Friday, July 08, 2011

Language Acquisition

Let's talk about language.

Having helped with many adoptions and read up on international adoption, I know in my head that generally within the first 3-6 months most children will "lose" their first language gradually if they aren't exposed to it in their new home environment.  From 6-9 months is generally a frustrating time for a child to express language since their thinking and speech and everything is "converting" to the second language.  From 9-12 months, a child generally gets full language acquisition in their new language, of course within reason since learning is constant no matter whether adopted or moved between languages, etc.

Many parents note that their new children who don't have developmental delays are able to speak in full sentences in English as soon as 2-3 months after initial exposure, and by about 6 months appear to have full language acquisition.

Often times children with Down syndrome have no speech in their native tongue.  Some cultures don't place importance or even really conceptually believe it is possible, on teaching children with Down syndrome to speak.  Those children that are over age 4-5 that are having to acquire speech from the very beginning stages but are fully capable of learning often begin using words and phrases within the first 2-6 months and acquire decent communication, whether in full sentences or not, by around 5-6 months home.  This doesn't mean they've learned their second language, but can communicate yes and no, understand general spoken commands given to them, and express their own basic needs such as toileting, playing, being hungry, or being hurt.

I'm speaking VERY generalized, and in this, none of my own children fit in to this model.  Emma is not a child who "had no speech in her native tongue but was fully capable of learning, because she has other issues from her medical complexities.  Micah was adopted at 18 months and at 4 1/2 is acquiring some speech, use of sign, and has recently begun following more complex directions and such.

Then, we come to Wesley, who has been home just over 6 full months now, and is understanding quite a bit of what is going on around him.  He appropriately nods yes and no, and does so playfully telling us no with a big grin on his face when he wants to tease.  He understands familiar basic commands such as to take his hands out of his mouth, to stop, to wait, to drink or eat, swallow, chew.  He understands high five, to 'come here' (and he tries!), and other basic things that are within his realm of ability.  He has some vocalizations which aren't quite getting in to understandable things for the most part, but he is trying... and part of his disability is his difficulty with the muscle control in his mouth.

Lastly, we have Aleksa, and the reason for my post :).  Aleksa has also been home for 6 months and although from her social skills, her cognitive (seeming) ability in figuring out routines and her ability to adapt well to new situations, Aleksa has not developed much speech at all.

Here are some of the things she IS doing with some notes about some difficulties she may have with them:

  • waving "hi" and "bye" and with visual prompting, approximating the words (though bye is not easy for her without a strong visual reminder).  Her 'words' are all 2-syllable, therefore "hi" is "hiya" and "bye" is something with two syllables.. not always resembling 'bye'.
  • requesting use of the restroom by signaling to her body parts which expel it... it works... for now...
  • giving hugs, kisses, high fives, and handshakes to people if visually requested (or at random to strangers when we're not close enough to keep her from doing it!).
  • getting her shoes out of the shoe drawer when asked to put them on (often requiring signing along with it).  She can find her own play sandals, but church sandals she gets her own and Lynae's mixed up... they are different designs and sizes, but both pair are white...
  • She can use the restroom independently and wipe independently with visual reminders to wipe her back side well, or a little assist.
  • She can dress independently, putting her underwear on first, then shorts, shirt.  She doesn't get them on in the right orientation (inside out, backward, etc).  When asked to take her shorts off and fix them, she will often take off her shirt or vice versa.  She doesn't recognize when she hasn't gotten her clothes on correctly and doesn't focus when we explain how to lay out her clothes so she has them on correctly, or when we point out the tags in the front, etc. if she has them on backward.  She also will take off everything if she doesn't understand what is being said.  For instance, if she puts on her shorts and underwear correctly then say "great job, Aleksa!" she may sit down and take them back off. 
  • Aleksa will hold her siblings' hands when we are out places and is good with staying close by us now.  he will grin and start to stay back or walk another way, but when asked to come 'hold' (usually a hand or the side of a stroller), she will do so and stay with us.
  • She has learned (usually) to wait to eat until everyone has sat down at the table for a meal and we've prayed together.  She even folds her hands and bows her head to encourage us all to go faster, knowing that when we're done praying she can dig in :)
  • Aleksa will help pick up toys, though she often invests her pick-up efforts in to signaling others with pointing and 'grunts' to pick the toys up rather than doing much of it herself, as we see in several other realms as well.
  • Aleksa can put a nighttime pull up on and generally stays dry throughout the night.  When she is getting dressed in the morning, she hasn't figured out that the diaper goes in the diaper pail and the clothes go in the hamper.  After repeatedly telling her to put the diaper in the pail, almost every morning we have to signal to the diaper pail to get her to put the diaper in it, and open the hamper for her clothes.  She "freezes up" when she thinks she is doing something wrong, and will stand there "flipping" whatever she has (diaper, if it's when she's changing clothes, or her underwear/shorts/shirt if she's been asked to take one of those off and fix it).  
So... there's a little glimpse into our world.  I by no means think that she is just ignoring us completely, though it has been a thought.  We are having her hearing tested next month.  She appears to hear sounds, at the very least, but she doesn't appear to have picked up much language at all.  It's as if she hasn't been hearing us speak to here continuously for the last 6 months... to have learned some basic things like underwear, shorts, shirt.

She seems to come when called, and follows routines well.  I'm really at a loss as to what we're really dealing with (as far as her not gaining language goes) if it's not her hearing.  Aleksa appears to be doing very well and for lack of a better way to put it, she is "mid-high" functioning as far as her physical abilities, memory, and social aspects of life.  YES, we are having bonding difficulties, but that is unrelated to this (and slowly making strides in the right direction).  And yet... we are still struggling SO MUCH with language.

This is probably the most frustrating part of life right now for us and her.  We are signing with her all the time, and she is repeating some signs as well as using some independently.  She is very good at figuring out the "means to an end" and will sign more, please, thank you, sorry, etc... when she has needs. 

So... if you've adopted a child with Down syndrome that seems to have a potential for developing language (whether they used their first language or not), would you share?  How old was your child at adoption and how long before they began to acquire language? There are 4 types of language... receptive (understanding), expressive (speaking), body language (social/ situational), and sign language (actual signs learned).  Right now, the first two we are at about 4-5 words each.  MAYBE.  The second two, we're doing pretty well.


  1. Alina had basically no speech in Ukraine. She would repeat 'Paka, spaseeba, parjalsta' but they were jumbled like 'Pata, beeba, joshta'. She's been home for 8.5 months and she has a speech delay (likely from her CP) but she talks non.stop. She understands everything from about 3/4 months home and about 5/6 months home she started really speaking. She repeats everything and she doesn't miss a thing. Its so individual, we really thought she would be delayedi n Ukraine but nobody every talked TO her, once she figured out that words have meaning she just started talking all the time.

  2. Meredith - how are her verbal imitations - like, can she imitate sounds of any kind (animal noises, motor sounds, anything that someone does even if they aren't supposed to!)? Does she seem to have oral motor control in drinking, does she drool, that kind of thing? These are just very general but I would be curious to see.

  3. I've, or course, no experience at all... but just from the perspective of an "outsider" I want to encourage that had you not described the "average" for children to acquire language, I would be astounded as to how well it sounds she is doing. She is of course much older than Charlie (who is 5, but at age 2 developmentally), but I was going to say she sounds as though she is higher in language than Charlie, a native speaker. In fact, she sounds very much like my 3 year old typical son, who is advanced in language. We often need to reiterate things for him, point out his clothes are on backwards, remind him where the hamper is. He too excels in "means to and end" communication, and I've always been told this typical. She sounds so normal, and to think she is new to the country, new to family life, new to having responsibility in so many areas. I understand your concern, and that it is likely frustrating, but she sounds as though she is doing miraculously well.

  4. I have no personal experience to share with you but just a thought that struck me as I was reading. The first is that at least with one of the examples you gave (and I know this is just one example and doesn't fit the whole issue) of her taking off her shirt instead of her shorts or vice versa is that some kids have a hard time distinguishing vowel sounds and that could be why she is getting those confused since the words are so similar. But again, that's obviously only in that one instance. The other thought I had was that maybe you could have a speech therapist evaluate her to give you more ideas of things you can do to help with the language acquisition even if she doesn't see the ST regularly. You've probably already thought about that but it was just something that came to mind. I hope/pray that you can figure something out or that if it is her hearing that is causing the problem that once that is addressed her language will take off. Not being able to communicate can cause a lot of frustration for everyone involved. Hopefully others will have more personal ideas too. :)
    Cristina (a reader who rarely comments)

  5. I do not have a child w/ DS. However, I have kids w/ FAS and many other developmental delays. Also, have a child w/ hearing issues. If her hearing comes back fine, you still may want to request an ABR. our son has AN(auditory neuropathy). They can hear you but their hearing is chaotic and they basically can not understand you b/c they are hearing the sound literally different each & every time. In addition, they'll show anywhere from a mild hearing loss to profound. And different each time. We could go one day & Nik's would be mild hearing loss. Next day, it would be profound. It really does boggle the mind but explains so much. Just throwing thoughts out there as to why she may not be acquiring language as much. Good luck with everything. Stephanie

  6. Joey, age 10, adopted from Ukraine at 6.75 years, was speaking in Russian at about a 2 year old level at the time. If the subject was known to the listener, and the listener knew Russsian, he could be understood. He had a few phrases that he used that we could understand. He could also cuss like a Russian sailor! OUr daughter could clearly understand exactly what he was saying, but after being home 3 years, could not translate because she "didn't know those words in English yet!". He understood English quickly, and although he is difficult to understand now, he does speak in full, if somewhat non gramatically correct, English sentences.

    James, non DS, but FAS, adopted at almost 7 from Ukraine with his bio sister, age 14 (the one who told me what Joey was saying!LOL) lost his native language within 6 weeks. He has been home 7 years now, and will occassionally have a moment when you can tell English was not his first language.

    Jacob, age 11, adopted at age 10 from Serbia, has very little expressive language. We were told that he was "mute" and "could not communicate". Well, he is not, and he can. He has about 20 signs that he uses spontaneously, and quickly. We notice that he does not have difficulty processing verbal information, but can answer quickly and accurately. He is beginning to consistently put 2 signs together. He is making some sounds, and still very much an infant in playing with his voice. We encourage him to use words, but he will probably be a mainly signing communicator.
    The thing that struck me as I was reading about ALexa, though, is it does sound almost as if it IS attachment related. She is remaining in control. She does not want for you to control her, as she feels not safe unless she is in total control. This could be a way that she exhibits this control. We see this frequently with Joey, especially. And a lot lately.
    Is her hearing ok? The other thing that we noticed with Joey is that despite him being pretty bright, and clearly higher functioning, he has learned very little academically. I really think this is because he spends all of his energy trying to control in every situation, that learning colors or numbers is just not high on his it is something someone else has required of him, making him not in control.
    Just a thought.
    Mary Stolz

  7. Hi Meredith, I have followed your blog for quite sometime but I cannot recall if I have ever commented. As a speech language pathologist, your post title caught my eye and of coarse I had to come and read. Just for some background and so you know I am not just spouting off I serve the children throughout my county with the most significant needs. Most of which are in self contained classrooms. My specialty is Augmentative Alternative Communication and I have spent most of my adult life researching this topic and working with children and adults with special needs. I felt compelled to write as I know all too well how frustrating a language deficit can be. I in no way want to step on the toes of your SLP but the truth is most of my colleges are not sure how to approach AAC or children with significant language, motor and/or cognitive needs. As I am sure you know learning language is extremely complex and draws from several areas of our brain. First off ... motor planning. Our brain must be able to send the signals to the articulators to form the words we see, it is the same with signing. This of coarse is broken down into sounds and then blending those sounds to create the words. Second .... our cognition. We must be able to not only associate the words we learn with objects but also across many situations in order to know when to use those words and how to use them. Third ... cognition again in the form of receptive language. Breaking it all apart and interpreting what is being said to them. Now as you can imagine when you have to learn to communicate and you have to use all these systems and decipher all the signals coming at once and what should be coming out, the pathways tend to get a little "blocked up" and slower moving in a processing system that is already challenged. When you take away the need to figure out just one of those factors mentioned above you open up those "pathways" for more efficient synaptic travel if you will. For instance if I teach a child to use a communication device I now take away the need for them to concentrate on learning completely new motor postures in their mouth, I take away the frustration of teaching a sound over and over only to have to be repeated anyway because the listener didn't understand it and I now free up more opportunity to be able to concentrate on understanding what is being said to her and thinking more about the language than the formation of the words. NOW LET ME ASSURE YOU, I DESIRE FOR ALL CHILDREN TO COMMUNICATE WITH THEIR OWN WORDS, WITH THEIR OWN VOICE BUT MORE THAN ANYTHING I WANT PEOPLE WITH SPECIAL NEEDS TO BE HEARD AND UNDERSTOOD. I DON'T WANT TO MISINTERPRET THEIR HOPES AND DREAMS AND IF IT TAKES A COMMUNICATION DEVICE TO BE ABLE TO DO THAT THAN BY ALL MEANS I WANT TO GIVE THAT TO THEM. Now there are a million and one ways to teach a device an I can assure you I am very opinionated about just how you do that. I won't get into any of that. I just wanted to offer you another option. I believe a well rounded understanding is MOST important as parents in general and even more so as parents of children with special needs. Please feel free to email me at sband3 @ gmail. com (remove the spaces)if I can help you in anyway. My hope is to see EVERY child/person develop a method for sharing their hopes and dreams with the world! This is rather long ... so sorry. Please don't feel obligated to post it. I just wasn't sure how else to get you the info.
    Forever in HIS grip,

  8. I wondered about Aleksa's hearing too as I read.

    I also just wanted to point out that the "full language acquisition" a child develops within 9-12 months of adoption is every-day social language. Academic fluency takes longer. My brother (typically developing) who was adopted at age 10 was understanding everything at home and communicating easily within a year, but when he started school he often had no idea what was going on. (In ESL books they says Basic Interpersonal Communication takes 1-2 years to develop fluently, cognitive academic language proficiency takes 5-7 years. Of course, that is with ESL students still speaking their first language in their home environment, it's faster with adopted children from what I've observed, but it's still a long process)

  9. Hi Meredith,

    I think you might be on the right track with hearing. A lot of what you described is exactly how it was with Macey. While she could hear sounds etc... she learned to survive, follow routines and figure out things by watching. At times when we would correct her or say great job she would get confused just as you described with Aleska. Other times it seemed that she was hearing well (I would say things that I knew she loved or wanted while behind her) She would pick right up on. Other times it seemed as if she was being defiant or ignoring us so I would test my theory again. Unfortunately there is no real way to tell if our children have fluid on there ears or not there by hindering their hearing on and off. Macey however has normal hearing in one ear but significant hearing loss in the other...that is if there is no fluid. Tubes and hearing aids have made a significant difference for her and eliminated a lot of frustration. Even as we are approaching our 4th anniversary as a FF her language still has gaps. Things that I would think she should know the name of or have the word for sometimes are not there. I may not have even noticed some of the gaps had we not started homeschooling back in January. In the past before we got the hearing aids she would lose her tubes and it takes so long to get into the ENT here that she would go silent and rely on sign only. I have heard this very issue from many parents so we made macey attempt to speak the word of the sign she was using. She would sign to me and I would give her a quizical look sign it back and say I cannot hear you? She would sign again and I would put my hand to my hear and say can you use your words too and help me.... If I felt she just didn't know the word I would use the sign and word and then ask if that was what she wanted.... if she shook her head yes or no I would say you say it too... she didn't have to get it right but she at least had to make a sound and I would praise her and follow through on her request. Today Macey is speaking much better still unclear in a lot of areas and of course it is always easier to figure out the unclear item if it is in context. Her acquistion still far exceeds her verbal but still has some gaps. I am not sure if she ever had any language in her own tongue or not. Okay that is a bit of our experience hope it made sense.

  10. Hi Meredith,
    We've had our kids home a bit longer than Aleksa and Wesley, but your description of Aleksa sounds very close to our oldest girl, who is six. She babbled a lot when we first got her, but all the russian speakers said she wasn't saying anything recognizable. Then her babbling started to sound a lot like english, but still not recognizable. At first she would attempt to say anything I asked her, and it usually didn't sound anything like what I was asking for. Now she is pretty quiet except for the occasional long sentence which is incomprehensible, or short bursts of "Mom!" "Hi!" "Bye!" "Be nice!" or "I eat!" We encourage lots of babbling, and we speak clearly, too. We always respond when the kids speak, although we don't know if it's the right response or not.

    The other two kids are four years old, and the girl makes a few "words" like "Bau!" or "Doo!" with some occasional babbling mixed in. Her approximations of a word can be pretty close, but that doesn't mean she'll use it. Our boy said, "yeah!" in various tones of voice for months, then "gack!" for months, and now no special "word" that I can put my finger on.

    All three kids seem to be neck and neck when it comes to receptive language, and even though the boy has some other issues going on, and likes to ignore us, they all seem to understand about the same amount. Same as you mentioned with mixing up shirt and shorts, or undressing when you say, "Take off your shoes." Mixing up commands to throw something in the garbage vs. in the laundry.

    We've been working on body parts consistently for about 7 months, but still lots of confusion. They love to point to "eye" but always need the cue. New thing lately: "where is your hair?" answer with sign for "bear" or "where are your feet?" and answer with sign for "eat."

    We haven't consulted a speech therapist yet, since they seem to understand more and more english every day (granted, it's on a very slow schedule) or had their hearing tested, since everyone seems to be the same as far as answering when called, and obeying commands (with the exception that the boy doesn't babble like the girls, and has issues with following commands anyway.) Our boy would be the most likely to have hearing issues based on his behavior, but he is a boy, and does have the autistic tendencies thing going on, so we're just giving him some extra space. We're giving the kids a "babyhood" with us, while we get acquainted, and try to identify their strengths and greatest needs. Not attempting much academically, just reading to them, etc.