Down Syndrome and Speech Problems

If you have a child with Down Syndrome, you may have noticed their struggles articulating words that affect their ability to express themselves or hear and understand. This is because Down Syndrome is often associated with anatomical and physiological differences such as low muscle tone in the tongue or a small upper jaw in the children’s mouth area that lead to feeding, swallowing, and speech difficulties.

What Is Down Syndrome?

Down Syndrome is a genetic condition that occurs when a child has an extra chromosome 21. Human cells have 23 pairs of chromosomes, with each chromosome in a pair coming from each parent, i.e., one from the mother and the other from the father. In the case of Down Syndrome, the child has 3 copies of chromosome 21 instead of 2, resulting in physical and developmental challenges.

Although most disabilities associated with Down Syndrome are lifelong, getting the proper care can help your child live a full, meaningful life. However, it is critical to note that the severity of the condition varies from one child to another, thus affecting their intellectual disabilities and developmental delays in different ways.

What are the symptoms of Down Syndrome?

Here are a few examples of symptoms:

  • Weak muscle tone
  • Protruding tongue
  • Loose joints
  • Noses that are either small or unusually shaped 
  • Brushfield’s spots, i.e., tiny white spots on the iris or the colored part of the eye
  • Palpebral fissures or upward slanting eyelids
  • Small head and flat facial features
  • Short height, small hands, and feet

While these problems are common among children with Down Syndrome, the effects are different for each child. For example, some can grow to live entirely on their own, while others will require more assistance. Their mental abilities, although most tend to have mild to moderate cognitive impairment, lead to issues with thinking, reasoning, and understanding.

Are there different types of Down syndrome?

There are three types of Down Syndrome:

1. Trisomy 21

Trisomy 21 is the most common type of Down Syndrome accounting for 95% of cases. It occurs from chromosomal error where every cell in the child’s body has three copies of chromosome 21 instead of two. 

2. Translocation Down Syndrome 

In this type of Down Syndrome, the extra or partial copy of chromosome 21 is attached to another chromosome instead of being on its own. It accounts for approximately 3% of Down Syndrome cases.

3. Mosaic Down Syndrome

Mosaic Down Syndrome is the rarest type of Down Syndrome, accounting for approximately 2% of total cases. It occurs when only some of the body cells have the extra chromosome 21, indicating that the children with this type may have fewer characteristics of Down Syndrome.

What Speech Problems Are Common Among Children With Down Syndrome?

Children with Down Syndrome tend to have weak oral muscles, low muscle tone, a small upper jaw, and a high arched palate. These issues lead to language and communication difficulties that range from mild to severe.

Some speech difficulties exhibited by children with Down Syndrome include;

a.) Delayed language development

Children with Down Syndrome develop language skills more slowly than other children, thus delaying language acquisition and vocalization. While most children without Down Syndrome start talking between 10 to 18 months, those with the condition begin at 24 to 36 months old. 

Besides the delayed speaking, you may notice that your child has sentence and grammar challenges. For example, the child will likely use keywords such as “me go school bus” instead of complete sentences. In addition, the intelligibility of their speech may be compromised, making it difficult to understand them.

b.) Uncoordinated oral-motor skills

Differences in oral structure and function among children with Down Syndrome are likely to affect their speech production. For instance, some children with Down Syndrome may have features such as a narrow, high-arched palate and a small oral cavity with a relatively large tongue leading. These differences are associated with limited skills in coordinated speech movements, reduced rate of speech, inappropriate intonation, and improper stress on words. 

c.) Trouble with auditory tonal processing

Many children with Down Syndrome have difficulties correctly processing tones, leading to challenges in language processing. The problem is associated with a breakdown in the hearing process where a child’s brain fails to make sense of what their ears hear because the auditory signal is distorted. For example, you might notice that your child has difficulty understanding the meaning of words and sentences or following instructions. As a result, they may struggle to express themselves since children must first understand spoken language before they can use it to communicate.

What treatments are available for Down Syndrome?

One primary intervention for treating speech difficulties among children with Down Syndrome is speech therapy. The speech therapist assesses the child to identify areas the child is facing challenges, such as articulation, receptive or expressive language skills, or social and play skills. Following the assessment, an intervention plan is developed and implemented.

How can speech therapy help Down Syndrome?

Below are some ways a speech therapist can help;

  • Oral-motor therapy 

This approach involves various activities to improve the child’s strength, control, and coordination of oral muscles, including the jaw, lips, tongue, and vocal folds. Examples include blowing whistles and bubbles, chewing gum to improve jaw strength, tongue extension, and retraction exercises, cheek puff exercises, and lip retraction and protrusion.

  • Articulation speech therapy

Most children with Down Syndrome have anatomical differences such as lower facial muscle tone and a larger tongue for their mouth size that make articulation and speech production difficult. Articulation speech therapy can support children with Down Syndrome through exercises that allow the therapist to correct the child’s use of sounds and syllables in words and sentences during play activities.

For example, the speech therapist can use a mirror during sessions where the child looks to notice the exact positioning of the tongue, lips, and teeth. The child then uses the mirror to repeat the exercise until they can produce the proper sounds and words.

  • Speech and language therapy

Children with Down Syndrome can benefit significantly from speech and language therapy because it supports, develops, and improves speech, language, and communication skills. Some areas of focus in this intervention may include;

  • Increasing the child’s vocabulary
  • Helping the child improve and develop speech sounds
  • Supporting language learning through alternative techniques such as visual aids and sign language
  • Enhancing the child’s comprehension skills to ensure they understand the language spoken to them

A speech therapist can offer a wide range of interventions based on your child’s difficulties and the severity of Down’s Syndrome. Therefore, parents should engage a Speech-Language Pathologist for a proper evaluation and assessment.


  1. “Down Syndrome.” Spectrum Speech,,tongue%20and%20weak%20oral%20muscles.
  2. Pathak, Neha (2020). Down Syndrome, WebMD,
  3. “About Down Syndrome.” National Down Syndrome Society (NDSS),
  4. Jacky G. Speech Difficulties in Down Syndrome. Speech Buddies,
  5. Chalko, Kayla. Why is Speech Therapy Needed? The Value of Intervention for Children and Adults. Walkie Talkie Speech Therapy, 
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