American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

New York State Department of Health, Early Intervention Program; U.S. Department of Education
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0–3 Years).

New York State Department of Health, Early Intervention Program. (2006).
Albany (NY): NYS Department of Health, Publication No. 4959, 292 pages.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations pertaining to the assessment and intervention of young children with Down syndrome. The intended audiences for this guideline include families and professionals. Of particular importance to speech-language pathologists and audiologists are recommendations regarding assessment and management of communication, cognition, social relationships, oral-motor feeding, and hearing. The recommendations are classified A, B, C, D1 or D2, based on the strength and quality of evidence. Level A recommendations are considered “strong evidence” based on high quality evidence from two or more efficacy studies. Level B recommendations are considered “moderate evidence" and based on evidence from at least one high quality efficacy study. Level C recommendations are "limited evidence" and based on evidence from at least one efficacy study with moderate quality or applicability to the topic. Level D1 and D2 are consensus recommendations. Level D1 recommendations are consensus panel opinion based on information not meeting criteria for evidence in systematic reviews and Level D2 recommendations are based on information where a systematic review has not been done.

Recommendations:

 

  • Swallowing Screening/Assessment

It is recommended that an oral-motor and feeding assessment include:

    • physical examination and thorough medical and feeding history
    • observation of interaction patterns between the child and primary feeders
    • body posture/positioning
    • oral-motor exam assessing: oral reflexes, structure of lips, tongue, palate, oral sensation, laryngeal function, control of oral secretions, respiratory control, swallowing function, and oral postural control
    • parents knowledge of feeding and diet
    • specialized studies, such as videofluoroscopy, as appropriate (pp. 92–93)
  • Swallowing Treatment
    • It may be useful to consider using behavioral or oral-motor intervention to improve oral movements
    • Medical management may be necessary to treat chronic sinus and other respiratory conditions that may impact feeding
    • Palatal plate therapy may be considered as an option to other oral-motor interventions (p. 159)
  • Language Screening/Assessment

When assessing communication, it is important to:

    • consider the interrelationship between cognitive development, motor development, and language milestones
    • provide appropriate postural support
    • consider medical history
    • assess intervention needs
    • ensure that the environment is distraction free
    • use parent scales
    • evaluate the child's responses to persons and objects
    • conduct the assessment in various environments
    • obtain language samples
    • make use of norm-referenced or standardized tests as appropriate
    • assess use of gestures
    • assess hearing
    • assess oral-motor and speech abilities
    • consider developmental milestones (pp. 55–59) 
 When evaluating social relationships, the following should be assessed:  
    • social initiation
    • social imitation
    • age-expected reciprocity
    • child's attachment behavior patterns
    • social interactions with familiar and unfamiliar peers and adults
    • child's ability to make transitions
    • joint attention (p. 64)
  • Language Treatment
    • Type, frequency and intensity, and setting of speech and language therapy should be individualized to the child.
    • Early intervention should begin soon after birth.
    • Principles of learning theory should be applied when conducting intervention.
    • Communication intervention should be incorporated into daily activities.
    • Alternative and augmentative communication should be considered, especially use of total communication (sign language, oral communication, and visual cues) (pp. 125–126) 

Important activities to increase social development include:

    • stimulate and reinforce affective responses
    • facilitate language
    • improve peer interactions
    • promote generalization
    • training social initiation (pp. 139–140)
  • Cognitive Screening/Assessment
    • 0–6 months: Use of norm-referenced cognitive assessments are generally not recommended
    • 0–12 months: Use of a norm-referenced or curriculum-linked assessment is recommended
    • 1–3 years: Use of a standardized or norm-referenced test is recommended
    • Evaluation of cognition should include assessment of conceptual development, memory, attention, problem-solving skills, perceptual motor function, functional motor skills, receptive and expressive language, adaptive behavior, nonverbal and verbal measures, and the child's ability to use skills and information in varied environments (pp. 50–51). 
  • Cognitive Treatment
    • Cognitive interventions should focus on both global and specific cognitive skills.
    • Cognitive interventions should include motivating tasks, information processing skills, and short and long-term memory activities.
    • Intended outcomes should be functional.
    • Cognitive skills should be taught using principles of learning theory (p. 121). 
  • Hearing/Balance Screening/Assessment
    • Because of the increased risk for otitis media with effusion in children with Down syndrome, assessment for possible middle ear infection should be conducted when signs of upper respiratory infection or fever are present.
    • Children with Down syndrome should have ongoing monitoring and hearing testing.
    • A comprehensive hearing assessment for infants and young children should include: hearing history, behavioral audiometry, and electrophysiologic procedures as appropriate (pp. 95–97). 
  • Hearing/Balance Treatment
    • It is important to facilitate the acquisition of listening behaviors by providing opportunities for and drawing attention to exposure to sounds.
    • Hearing aids should be considered if a hearing loss is present.
    • FM systems may be useful for children who demonstrate difficulty hearing in noise (p. 160).

Keywords: Down Syndrome

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Added to Compendium: November 2010

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