In this case, the possibility of multiple repetitions can be provided, which will mitigate the inherent difficulties in retaining new information in memory for these children.

This study was, firstly, to test the capabilities of a consultative model, which specifically involves the training of teaching assistants and the use of a portable device for classes with children with Down syndrome at school, and secondly, to evaluate the actual role of EPG in improving the speech intelligibility of students primary school aged 6-10 years. The author of the present report, Sarah Wood, noted positive changes in articulation patterns, an increase in the number of consonants that were perceived correctly, and an improvement in the speech intelligibility of the study participants. She also believes that the method of using EPG for children with Down syndrome has advantages over conventional speech therapy techniques, in particular in terms of maintaining the result after the end of the course of therapy.

In conclusion, we note that the study of foreign publications on the topic of improving the speech intelligibility of people with Down syndrome revealed at least two facts. Firstly, experts are concerned about the problem of poor speech intelligibility of adolescents and adults with Down syndrome, which is for them the main obstacle to socialization. This concern is evidenced by the growing number of related scientific studies. The second fact is that there are no methods that have empirically proven their effectiveness yet, despite the awareness of the need to continue speech therapy work with people with Down syndrome during their school years and later.

This situation, among other things, indicates the existence of a wide field for research by interested scientists and specialists.

Literature

Bisterveldt A. K. van, Guyon J. T., Foster-Cohen S. An integrated approach to the development of pre-reading skills in children with Down syndrome // Down Syndrome. XXI Century. 2010. No. 2 (5). pp. 70-71. URL: https://downsideup.org/ru/catalog/article/kompleksnyy-podhod-k-razvitiyu-navykov-predshestvuyushchih-chteniyu-u-detey-s
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[1] Apraxia of speech is a specific motor disorder of the pronunciation side of speech (sound pronunciation, prosody), caused by difficulties in coordinating phonemes (at the syllable, word level), without visible paresis and paralysis, expressed in various pronunciation errors and associated with disorders of phonemic perception ( https://megapredmet.ru/1-19172.html).

[2] Coarticulation (from Latin co(n) “with, together” + articulatio “articulately, clearly pronounce”) - the imposition of articulation characteristic of the subsequent sound on the preceding sound.

[3] Ecological validity is the degree to which the experimental conditions correspond to the reality being studied.