Downs Syndrome: Becoming Just One of the Kids
The Listening Centre
599 Markham Street
Toronto, ON, M6G 2L7 Canada
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Reprinted with the permission of the author|
Originally presented at the meeting of the Association for Down Syndrome of Mexico City in 1989
© 1989 Paul Madaule
As recently as four decades ago, children with Down syndrome were
not expected to live until adulthood. Thanks to modern medicine and,
above all, to the move away from institutional placement to home
rearing, the life expectancy for people with Down syndrome is almost
the same as that for the rest of the population.
The second major result of children being raised at home with
loving, attentive families is the uncovering of the hitherto unseen
potential of these children who were believed to be severely
retarded. Now, the majority of children with Down syndrome are
moderately to mildly retarded with small numbers having severe
difficulty and small numbers in the low normal to normal intelligence
As we observe new generations of children with Down syndrome who
have had exposure to infant stimulation programs, increasing
integration and normalization, new speech and language therapies, and
tools such as the computer, many parents and professionals feel we do
not yet really know what the true potential of these children is.
Significant Steps in the Right Direction
Many of the conclusions drawn about the intelligence of Down syndrome children are in fact unreliable because these children have
such poor receptive and expressive language skills. According to Laura Meyers of U.C.L.A. (Meyers, 1986, 1987), children with Down
syndrome have a slow processing which prevents them from hearing
short words, especially conjunctions and articles which are critical
in the construction of sentences. This leads them to use single or
multiple words instead of complete sentences when they express
themselves. To compensate for this difficulty, Meyers devised
computer programs which help the child to complete the sentences.
Once again, the traditionally acknowledged limitations of these
children are being challenged.
We also know that many children with Down syndrome have poor
muscle tone which results in a distinctive posture characterized by a
curved back a slouched shoulders. This poor muscle tone also gives
some children an expressionless facial mimicry and a tendency to keep
their mouths open with their apparently oversized tongues protruding.
Speech production, in particular articulation, is adversely affected.
The work of Dr. Alfred Tomatis (Tomatis, 1974) shows that the ear
is actively involved in the processing of language and in the
auditory control of speech. He has differentiated hearing, which is
the passive reception of sound from listening, which is the active
focussing ability of the ear. The middle ear, through the action of
its muscles, acts like radar, selectively directing hearing toward
the sound of interest as in the case of language sounds we want to
perceive. This active involvement of the middle ear is not only the
first but also an essential step in auditory processing. For Tomatis,
the way listening works is comparable to the ocular function in
The rate and precision of the adaptation of the "auditory radar"
is critical in verbal expression. Close observation of the
neuro-muscular links between the middle ear and the phonatory
apparatus sheds light on these audio-vocal connections. The
trigeminal nerve (5th cranial pair) and facial nerve (7th cranial
nerve) are both involved in the production of voice and speech. The
trigeminal innerves the temporal and masseter muscles instrumental in
the closing of the mouth. The facial nerve innerves the digastric
muscle involved in the opening of the mouth as well as the muscles of
the lips, which are so important in the articulation of speech.
Tomatis stresses that the same trigeminal nerve also innerves the
hammer muscle (tensor tympani) and the facial nerve innerves the
stirrup muscle. These two muscles are located in the middle ear and
are in charge of its regulation. Poor muscle tone slows down the
movements of the middle ear muscles affecting auditory processing and
the auditory control of speech. The resulting inability to produce
the shorter words (described by Laura Meyers), prevents proper
construction of sentences. Slow auditory processing and auditory
control of speech are typically observed in children with
listening-related speech, language and learning difficulties (Tallal,
Poor middle ear regulation may predispose the individual to ear
infections. These are commonly experienced by children with Down
syndrome, (chronic otitis media) producing further middle ear
dysfunction, which, in turn, impedes listening even more.
Dr. Tomatis has also shown that high frequency sounds send more
neural influx to the brain, and thus provide it with energy. In
speech, the higher frequency range is concentrated mostly in the
timbre of the voice. The poorly articulated voice of many children
with Down syndrome lacks timbre and is, therefore, poor in high
frequency content. Not only does this vice provide very little energy
to the brain but it also requires a considerable amount of energy to
be emitted. The resulting depletion of energy affects not only
language expression but also the thinking process as well as body
functions such as posture, balance, motricity and co-ordination. It
may also affect lateral dominance. Poorly established mixed dominance
is a common trait in the Down syndrome population. In addition, poor
posture affects breathing which is so important in speech and general
mental alertness. In response to all of the above, a child with Down syndrome, usually a keen communicator, has every reason to avoid
verbal expression as a way to socialize.
Physical and occupational therapists (Heiniger & Randolph, 1981) recognize the vital need for body movement early in the lives of these children. Movement stimulates the brain through the
vestibular system of the inner ear and literally "feeds" it with
energy. Poor muscle tone contributes to the tendency of some children
with Down syndrome to be physically passive. For this reason, their
need for stimulation through physical contact, exercise and sound is
Most children generally love music and readily sing and dance children with Down syndrome are no different. Sensory stimulation
such as music and motor stimulation such as dance should be a part of
the education of these children from as young an age as possible.
This will "feed" their nervous system with the energy they greatly
need. Music is composed of highly structured series of sounds and
contains most of the elements, which constitute language pitch,
rhythm and timbre. Listening to music, singing and dancing help the
child with Down syndrome to prepare the sensor-motor neuro-muscular
tracks involved in the acquisition of language.
The Tomatis Method Applied to Down Syndrome
Dr. Tomatis has used his method of sound stimulation and
counseling to help children and adults with Down syndrome at his
Paris Centre for over 25 years. The Listening Centre in Toronto and
other North American centres using the Tomatis Method have been
helping these children for the last five years. Results are
considered very satisfactory in more than 70% of the cases. (For
further information, see Gilmor, Madaule & Thompson, 1989).
The following section is an attempt to classify the different
levels of intervention of the Tomatis Method when applied in cases of
Down syndrome. This classification is based on progress most commonly
observed and reported during and after the sound stimulation.
- It provides "high energy" sounds or, as Tomatis calls them,
"charging sounds". These sounds come from violin music by Mozart
which is modified by filtering out the low and medium frequencies and
electronically densifying the higher frequency range. The mother's
voice when modified through the same electronic process has a similar
beneficial effect with these children.
- It actually "exercises" the middle ear muscles, increasing
their tonicity by using the above described high frequency music
through a device called the Electronic Ear. This apparatus is an
amplifier with two channels, each of which has its own filter system.
The incoming sound is dispatched from one channel to the other
through electronic gates. This provokes a repetitive pattern of
flexion-relaxation of the ear muscles as any good exercise does. This
exercise increases the child's level of vigilance and alertness,
making him or her more attuned and more responsive to external
stimuli. It also improves muscular control, posture and body image
- It helps to establish or reinforce auditory dominance to the right
by a progressive decrease in the sound energy level received by the
left ear. Increased facial expression is often observed near the
beginning of the sound stimulation program. This is followed by a
greater ability to construct phrases and sentences. Improved
coordination as well as a better sense of time and space are also
- It helps to establish or reinforce the audio-vocal control loop
through active vocal exercises with the Electronic Ear. After his
listening ability is improved with filtered sounds, the child is
asked to repeat songs, words and sentences. The child's voice is
picked up by a microphone, processed and modified with the Electronic
Ear and fed back via the headphones to his ear. This modified loop
makes the child listen to himself the way a "good" ear would hear his
voice while singing or speaking. The result is a faster and more
precise control of vice production at the level of phonation,
articulation, intonation and rhythm. Better audio-vocal control not
only makes speech production easier and clearer but also permits more
elaborate sentence structure. Consequently, the thinking process is
enhanced. Furthermore, the child increasingly enjoys expressing
himself verbally and does so with more spontaneity. This helps to
improve his relationship with peers and his overall socialization
The Tomatis method also provides counseling for the families of
any child attending The Listening Centres including those with Down
syndrome. This counseling usually leads parents to a deeper
understanding of the hidden and untapped potential of their child and
to ways of helping the child make use of it.
Children with Down syndrome are more like typical children in the
community than they are different. Just like other children they have
their unique personalities, personal preferences, strengths and
needs. Their developmental pattern is identical to that of any other
child but may unfold more slowly. While their pace of learning and
motor development may be slower, their difficulty with spoken
language should not keep us from acknowledging their capacity for
learning and thinking. Children with Down syndrome can generally
expect to master basic academic skills such as reading and writing.
Integration and normalization offer children with Down syndrome
the greatest opportunity to develop their potential, especially when
this is reinforced by remedial tools and techniques such as speech
and language therapies, recommend that parents make use of
recreational and cultural programs to develop their children's
Parents must also remember that children with Down syndrome, like
all children, need to like themselves and feel good about who they
are. Good self-esteem is critical for good mental health and
The job of a family is to raise these children to independent
living. This is no different for families of children with Down syndrome even though they may make varying amounts of effort to
prepare their child for independent living in the community. Children
with Down syndrome need to learn skills ranging from playing with
their friends to using public transportation, banking, working, and
The Tomatis Method is also recommended for children and adults
with poor muscle tone and control due to genetic or neurological
causes. It can be particularly helpful for children suffering some
forms of cerebral palsy. Better posture, balance, speech and language
are most commonly observed. It is often reported by the physical and
occupational therapists of these children that they are keener to
accept and be actively involved in therapy during and after the
listening program. We attribute this change to a better
self-acceptance including greater acceptance of their body.
In the light of such results, the frontier which separates these
children from being "normal", whatever meaning this word still
manages to retain, is yet again challenged.
Gilmor, T.M., Madaule, P. & Thompson, B. (1989), (Eds.) About The Tomatis Method. Toronto: The Listening Centre Press.
Heiniger, Margot, C. & Randolph, Shirley L. (1981), in Neurophysiological Concepts in Human Behaviour: The Tree of Learning. Boise, ID: The Tree of Learning Press.
Meyers, Laura F. (1986) "By-Passing Scaffold", Proceedings of the 1986 Closing the Gap Conference.
Meyers, Laura F. (1987) The Language Machine, College Hills Press.
Tallal, Paula. "Auditory Perceptual Factors in Language and Learning Disabilities". In Knights, R.M. & Baker, D.J. (Eds.) The Neurophysiology of Learning Disorders: Theoretical Approaches. Baltimore: University Park Press.
Tomatis, A.A. (1974) Vers l'Ecoute Humaine, Tome 2, Edition ESF, Paris.
Paul Madaule graduated in psychology from Sorbonne University in
Paris. He worked for 10 years with Dr. Tomatis before immigrating to
Canada in 1978 to participate in the development of the Tomatis Method
in North America. He is presently a co-director of The Listening
Centre in Toronto and consults network of centres and school boards
using the Tomatis Method in Canada, the United States and Mexico.
- The author wants to thank Louise Bailey for her help in editing
this paper. Mrs. Baley is the director of The Baley Progressive
School, 272 Codsell Avenue, Downsview, Ontario, M3H 3X2.
- See also "Walking Sleeping Souls" by Jerry Adler and Lisa Drew,
Newsweek: March 28, 1988. There are unpublished summaries on her
investigation available upon request from PEARL Software, 5000 N.
Pakwy Calabosas, Suite 105, Calabosas, CA 91302.
- Other work of interest is that of Christine Nelson, Ph.D. and
Raquel Behabibi at the Centro de Aprendizaje de Cuernavaca, Rio Balsas
14, Col. Vista Hermosa, Cuernavaca, Morelos, Mexico 62290.