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Developmental Scale forChildrenwithDown SyndromeThomas L. Layton, Ph.D.Extraordinary Learning FoundationT and T Communication Services, Inc.100 Meredith Drive, Suite 100Durham, NC 27713
Developmental Scale for Children with Down SyndromeThomas L. Layton, Ph.D.T and T Communication Services, cial and Communication IssuesOne of the most frequently asked questions byparents of children with Down syndrome is howtheir child is doing compared to other childrenwith Down syndrome? They are curious as towhether their child is keeping up with typicallydeveloping children, but realize that it is moreimportant to judge their child with otherchildren with a similar syndrome. To assist inthe answer to this question, I have developed aDevelopmental Scale for Children with Downsyndrome. The Developmental Scale providesthe best information I know about youngchildren with Down syndrome seen in our clinicas well as what we have read in the literature. Italso provides what typically developing childrendemonstrate during infancy, toddler, andpreschool ages. The Developmental Scale hasnot been scrutinized by colleagues or parents,and, therefore, provides only our best judgmentof what can be expected.It is important to point out that all children, eventypically developing children, do not look alike.Each child is different and progresses at his orher own rate: each presents with ses. This, of course, is the same forchildren with Down syndrome. It is hard to justpresent a picture of what a child with Downsyndrome looks like at a particular age. A lotdepends upon the child’s medical and healthissues. For instance, has the child had aproblem with hearing, especially middle earpathology? If so, this can slow down or affectthe development of speech production andexpressive language.Does the childdemonstrate related difficulties such as autism?This clearly can affect the social interaction andrate of language acquisition. Does the childhave a severe oral-motor problem? Again, thisproblem can delay speech production, can affectthe quality of spoken speech, and can alterexpressive language skills.It is important, therefore, for aunderstand these issues wheninformation about what to for theirwhat services are available. Howlanguage pathologist helps a childrelated to these and other social,emotional, and health issues.parent toseekingchild anda speechis clearlycognitive,There are several publications available to helpparents better understand these issues. It is notthe intent to delve deeply into these areas, butinstead to present the communicative skills ofyoung children with Down syndrome.Developmental Scale for Children with DownSyndromeThe Developmental Scale for Children withDown Syndrome begins at Birth and increases in4 months steps until age 24 months, at this pointit progresses in 12-month steps. The Scale endswhen the child is just turning 6 years of age (or71 months). The reason for the difference in theearly ages compared to the later ages is thatyounger children, even children with Downsyndrome, progress more rapidly in the youngerages than they do in the older ages. This is
especially true for motor skills as well aslanguage skills.but, understanding of words is not reallyexpected yet.Birth to 5 monthsMost children with Down syndrome do notbegin to babble or “talk to themselves” untilaround 10 months of age. Babbling is animportant indicator as to how well the child isdoing and whether he or she will be a talkerlater on, it helps to determine whether a childwill or will not have trouble with spokenspeech. Just because a child does not babbledoes not necessarily mean he or she will not talklater on. It may, however, indicate that moreoral-stimulation and speech-stimulation isneeded to assist the child in developing theneeded movements for later speech productions.During the first stage, Birth to 5 months, aparent can expect their child to react to a soundsometimes and not at other times. The reasonfor this is that the child may be congested with amiddle ear fluid, or just may not be attending asreadily to his environment. Inconsistentresponses to sounds are a common occurrence atthis age.Because of this, the child with Down syndromemay or may not turn his/her head toward thesound source and may or may not be watchingthe parents’ face when they talk. It is stronglysuggested that a child should be seen for anaudiologic evaluation since it is well known thatmiddle ear problems are common and childrenwith Down syndrome are more often prone tohave a sensori-neural hearing loss. It is,therefore, important to have the child’s hearingchecked early.Children with Down syndrome seldom vocalizeduring the first 5 months of life, which oftenconcerns parents. This concerns us too, but aslong as the child’s hearing has been checked andthe child does not demonstrate oral-motorproblems, it should not be too alarming. Justkeep talking to your child and read bookstogether on a daily basis. Reading is anexcellent teaching tool for speech, language, andcognitive development. We find many youngchildren, even 4 – 5 months of age, love to beread too.6 – 10 monthsThe children during the second stage, or 6-11months, begin to watch their parents’ face whenbeing talk too and localize where a sound hascome from, especially when the sound is suddenor unexpected. These children notice theirparents’ reprimands, such as, saying “no-no”;11 – 15 monthsThe children at this age are beginning to showsigns of language understanding.Parentalreports of vocabulary development indicate thatthese children demonstrate an understanding ofabout 20 words and try to communicate bylooking at the parent, gesturing, or moving as ifto say something. These children want tocommunicate but the motor speech area in thebrain is not developed sufficiently to allow forit. Thus, we encourage the use of manual signsto allow the children to express his/her wantsand needs. Oral-motor skills have improved sothat now they can chew semi-solid foods, blowbubbles, and can stand up if allowed to holdonto something. When this occurs, it is a strongindicator that spoken words are about to appear.16 – 20 monthsComprehension of words, during this stage, hasgrown to 40-60 words. The child now should bechewing solid foods, sucking through a straw,standing, and walking. Children now like tolisten to simple stories and are beginning topoint to objects and pictures in the story. Thesechildren are more interested in producingsounds and attempt to repeat sounds, especiallysounds of animals. However, there are still nointelligible spoken words yet. Feelings are
beginning to be displayed more openly, such asshowing displeasure when a toy is removed orthrowing a toy on the floor when it will notwork. The child, at this stage, has a clear choiceof favorite toys and seeks or requests them,often with gestures.21 – 25 monthsThis stage is marked by the obviouscomprehension of language. The child has awide understanding of words, including nouns,verbs, adjectives, and some prepositions. He orshe is a social person: one who wants to interactwith others and be a part of family “events.”The child wants to show others a favorite toy orretrieve an object on request: the child watchesothers carefully, by holding good eye contact,waiting, and responding when talked too, orrepeating an activity when asked to dosomething again. Unfortunately, many children(i.e., approximately 40%) demonstrate signs ofpoor oral motor skills. These poor oral motorskills are quite obvious at this stage and canhave an effect on the child’s eating, chewingand swallowing. They also can have an effecton spoken words.Typically, most children with Down syndrome,at this stage, still do not produce spoken words.26 – 30 monthsThe child of 26-30 months is now ready tobegin to speak. This is when the child sayshis/her own name, labels animals, requests“bottle” or “juice”, and calls for “mommy” and“daddy.” During this stage, the child shouldhave approximately 10-20 intelligible words.Comprehension also has grown to where thechild understands as many as 150-175 differentwords. The child points to his/her toes, eyes,and nose, and follows a simple one stepcommand, such as, “put the block on the chair,”or “put the book away, please.” The child isalso interested in listening to simple stories,either those being read or those being told bysomeone else, especially about the child’sadventures for that day.The child with an oral motor problem, however,is less productive in spoken words. He or shemay attempt to speak several words, but fewindividuals, or only a family member, canunderstand them. There may be one or twowords that others understand clearly.31 – 35 monthsChildren at this stage are more talkative andtypically produce 30–80 intelligible words,combined with other non-intelligible words.Parents often report that the child, at this stage,is trying to say phrases and sentences, but noreally understand them. Comprehension hasnow grown to where the child understands asmany as 250 words. These children listen tomuch longer stories and attend to stories that are15 – 20 minutes long. Some spoken two-wordcombinations are heard, and the child may ask aquestion by raising his/her pitch at the end ofthe phrase. The word “why” is often heard.Speech sounds, produced during this stage, aretypically those that develop early: p, m, n, w, h.;however, they are often omitted at the ends ofwords. Since these children have a weakauditory memory and demonstrate poor soundto-symbol associations, this could account forthe poor speech production.Children with oral motor impairments tend toproduce words with just vowels and producemore sounds that are formed toward the back oforal cavity, such as, k and g. They have lessability to use their tongue tip or close their lipswhen producing sounds. It is for this reasonthat intelligibility is so poor for this group ofchildren.36 – 40 monthsDuring this stage, the children becomeconversationalists:they engage in shortdialogues with others and often use 2 word
sentences. They actually produce up to 150intelligible words, although there still may bemany sound errors. Typically, these sounderrors include substitutions (i.e., t for s, t for th,p for f) or distortions, especially fricatives (i.e.,f, v, s, z, sh, ch, zh). These fricatives distortionsare not produced with a high clear frequencysound, but instead are produced more like a“slushy” sound.Children now begin to ask simple questions,recognize nearly all of the primary colors, useboth verbs and adjectives in their sentences, anduse some morphemes like plurals (dog, dogs),irregular past tense (went), and actions (-ing,running). Pronoun use includes I and me in thesubject position; as well as, you, mine, and your.Sometimes the child uses the pronouns he andshe appropriately, while other times they areconfused with the gender.Children, with oral motor impairments, producemany omitted sounds. The omitted soundsoccur in the initial position (“-ar” for “car”), inthe medial position (“bo-el” for “bottle”) as wellas the final position (“bi-” for “big”). However,their comprehension is similar to other childrenwith Down syndrome, i.e., approximately 250 –words: it is the production of speech that clearlydifferentiates the two groups.41 – 59 monthsAt this stage of development, children withDown syndrome now have a comprehensionvocabulary that can reach 900 words. They areeasily producing oral words, with 2-3 wordsentences, and retelling short stories. They arebeginning to recognize environmental symbolslike stop signs, McDonald’s arches, and open.They may know most letters of the alphabet andhave a sight word reading vocabulary of 15-20words.60 – 71 monthsThe highest stage of development for the scaleis when the child reaches about 5 years old.Here the child is producing longer sentencesthat are usually 3-4 words long but can be some5-6 word phrases.Their comprehensionvocabulary can exceed 10,000 words. Theymay be producing 400 or more intelligiblewords, but few signs. At this age, usuallychildren with Down syndrome drop off and donot use their signs any more. They can count 10objects, know their primary colors, use bothverbs and adjectives in their sentences, refer tothem self with a pronoun form, and use regularplural verb forms. They are now reading shortdialogues in stories and will have some wordattack skills.Comparison with Typical ChildrenIt is obvious that children with Down syndromedo not keep up with the rate of communicationskills of typically developing children, althoughthere are some noticeable similarities betweenthe groups. For one thing, at the younger stages(i.e., Birth to months, 6 – 10 months, 11 – 15months, and 16-20 months), the children withDown syndrome seem to be only around 6months behind their typically developing peers.An exception to this is the number of spokenwords, where the children with Down syndrometend to lag as much as a year behind. Also adissimilarity exists in the rate of vocabularycomprehension, where the children with Downsyndrome appear to increase their vocabularycomprehension from stage to stage, but just notas fast as their typically developing peers.There are, however, quite a few similarities ingestures, socialization, and playing with toys.These areas seem to lag only slightly behind.At the later stages, beginning at around 26months of age, the gap between the childrenwith Down syndrome and the typicallydeveloping peers widens. For instance,comprehension and spoken words increase, buteven at the 60 – 71 month stage, these skills arecomparable only to the typically developingchildren at 31-35 months of age. Older childrenwith Down syndrome do have concepts andsocial exchanges that are more like the typically
developing at 36-40 months of age. Thus, somedevelopmental skills appear to be above theirmeasurable vocabulary and spoken languageskillsConclusionIt is hoped that the Developmental Scale hasprovided clarification for where children withDown syndrome fit compared to typicallydeveloping peers. It is hoped that it sheds somelight on how your individual child is doing. Thevalue of early intervention, oral motor training,speech stimulation, joint-book reading, andlanguage training has not been discussed. It isimportant to realize that many children withDown syndrome are fully included in regulareducation classrooms. These children startedoff much different from their typicallydeveloping peers, but through strong parentadvocacy and professional assistance, they madeoutstanding gains. Your child can do this too.It is my expectation that in the next few yearsthe Developmental Scale will be outdated: thestages will need to be altered because early andappropriate intervention has made a differenceamong children with Down syndrome. Untilthen, use the chart to determine your child’sprogress and use it to help plan for the nextstage.ScoringThe Developmental Scale for Children with DownSyndrome is scored either with a parent’s inputor by directly observing the child’s behavior.Often times, the actual number of spoken wordsand oral words are scored by including testresults from other tools, like the MacArthur’sScale for Infants and Toddlers. The author hasnormative data on children with Downsyndrome acquiring their first oral and signwords and number of word comprehended onthe MacArthur. To score the DevelopmentalScale for Children with Down syndrome theexaminer should mere place a sign for allbehaviors observed or reported that arefrequently present. A score of 0 should bemarked for all behaviors that are not present. Amark of is provided for all behaviors thatoccur but not frequently, or in transition.Only the scores are calculated per stage. If achild has all but one score at a particular age,the child is considered to be at that age. If thechild passes with a mark for half of the itemsat any stage, the examiner should take theyoungest age and add two years to determine thechild developmental age. For example, if thehas the following scores at the 16-20 monthlevel, would be considered to be at 18 months ofage. Identifies by pointing Sucks threw a straw Chews solid foods0 Walks (at around 18 months) Seeks toy for appropriate play0 Listens to simple stories being read(single lines per page) Indicates displeasure when toy is removed0 Comprehends 40-60 words0 Recognizes family names Gestures and vocalizes needs Points to objects and pictures0 Tries to repeat sounds0 1-2 oral words
D evelop m en ta l S ca le forC h ild r en w it h D own S yn d r om eDS--CDSExtraordinary Learning Foundation100 Meredith Drive Suite 100Durham, NC 27713Phone: 919-484-0012Fax: 919-484-0081Email: tllayton@earthlink.netName: Test Date Year Month DayGuardian’s Name Birth Date Year Mon th DayExaminer Chronological Age MonthsExaminer’s title Gender Boy GirlAddress ZipTelephone:Highest Age Scale:Typical Developing Child:Child with Down Syndrome:Developmental Scale for Children with Down SyndromeCopyright 2004 Extraordinary Learning Foundation 100 Meredith, Drive Suite 100 Durham, NC 27713
Developmental Scale for Children with Down SyndromeTypical Developing ChildrenChildren with Down syndromeBirth to 5 months Reacts to soundTurns head toward sound sourceWatches face when parent speaksVocalizes (coes, laughs, giggles,cries, fusses)Differentiated cry for different needsMakes noise when talked tooBegins to blow bubblesFixes eyes on spoon or bottleAnticipates feeding when sees bottleLaughs when playing with toySmiles at parentLocalizes sound source/speaker Reacts to sound occasionally Does not necessarily turn head towardsound source Does not necessarily watch face whenparent speaks Needs audiologic evaluation Minimal vocalization (cries, fusses) Ceases sounds when talked too6 – 10 months Understands some verbal commands(“no-no”, “sh”-quiet) Understands gestures (“come here”,“look”) Babbles (says, “ba-ba-ba”, “ma-ma”) Waves “bye” Tries to communicate by action orgestures Gestures and vocalizes to protest Points to objects and pictures Tries to repeat sounds Comprehends 10-15 words Recognized own name Extends arms to be picked up Sucks threw a straw Sits unsupported Stands holding on Seeks toys for appropriate play Comprehends “no-no”Does not babble until 10-12 monthsWatches face when someone speaksSmiles at parentLocalizes sound source/speakerComprehends less than 2-4 wordsNo oral wordsNo signs Engages with parentDevelopmental Scale for Children with Down SyndromeCopyright 2004 Extraordinary Learning Foundation 100 Meredith, Drive Suite 100 Durham, NC 27713
Typical Developing ChildrenChildren with Down syndrome11 – 15 months Comprehends 20 words Able to blow bubbles Tries to communicate by action orgestures Stands holding on (at around 12months) Chews semi-solid foods Understands some verbal commands(“no-no”, “sh” –quiet) Understands gestures (‘come here”,“look”) Waves “bye” Limited use of manual signs First oral wordProduces less than 10 wordsProduces animal soundsComprehends 50 wordsRecognizes family namesListens to simple storiesResponds to yes/no questionsGives toy or object on requestIndicates displeasure when toy isremoveInitiates vocalizations to othersImitates familiar sounds and actionsBrings object to show othersFeeds othersImitates patting a dollFollows one step commandsWalks at 12 months16-20 months Produces 10-15 wordsProduces familiar objectsSays own name on requestVerbalizes “no”Comprehends 50-100 wordsAsks questions by raising intonationat end of phraseAsks for “more.”Points to toes, eyes, and noseFollows simple one step commandsAcknowledges others by eye contact,responding, or repeating Identifies by pointingSucks threw a strawChews solid foodsWalks (at around 18 months)Seeks toy for appropriate playListens to simple stories being read(single lines per page)Indicates displeasure when toy isremovedComprehends 40-60 wordsRecognizes family namesGestures and vocalizes needsPoints to objects and picturesTries to repeat sounds1-2 oral words1-2 signs9Developmental Chart for Children with Down Syndrome
Typical Developing ChildrenChildren with Down syndrome21 – 25 months Comprehends 200-300 wordsProduces 50 intelligible wordsMay omit final consonantsBeginning of two word phrasesBegins to use some verbs andadjectivesRefers to self with pronounAnswers “where” and “what”questionsListens to longer storiesCarries out two stage commandsComprehends 100-125 words3-6 oral words10-15 signsFeeds othersImitates patting a dollFollows one step commandGives toy or object on requestInitiates vocalizations to othersImitates familiar sounds and actionsProduces animal soundsBrings object to show others Acknowledges others by eye contact,responding, or repeating26-30 months Comprehends 300-500 wordsProduces 50 intelligible wordsMatches colorsDeveloped routines for bedtimeNames one or two colorsUses negativesShares toysRefers to self with pronounUse some two word sentencesRefers to self by nameUnderstands concept of firstComprehends 150-175 wordsProduces first 10 –20 oral wordsUses 20-25 signsSays own name on requestVerbalizes “no”Points to toes, eyes, and noseFollows simple one step commandsListens to simple stories (2-3 lines perpage) Responds to yes/no questions Gives toy or object on request10Developmental Chart for Children with Down Syndrome
Typical Developing ChildrenChildren with Down syndrome31 - 35 months Comprehends 180-250 words Produces 30-80 intelligible words Produces 13-20 signs (starts to loosemany signs) Produces most familiar objects Omits many final consonants Responds to simple questions Listens to longer stories (e.g., GoodNight Moon.) Carries out one stage commands Understands concept of firstComprehends 500-900 wordsUnderstands several action wordsProduces 100 wordsConsonants mastered: p, m, n, w, hImitates three digit numbersUses some prepositionsSome pronouns are emergingUses first and last nameCounts to fiveInterested in how things workKnows parts of objects36 – 40 months Comprehends 250-400 words Produces 90-150 intelligible words Produces 10-15 signs Beginning of two word utterances Names several colors Counts 3 objectsConsonants mastered: b, d, k, g, f, yComprehends 1,200 wordsProduces 200-500 intelligible wordsListens to 20 minutes storiesMatches colorsKnows in/on/under; big/littleAnswers “who, why, where, howmany” questionsAsks simple questions (What’s that?)Uses “a” and “an in utterancesUses regular plurals (dog, dogs)Repeats sentence of six or sevensyllablesEngages in short dialoguesUses language in imaginative waysRequests for clarificationsNarratives are heaps: collection ofunrelated ideas Selects own story Carries out two stage commands Asks questions by raisingintonation at end of phrase Attends to longer stories11Developmental Chart for Children with Down Syndrome
Typical Developing ChildrenChildren with Down syndrome41-59 months Comprehends 2,500 wordsProduces 1,500 –2,000 wordsVery intelligible speechRecognizes most primary colorsCounts 10 objectsRepeats four digitsUses “what do does” questionsClassifies according shape, colorAsks meaning of wordsTells long storiesUses terms this, that, here, thereNarratives: unfocused -sequence ofevents but no central character Recognized icon symbols likeMcDonald’s arches, stop signComprehends 500-900 wordsProduces 200-300 wordsLimited sound-symbol associationRepeats three digitsKnows in/on/under; big/littleUses negativesTells short storiesRecognizes icon symbols likeMcDonald’s arches, stop signs Knows most letters of the alphabet Reads 15-20 sight words Knows first and last6 0 – 71 months Consonants mastered: t, ing, r, lComprehends 13,000 wordsUnderstands oppositesUnderstands more/less, some/many,several/few, most/least/ before/after,now/laterKnows half and wholeCounts 12 – 20 objectsNames letters of alphabetKnows first, second, thirdNames days of weekUses all pronounsUses comparatives (bigger) andsuperlatives (biggest)Uses 6 – 7 word sentencesNarratives: focused – centralcharacter with logical sequence butending is unclearReads 15 – 20 words Uses 3-4 word sentencesProduces 100-400 intelligible wordsComprehends 500-900 wordsProduces substitutions and distortionsof most fricatives (f, v, s, z, sh, ch,zh)Uses “a” and “an” in sentencesRecognized most primary colorsCounts 10 objectsUses some verbs and adjectivesRefers to self with pronounUses regular plurals (dog, dogs)Uses some pronounsAsks simple questionsEngages in short dialoguesReads short storiesHas sound phonics with some wordattach skills12Developmental Chart for Children with Down Syndrome
young children with Down syndrome. Developmental Scale for Children with Down Syndrome The Developmental Scale for Children with Down Syndrome begins at Birth and increases in 4 months steps until age 24 months, at this point it progresses in 12-month steps. The Scale ends when the child is just turning 6 years of age (or 71 months).
