Communication Series: Dual Diagnosis ASC/DS

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.

Supporting 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
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.

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
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.
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.

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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