A Facilitating Technique to Improve Speech Intelligibility in Individuals with Down's Syndrome

Simalee Smith-Stubblefield, M.A., C.C.C. - Assistant Professor
Karen Guidi
Department of Speech-Language Pathology, Thomas J. Long School of Pharmacy and Health Sciences
University of the Pacific
  Reproduced with the permission of the primary author.

Program Description

"See the Sound with Visual Phonics" is a system of 46 moving hand shapes that look and feel like the sounds they represent. This system also utilizes written symbols which are visual representations of the hand shapes. (See Appendix A)

The system was developed by the International Communication Learning Institute (I.C.L.I.) of Edina, Minnesota. Further developments and improvements to this system continue to be made by I.C.L.I.

In speech production, there are many ambiguities even with sounds that are visible, such as voiced (b, v) versus unvoiced (p, f) consonants. Vowel discrimination can be very difficult. In reading, there are always expectations to rules. For example, the allograph "ough" has the same "f" sound in the words "rough" and "tough", but in the word "dough" it has a long "o" sound. This system reduces the ambiguities of spoken and written English to allow for the exceptions to the rules by using a multisensory approach.

This may sound similar to Cued Speech, however, this system is different in several ways. In that system, random hand shapes and hand positions represent different syllables. In "See the Sound with Visual Phonics", each hand shape represents a sound which also has a written symbol that is in some way suggestive of the manner of production, it is not random.

During speech production and training, it is not necessary to "cue" each sound of each word. This system is to be utilized only as a cueing system, not as a communication system. For example, if the individual produces "ca" for the word "cat", all that is necessary to cue them would be the hand shape/movement for the sound "t" while saying the word. It is less cumbersome than one might think. However, syllabification and stress can be improved by cueing the entire word as one says the word. The system is flexible to meet each individual's needs.

"See the Sound with Visual Phonics" uses a multimodality approach which is the main reason it has been thought to be so successful, not only with hearing impaired, but with developmentally delayed, learning disabled and many other individuals who have difficulty producing speech and reading.

Background Information

Individuals with Down's syndrome often have a difficult time trying to make themselves understood when speaking. This population, unfortunately, often has decreased speech intelligibility. In order to help this population communicate in a more intelligible manner, several studies have been conducted to learn more about the speech of these individuals and what can be done clinically to improve intelligibility.

Some of the types of communication or facilitating techniques that have been used include the use of augmentative devices, computers, and sign language. All of these can facilitate communication, however, none of these actually help the individual to produce more intelligible speech.

The following study focused on the use of Visual Phonics to improve speech intelligibility in individuals with Down's syndrome.

Method and Procedures

Four children with Down's syndrome were selected to participate. They ranged in age from four years, ten months to nine years, five months. One of the children had a documented mild hearing loss. All children were highly intelligible and used sign language in different degrees to facilitate their spoken message.

All children were seen in the University of Pacific Speech, Language and Hearing Center by student clinicians who were trained in the use of Visual Phonics. Each child attended sessions that were one hour in length. These sessions also targeted other areas such as improving expressive and receptive language skills. Approximately 20 to 40 minutes of each session focused on increasing intelligibility.

Each clinician evaluated their client's overall communication, language, speech and hearing abilities. Three of the four children's hearing was shown to be within normal limits. The forth child had a documented mild hearing loss. Intelligibility ratings were taken with context known or unknown.

Each clinician selected phonemes that would enhance the overall intelligibility for each child. They also selected a functional word and/or phrase list often in conjunction with the parent. These words that were important to the child or were frequently used by the individual.

Parents were taught the Visual Phonics signs and symbols to enhance carryover in the home environment. They also occasionally observed the clinician work with their child for additional training information.


Age Language Rec Age Exp Pretreat Overall Intelligibility No Sessions Post Treat Intelligibility - Overall Post Treat Intelligibility - Target Improvement Overall Intelligibility
8:05   5:11 3:09 25% known 15 30% 40% 5%
4:10 4:06 3:04 29% unknown 22 41% 70% 12%
9:05 5:00 3:08 20% known 14 48% 74% 28%
5:01 4:00 3:06 40% known 23 48% 70% 8%


The overall intelligibility of all four children included in this study increased from 5% to 28%. Targeted functional words and phrases were also more intelligible after the introduction of See the Sound with Visual Phonics.

The production of the specific targeted phonemes increased. Another benefit realized when the children used the Visual Phonics hand signs was that it slowed their rate of speech which also greatly influenced intelligibility.

All the children enjoyed using the Visual Phonics hand signs but at times would over generalize then to other phonemes. Even though all children knew and used sign language, these two forms were not confused.

Visual Phonics was not the sole technique used to increase the production of sounds. However, this study indicated that it was a very useful multisensory technique that was effective with increasing intelligibility in those individuals with Down's syndrome.