The design of See and Learn Speech

The design of See and Learn Speech is informed by what we know about how typically developing children learn to say words and what we know about speech development for children with Down syndrome.

Speech development challenges for children with Down syndrome

Children with Down syndrome begin to produce speech sounds later than typically developing children and have difficulty producing clear speech.[1,2,3] They master speech sounds in the same order as other children but much more slowly and less accurately.[4] Their speech skills influence their language development - the rate at which they understand and say words.[4,5] Their speech difficulties make their spoken language more difficult to understand, often throughout their lives.[6] The reasons for their speech difficulties are not fully understood but include:

  • anatomical differences making speech sounds and words more difficult to produce
  • a high incidence of conductive hearing loss in the early years which affects hearing in the speech sound range
  • verbal short-term memory difficulties that make vocabulary and language more difficult to process and remember
  • difficulties storing the precise phonological (sound) patterns of words
  • lack of practice

Speech development

Speech development starts early in life. Typically developing babies can discriminate speech sounds and patterns from the early months and by 6-7 months they are good at discriminating sounds in the language they are hearing. Spoken input to infants from the first weeks of life is therefore important. Infants need to hear and discriminate the speech sounds in their native language to be able to start to remember and copy them.[7]

Children use the visual information of lip and face movements (speech-reading) to help them discriminate phonemes from the early months of life. Talking to babies in face-to-face games and 'conversations' is therefore important so that they can see a speaker's face and lip movements as they talk.[8]

Research has shown that there is a link between a child's ability to produce speech sounds and beginning to say words. The more vocalizing and babbling a baby does, the earlier they say words. The more parents encourage babies to imitate and respond to them as they vocalize and babble, the faster they learn to produce speech sounds.[7] The speech sounds that babies produce in their babble predict the first words they attempt to say.[7]

Practice and feedback are essential for developing speech clarity and intelligibility. Speech production is, in part, a motor skill, requiring motor planning and control. As with all motor skills, speech skills improve with practice and opportunities to monitor and learn from performance. Children need to produce and hear the sounds they are producing to develop clear sound and word production.[7]

Practising sounds and words develops children's verbal short term (phonological) memory.[9] This suggests that the verbal short-term memory difficulties shown by older children with Down syndrome could be, in part, a result of delayed speech sound production.

In order to be able to say a whole word clearly, a child has to store an accurate memory of the sound pattern of the word. Recent research suggests that children with Down syndrome have difficulty learning fully detailed sound patterns (phonological forms of words). They remember enough of the sound pattern to recognize the word and link it to the correct object but not enough to discriminate it from similar sounding words.[10] Difficulty in learning and remembering the fully detailed sound patterns of words may be one of the reasons for not being able to say them clearly. Activities which provide repeated opportunities to hear and say words may help children store all the sounds in words.

The available research evidence therefore suggests that it is important to help children with Down syndrome to hear, imitate, produce and practice speech sounds and words from the first year of life to improve their speech production skills. This should lead to clearer speech, and also support word learning and verbal memory development with wider benefits for language and literacy skills.

How See and Learn Speech is designed to support speech development

Practice and repetition

Children with Down syndrome are likely to benefit from a structured approach to speech development in addition to developing their skills through natural interactions. A structured approach increases opportunities for repetition and practice. Research suggests that it is possible to accelerate phonological development for young children with Down syndrome with repetition and practice.[11-14]

See and Learn Speech is designed to provide extra input and practice at each stage of speech development.

Listening and discrimination

Babies and young children with Down syndrome should benefit from extra practice at listening to the sounds of their language, building their memory for sounds. They can also practice noticing and hearing the differences between sounds as they become familiar with them. Through this process they can develop the skills that they need to produce sounds.

See and Learn Speech Sounds is designed to help children to practice these skills.

Combining sounds

When a child can produce a few individual sounds, they can begin to learn how to combine sounds in meaningful ways. Children with Down syndrome often struggle with the coordination necessary to move from one sound to the next, and can benefit from extra practice.

See and Learn Combining Sounds is designed to help children practice combining individual sounds.

Saying whole words

When a child has learned to combine sounds, they can begin to learn to say whole words, starting with words with one or two syllables.

See and Learn Saying Words 1, See and Learn Saying Words 2 and See and Learn Saying Words 3 are designed to help with regular practice using a selection of early one, two and three syllable words and progressing through a sequence of initial sounds. These three steps work through groups of initial sounds in the order they are generally learned by young children.

Saying longer words and phrases

Children who have learned to say shorter whole words can then move on to learn to say longer words and phrases clearly.

The benefits of improved speech skills

Being able to produce speech sounds and join them together for words may influence how fast children learn new words. It may also influence their verbal memory development. Over time it may help them to talk more clearly.

Many children with Down syndrome experience difficulties in making themselves understood and parents report this as one of their highest concerns. Parent reports suggest that 58% of children with Down syndrome frequently have difficulty being understood.[15]

Poor speech can be a major barrier in everyday life. Speech clarity is important because it aids or hinders understanding of a person's message. It also affects our judgment of a person's abilities. When a person with Down syndrome has trouble speaking clearly, listeners may underestimate their abilities.

Some children who have difficulty communicating can become frustrated and resort to problematic behaviors to express themselves.

Improving speech clarity is therefore likely to improve quality of life for young people with Down syndrome in many ways.


  1. Roberts, J.E., Price, J. & Malkin, C. (2007) Language and communication development in Down syndrome. Mental Retardation and Developmental Disabilities Research Reviews, 13, 26-35. doi:10.1002/mrdd.20136
  2. Dodd, B.J. & Thompson, L. (2001). Speech disorder in children with Down's syndrome. Journal of Intellectual Disabilities Research, 45, 308-316. doi:10.1046/j.1365-2788.2001.00327.x
  3. Sokol, S.B. & Fey, M.E. (2013) Consonant and syllable complexity of toddlers with Down syndrome and mixed-aetiology developmental delays. International Journal of Speech and Language Pathology, 15, 575-585.
  4. Burgoyne, K., Buckley, S. & Baxter, R. (2021) Speech production accuracy in children with Down syndrome: Relationships with hearing, language, and reading ability and change in speech production accuracy over time. Journal of Intellectual Disability Research, 65, 1021-1032.
  5. Naess Næss, K. A. B., Nygaard, E., Hofslundsengen, H., & Yaruss, J. S. (2021). The association between difficulties with speech fluency and language skills in a national age cohort of children with Down syndrome. Brain Sciences, 11(6), 704.
  6. Wild A., Vorperian H. K., Kent R. D., Bolt D. M. & Austin D. (2018) Single-word speech intelligibility in children and adults with Down syndrome. American Journal of Speech-Language Pathology 27, 222–36.
  7. Stoel-Gammon, C. (2011) Relationships between lexical and phonological development in young children. Journal of Child Language, 38, 1-34. doi:10.1017/S0305000910000425
  8. Teinonen, T., Aslin, R.N., Alku, P. & Csibra, G. (2008) Visual speech contributes to phonetic learning in 6 month old infants. Cognition, 108, 860-866.
  9. Keren-Portnoy, T., Vihman, M.M., DePaolis, R.A., Whitaker, C.J. & Williams, N.M. (2010) The role of vocal practice in constructing phonological working memory. Journal of Speech, Language, Hearing Research, 53, 1280-1293.
  10. Jarrold, C., Thorn, A.S, Stephens & E. (2009) The relationships among verbal short-term memory, phonological awareness, and new word learning: Evidence from typical development and Down syndrome. Journal of Experimental Child Psychology. 102(2):196-218.
  11. Dodd, B., McCormack, & Woodyatt, G. (1994) Evaluation of an Intervention Program: Relation Between Children's Phonology and Parents' Communicative Behavior. American Journal on Mental Retardation, 98(5), 632-645.
  12. Cholmain, C.N. (1994) Working on phonology with young children with Down syndrome. Journal of Clinical Speech and Language Studies, 1, 14-35.
  13. Dodd, B. Crosbie, S. (2005) Phonological abilities of children with cognitive impairment, In Dodd, B. (Ed.) Differential diagnosis and treatment of children with speech disorders (pp.233-243) London: Whurr.
  14. Van Bysterveldt, A., Gillon, G & Foster-Cohen, S. (2010) Integrated speech and phonological awareness intervention for pre0school children with Down syndrome. International Journal of Language and Communication Disorders, 45, 320-335.
  15. Kumin, L. (1994). Intelligibility of speech in children with Down syndrome in natural settings: Parents' perspective. Perceptual and Motor Skills, 78, 307-313.