For Families and Carers : Communication series

These resources, co-written with a speech and language therapist, offer practical tips and activities for supporting children and young people with Down’s syndrome to develop their communication skills.

The series includes resources for supporting communication, language and speech development and can be used by families and professionals alike.

There are many ways for you to help your child’s speech, language and communication development. You will find lots of ideas in this Communication Series. Most of these can become part of your everyday life. For different ideas explore the resources on this website.

Introduction: Make communication part of everyday life

Use the ideas summarised in this series every day, when feeding, bathing, changing and playing.

You will already be doing many of these activities, as part of caring for your baby. However, interactions between parent and child can happen less when your baby has Down’s syndrome. That’s why it is helpful to use some specific strategies when interacting with your baby or child.

Introduction: Make communication visual

Support your child’s spoken communication with lots of visual cues.

For example, you can use gestures, objects, pictures and photos alongside speech, when you interact with your child. You can also learn a signing system (such as Makaton and Signalong). Sign and gesture will help your child to understand what you are saying, and will also help your child to communicate. Ask your speech and language therapist about where you can learn to sign. There are also great online resources where you can learn to sign, including Mr Tumble (CBeebies- BBC). Signing along with Mr Tumble is a fun way of learning simple sign language.

Introduction: Watch your child carefully and respond

Watch your child’s behaviour very closely, and respond to her ways of communicating.

She may be smiling, making noises, looking and/or gesturing. Copy your child. Tell her the word and make the sign for what she is interested in. Parents do this naturally, but it helps to watch children with Down’s syndrome very closely, because their attempts to communicate can be more subtle or take longer.

Introduction: Be animated

When your child tries to communicate, respond enthusiastically.

Smile, use lots of facial expressions, vary the tone of your voice and use gesture/signs. Being animated will help your child to pay attention to your facial expressions, words and gestures.

Introduction: Be repetitive

Use lots of repetition. When your child communicates, copy what he has said or done.

For example, if your child is interested in a dog and says “d” (or any other sound), repeat back, “Yes! Dog!”. Do the same thing with gestures and signs. If your child tries to speak or sign but it’s not quite right, respond by saying the correct word and making the sign.

Introduction: Be on your child's physical level

This helps you to see what your child is watching and interested in.

It also helps your child to focus on you – to listen and pick up on cues, like your facial expression and how your lips and tongue move when you make sounds, talk and sing.

Introduction: Take time

Children with Down’s syndrome often need extra time to respond.

Watch carefully, pause and wait when interacting with your child. It may take him longer to process what he sees and hears. It may also take him longer to respond by moving, gesturing, signing, vocalising or speaking. Always give your child extra time. Slow down your own talking too.

Introduction: Praise and reward

Most children enjoy social interaction. Give your child lots of praise and smiles to show that you are pleased.

She may enjoy other rewards too, like a favourite expression, song or activity. Praise will encourage your child to communicate.

Pre language skills for babies and young children
Encouraging Communication
Early Language: Developing understanding
Early Language: Using visual support

Children with Down’s syndrome are good visual (seeing) learners and often have poor auditory (hearing) learning skills.

Children with Down’s syndrome also take longer to process information. Visual support can help your child’s speech and language development. An added bonus of using visual information is that your child will be able to spend longer taking it in, because visual information lasts longer than auditory information. Visual supports can help your child’s understanding and also help your child to learn to communicate. There is no research to suggest that signing reduces spoken language.

Visual support can include:

  • Objects
  • Photographs
  • Pictures
  • Line drawings
  • Symbols
  • Written words
  • Gesture
  • Sign

Visual support varies in the level of understanding it requires. The easiest visual support for a child to understand is a real object because your child does not have to make a representational link. The ability to hold, feel and explore objects will help understanding. Photographs of real objects are the next level of visual support you can use. Photos are two dimensional, but give a real representation of what you are talking about. Pictures, line drawings and symbols are increasingly abstract, so it is best to use photos before you move on to line drawings and then symbols.

Gesture and sign are more momentary than objects and pictures, but they are essential in supporting your child’s language development. Gesture and sign have the added advantage that your hands are always with you throughout you and your child’s daily routine, so no extra equipment is required.


Makaton or Signalong communication systems are often used with children who have Down’s syndrome.

If you do not know how to use Makaton or Signalong, you can use natural gesture and lots of expression in your face and voice. This will also help your child to understand.

Visual supports for speech sounds

Children can also learn about speech sounds using ‘visual supports’. These include ‘Jolly Phonics’ pictures and gestures, ‘See and Learn’ speech resources, and ‘Cued Articulation’ by Jane Passy.

Written Words

Some children with Down’s syndrome can recognise written words from an early age, and will begin to learn to read.

When you use photographs, pictures, line drawings or symbols, you can write or type/print the written word underneath.

Further information

Jane Passy Cued Articulation

Jolly Learning


See and Learn


Special iApps


Early Language: Developing First Words
Early Language:'All about me' personalised books

There are many reasons why making personal books is a particularly good thing to do for children with Down’s syndrome. Sharing personal books is a fun way to engage with children. As most children understand more than they can say, using personal books can help them to communicate – they can use the book to tell people about themselves and the things they do. Sharing books can also help them learn to understand language and to practise saying words. Seeing words in print also introduces reading, which is an activity enjoyed by many people with Down’s syndrome.

Creating an ‘All about Me’ or Personalised Book can support:

  • Attention and listening
  • Vocabulary development
  • Initiating communication with others
  • Information sharing
  • Recognising written words

If your child is learning about single words, follow the instructions that follow.

You can create these on a computer, tablet and some phones. A useful app to create All About Me Personalised books is “Special Stories”.

If you don’t have access to these then printed photographs stuck onto pages with clearly, hand written words underneath are just as good.

If your child is learning about single words, make books that use single words, to practice vocabulary. It can be helpful for the vocabulary in your child’s book to overlap with the vocabulary you have chosen to target for teaching.

Early All About Me Personalised Books should include photographs of things that are important to your child, such as real life objects, toys, people, pets or animals in your child’s life. These first books designed to teach vocabulary should have a photograph and single written word on each page. Early books may only have four or six pages. As your child matures you can build up to having more photographs on each page.

As your child’s vocabulary understanding grows, you can make books that include action words as well as naming words, e.g. if your child enjoys kicking a football you could have a picture of him or her kicking a ball. To begin with you might just have the word “kicking” written under the photograph, but as your child’s language develops you could expand this into short sentences, such as “Tom is kicking the ball”.

Using All About Me/ Personalised Books

  1. Share your child’s personalised book, talk about the photographs. Say and sign the word. Point to the written words. Familiarise your child with the words in the book.
  2. See if your child can match the real object (e.g. favourite toy) to the photograph in the book. To do this have the page open with the picture of the object. Give your child two toys to choose from and see if he or she can match or point to the one in the book.
  3. See if your child can match a photograph to one in the book. To do this make a second, loose copy of each photograph. See if your child can match the loose photograph with the ones in the book.
  4. Make a second copy of the written word. Encourage your child to look at the word, then help match the word to the word in the book. Initially use words that look visually different, e.g. “dog” and “Mummy” or “ball” and “tractor”. Visually similar words can be words of a similar length or words that start or end with similar shaped letters. These are harder for your child to differentiate between.
  5. Take your child’s personalised book out and about. Encourage him or her to share it with other people, at playgroups and nursery or with family members. This will encourage your child to initiate communication, communicate independently of you and share information about what is important to her or him.
  6. When your children go to school, their personal book can be extended into a communication or conversation diary. This type of communication book is described in a separate resource [Coming soon].
Symbolic Sounds and Early Vocabulary
Early vocabulary pictures and words
Listening cards
Nursery rhymes
Feeding: Introduction

Some children with Down’s syndrome experience difficulties when feeding. However, most babies born with Down’s syndrome can be breastfed, and will become better at feeding as they grow and develop. Unless you have concerns or are advised otherwise by health professionals, approach weaning and the introduction of food textures and tastes as you would with any child.

Indications your child may have a feeding difficulty are:

  • Fatigue/tires when feeding or during mealtimes
  • Breathlessness when eating or drinking
  • Coughing, choking or sneezing when eating or drinking
  • Recurrent chest infections
  • Weak, breathy, hoarse, croaky or ‘wet’ sounding voice or cry
  • Effortful or noisy swallow
  • Weight loss
  • Difficulty controlling saliva, food or drink in mouth
  • Poor lip seal (pressing top and bottom lip together) to swallow

There are several reasons why a child made have a difficulty feeding. The following are physical issues that may occur. These include:

  1. Anatomical differences

Babies and children with Down’s syndrome may have:

  • smaller mouths and jaws
  • high, narrowly arched palates
  • tongue may sit low and forward in the mouth
  1. Health problems

Feeding can be affected by a variety of health problems, including:

  • Cardiac issues
  • Gastrointestinal issues, including reflux
  • Upper respiratory tract infections
  • Enlarged adenoids and tonsil
  1. Motor problems

Hypotonia (low muscle tone) can affect babies’ and children’s ability to feed. Some babies and children with hypotonia may require extra head, body, and jaw support. Difficulties with coordinating muscles for sucking, chewing and/or swallowing can also affect feeding.

  1. Sensory and/or behaviour problems

Babies and children with Down’s syndrome can be hypersensitive to particular textures, tastes or even colours of food. They may present with behavioural difficulties around food; for example, extreme fussiness (beyond what is expected at a particular age). It may be difficult to know whether food refusal or fussiness is caused by an underlying sensory issue, or by behaviour.

Sensory issues around food sometimes arise as a result of historical medical problems and interventions. For example being tube fed when suffering from cardiac, respiratory or gastrointestinal problems, or becoming averse to certain foods because they trigger reflux. Not all children who have medical problems and interventions go on to have feeding difficulties. It is possible to alleviate the likelihood of developing sensory issues around food, for example by continuing to give a child a variety of ‘tastes’ when he/she has to be tube fed for a while, or by encouraging the child to play with different food textures.

Ask for specialist advice and intervention if your child suffers from reflux or has to be fed non-orally for any period of time so you can be given a programme to support his/her feeding development.

Some children have sensory issues around food without a known cause. In this instance, it is important to have specialist support and advice around:

  • Meal and snack time routines
  • Tastes
  • Textures
  • Temperatures
  • Colours of food (this is most relevant in children with a dual diagnosis of DS-ASD)
  • Messy play
  • Nutrition
Feeding: Multidisciplinary Assessment

It is extremely important your child has a multidisciplinary assessment if you suspect he or she has any feeding difficulties. This is because poor feeding can result in other health complications further on in the child’s development. It can cause your baby to struggle with weight gain. It can also put your baby or child at risk of aspiration. Even small amounts of aspiration can result in recurrent chest infections as food enters the lungs instead of the tummy resulting in the child becoming poorly.

The following professionals may be part of the multidisciplinary team supporting your child:

  • Paediatrician
  • Breast feeding nurse or midwife
  • Specialist nurse
  • Dietician
  • Occupation therapist
  • Specialist speech and language therapist

Depending on the findings of multidisciplinary assessment, feeding can usually be managed safely with correct positioning, consistency of food and drink, special utensils including bottles, cups or cutlery and nutritional advice. A specialist speech and language therapist may advise on all aspects of feeding, including how to encourage the oral-motor movements required for feeding, for example by giving jaw support, encouraging lip closure and tongue lateralisation.

Feeding: General Advice

Just like all areas of development, feeding follows a developmental path and children with Down’s syndrome are likely to be delayed in this area. Most children go through the following stages:

  • Liquid
  • Smooth puree
  • Lumpy puree
  • Mashed
  • Finger foods
  • Chopped
  • Mixed textures and sauces

When weaning and developing feeding skills with your child, progress through the same developmental stages as other children. Your child may take longer to progress through each stage. However, if you have any concerns seek advice from a professional on your child’s multidisciplinary team.

Consistency of food

If you are not confident, remember to seek advice from a specialist speech and language therapist or a member of your child’s multidisciplinary team before trying anything new. Always individualise food choices, for example, does your child have any allergies or other reason why he or she should not try a particular food?

When you are ready to introduce different tastes and/or textures to your child put a choice of two or three types in front of him/her and allow the child to self-feed with their fingers, or a spoon to experiment with different flavours. If you are confident about food consistencies your child is able to cope with then here are some ideas of finger foods to practice with:

Foods that dissolve on biting


  • Sponge finger biscuits – which begin to soften and melt on sucking
  • Wafer biscuits
  • Some cereals, for example, sugar puffs and cheerios
  • Ice cream wafers
  • Meringues (not caramelised ones)


  • Baby weaning crisps – there are many different brands available, the consistency should  be Cheesy Wotsit consistency
  • Prawn crackers
  • Skips

Easy to chew foods


  • Ripe peeled pear, nectarine and/or peach
  • Cooked, peeled apple and/or pear
  • Banana


  • Ripe peeled avocado
  • Soft cooked root vegetables for example, carrot, parsnip, butternut squash
  • Smooth pates without bits
  • Crumbly cheese, for example Caerphilly, some feta’s
  • Soft cheese if not too ‘claggy’ or ‘sticky’
  • Soft whole meal bread, without seeds, i.e. not granary
  • Soft fish
  • Soft poultry
  • Soft pasta without sauce

Chewy foods


  • Dried fruit, for example, peach, pear, apricot, banana
  • Children’s soft fruit sweets, for example, fruity flakes and fruit straps
  • Liquorice


  • Toast
  • Dried meats


Stronger flavours, whether sweet, savoury or sour, increase production of saliva and give greater sensory stimulation than mild flavours. Be cautious with strong flavours if your child struggles to manage his own saliva. For some children, strong flavours give increased sensory cues to help stimulate oral motor movement, for example tongue lateralisation and chewing. It is important to seek professional advice if you are unsure how best to introduce different flavours to your child. Aim to give your child a wide range of different flavours to try.


  • Allowing your child to eat his preferred foods. Is your child’s nutrition being compromised?
  • Making food fun – consider presentation and colour
  • Allowing independence – finger foods, allow your child to make a mess, play with food and trying to feed oneself, offer dips with finger foods so your child has autonomy to dip and taste
  • Using rewards, for example a star chart
Dual Diagnosis ASC/DS: Supporting communication

The key principles of speech, language and communication interventions remain the same for all children with Down’s syndrome.  There are other titles in the DSA’s communication series which will help you with strategies for developing early communication.

Your child will be a strong visual learner, so introduce objects, sign, gesture, pictures, symbols and written words, just as you would with any other child with Down’s syndrome. Like all children, focus on introducing the easiest strategy first and always use sign and/or gesture to support the spoken word:

  1. Object – Easiest
  2. Photograph
  3. Picture
  4. Symbol
  5. Written word – Hardest
Dual Diagnosis ASC/DS: Motivation

As with all children, the key to developing communication skills is to find out what motivates your child, and use her areas of interest to work towards communicative intent.

Communicative intent is the use of gestures, facial expressions, verbalisations, and/or written words to deliver a message. There are two types of communicative intent: intentional and non-intentional. Non-intentional communicative intent is the communication of a message that is automatic and completed without thinking (spontaneous). Intentional communicative intent is the deliberate communication of a message to a person, whether it’s via gestures, gaze, or vocalisations.

Your  child may be less likely to find social rewards as motivating as other children with Down’s syndrome.

When working with your child, focus on non-verbal and intentional communication skills. Pictures, symbols, voice output devices, sign and gesture can all help your child to communicate, and they remove the pressure of him having to use spoken words. For example, Picture Exchange Communication System (PECS) or the use of a voice output device allows your child to exchange a picture or press a button to express his needs. If you think a voice output device communication system may suit your child, seek specialist support and advice about the different options available.

Practise — Give your child lots of opportunities to practise requesting (e.g. asking for help/to play/for attention). Practising making requests in everyday situations will help your child to understand that she can use her skills in different places and contexts.

Use ‘natural consequences’ to support requesting. For example, a natural consequence to a request for a toy car is to hand your child a toy car. When this happens, the need to say/sign ‘car’ or hold up a photo of a car in order get the car is reinforced.

Teach your child about learning to wait while his request is carried out.

Try to establish your child’s level of ability in listening and understanding information (receptive language skills). This will help you to pitch information at the right level for your child.

Teach your child new skills in a place where there are not too many distractions

Children with a dual diagnosis of DS-ASC can easily become anxious, so they need predictable routines. You can use visual guides, timetables, now/next boards and sand timers, to help your child understand what is happening next or when.  The DSA has a resource about Visual and Film Guides.

Dual Diagnosis ASC/DS: Social Skills

Social skills are an important part of communication. Social skills are affected in children with dual diagnosis of DS-ASC, but the degree to which they are affected will vary significantly between individual children. Your child may not be motivated by social interaction with others, but may have some social awareness and interest in others. You can support development of social skills by:

  • Creating opportunities for your child to interact with other children and adults across different social situations.
  • Target one social skill at a time. For example, sharing, or eye contact, or turn taking, or recognising emotions through facial expressions.
  • Reward the targeted social skill with whatever your child finds motivating. For example, stickers, or a toy key to unlock a box.
  • Be consistent about your expectations of your child in social situations.
  • Give your child regular opportunities to make choices.
  • Help your child’s peers to understand the ways in which your child communicates.
  • Facilitate play dates and social interaction with other children, through nursery, school, clubs, etc. Ideally on a one-to-one basis.
  • Respond to your child’s attempts to be social; follow her lead.
  • Find activities that your child can share with other children, that do not rely on the use of expressive language (talking).
  • Focus on teaching social skills when your child is relaxed; not in situations that may make her anxious.
  • Be explicit. Your child may not pick up on social situations and social cues instinctively, so teach by:
  1. Teaching in a learned situation. For example, using social stories, or modelling through role play. The DSA has a resource about Social Stories.
  2. Teach the same skill using a less familiar adult or child to role play with, but in a situation set up by you.
  3. Practising the skill in a spontaneous, unstructured situation.
  4. Generalise and reinforce the skill in everyday life.
  5. Use verbal, visual, or physical prompts, depending on which is most effective for your child
Dual Diagnosis ASC/DS: Behaviour

Behaviour is your child’s way of communicating. When your child displays a particular behaviour, think about what your child is trying to tell you. All children benefit from:

  • Expectations being set at the right level, so they are challenged but able to succeed.
  • Change of activities as frequently as required to maintain attention.
  • Use of activities they enjoy, to reinforce and motivate appropriate behaviour and the learning of new skills.
  • Having choices, so they develop the ability to control their environment.
  • Familiar structure and routines.
  • Forewarning and planning for changes in activity, routine and transition periods.
  • Use of ‘concrete’ language.
  • Use of visual support for communication.
  • Consistency.
Dual Diagnosis ASC/DS: Play

Your child may have little interest in play, or a limited use of toys and limited types of play (sometimes called a ‘play repertoire’). Play is important for developing language, communication and social skills. You can encourage play by:

  • Ensuring toys match your child’s ability and interests.
  • Choose toys promoting pretend play. For example, a teddy or dolly, or toy cookery items, and model what to do with these toys.
  • Model play to your child. For example, push a toy car and say, ‘brmm, brmm’; play snakes and ladders with other children, emphasising turn taking and eye contact; play cooking in a toy kitchen, or dressing up as knights and princesses, depending on your child’s ability and interests.

Remember, small pretend play toys (like Lego, Playmobil, dolls house people, miniature figurines) require more advanced play skills than large toys (like a teddy, dolly, or realistic play objects such as a phone or cup).

  • Find peers that your child is comfortable with. For example, this may be older children or siblings who know how to facilitate play with your child, or younger children who have the same interests as your child.
  • There are different ways to facilitate friendships between peers. School can implement a plan to support same age friendships (through shared activity with peers). The DSA can help on this through our helpline (if school calls us) and/or through online consultancy/training. Start with a list of things your child likes to do/play, then plan for peers to engage in each activity for a short period of lunch/play every day (5 – 10 minutes max). For example, your child may enjoy games that involve physical movement, which could lead to longer engagement and participation. Your child may like painting, singing songs, dancing or pretend play/role play. Begin with a list of what she likes to do, to form a basis for setting up games she could actively take part in with peers.

If your child has obsessive play tendencies or behaviours, you could use these behaviours as a reward. For example, encourage the child to push the car to you and then reward him with the obsessive toy or item. If your child is able to understand visual timetables, you can use these to show what is going to happen and when he can expect the reward.

Dual Diagnosis ASC/DS: Body Language

Interpreting body language is important for successful interaction with other people. It is an important part of non-verbal communication. You can encourage awareness of body language by:

  • Exaggerating your own body language. For example, emphasise slouching when telling your child you are tired, or emphasise fidgeting when saying you are bored.
  • Watch other people’s body language with your child. For example, when out and about, or watching a favourite TV programme. Pause when there is an obvious body language displayed, and see if your child can identify it by saying, signing or selecting a picture card.
  • Make a body language picture book, using photographs of your child or familiar people. Create the book together, and talk about how people use body language to express their feelings.
  • Role play.
  • Use social stories for different types of body language.

We will be adding information about emotions (in relation to body language) and social skills to this web page in the near future.




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