Speech impairment in Down syndrome: a review

Abstract

Purpose: This review summarizes research on disorders of speech production in Down syndrome (DS) for the purposes of informing clinical services and guiding future research.

Method: Review of the literature was based on searches using MEDLINE, Google Scholar, PsycINFO, and HighWire Press, as well as consideration of reference lists in retrieved documents (including online sources). Search terms emphasized functions related to voice, articulation, phonology, prosody, fluency, and intelligibility.

Conclusions: The following conclusions pertain to four major areas of review: voice, speech sounds, fluency and prosody, and intelligibility. The first major area is voice. Although a number of studies have reported on vocal abnormalities in DS, major questions remain about the nature and frequency of the phonatory disorder. Results of perceptual and acoustic studies have been mixed, making it difficult to draw firm conclusions or even to identify sensitive measures for future study. The second major area is speech sounds. Articulatory and phonological studies show that speech patterns in DS are a combination of delayed development and errors not seen in typical development. Delayed (i.e., developmental) and disordered (i.e., nondevelopmental) patterns are evident by the age of about 3 years, although DS-related abnormalities possibly appear earlier, even in infant babbling. The third major area is fluency and prosody. Stuttering and/or cluttering occur in DS at rates of 10%-45%, compared with about 1% in the general population. Research also points to significant disturbances in prosody. The fourth major area is intelligibility. Studies consistently show marked limitations in this area, but only recently has the research gone beyond simple rating scales.

Figure 1

The number of research articles on speech production in DS covered in this review, grouped in decade intervals since 1950. The number of articles is shown by category on the vertical axis and decade intervals are shown on the horizontal axis. The four categories are Voice, Speech, Fluency and prosody, and Intelligibility.

Figure 2

Plot of cumulative percentage of participants receiving a given intelligibility score in Kumin (1994). The horizontal axis is the intelligibility rating and the vertical axis is the cumulative percentage. For example, about 60% of participants had scores of 5 or less.