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'Exploring Fluency in Down Syndrome', by Monica Bray

Ben Bolton | 11.05.2016

Book review by Ben Bolton, Speech and Language Therapist, of Exploring Fluency in Down Syndrome: A discussion of speech dysfluencies for professionals and parents, by Monica Bray.

'Exploring Fluency in Down Syndrome: A discussion of speech dysfluencies for professionals and parents', by Monica Bray.People with Down Syndrome often experience difficulty talking in a fluent, easy way. But what do we mean by fluent or easy? And why does this present a particular challenge for people with Down Syndrome? Monica Bray is well placed to help answer these questions. She is a Speech and Language Therapist who has a whole career’s worth of knowledge and experience of working with children and adults with Down Syndrome, their parents, families and carers.

Exploring Fluency in Down Syndrome: A discussion of speech dysfluencies for professionals and parents presents a comprehensive overview of why talking is often difficult for people with Down Syndrome. It views fluency as far more that simply whether a person stammers or not, which in the case of people with Down Syndrome is extremely useful. The book is divided into four sections. These lead the reader through what we may mean by ‘fluent’ or ‘dysfluent’ speech, how communication skills develop typically and the challenges experienced by children with Down Syndrome, what factors may affect fluency, communicative competency, attitudes towards communication, and finally what we can consider to help people move towards easier, more fluent communication.

Each chapter builds a picture of a communication system under pressure

Readers may be forgiven for assuming that the majority of this book will concern stammering, and may therefore be slightly surprised to find that a large proportion concerns other communication difficulties experienced in Down Syndrome. However, that is not to say that it does not concern fluency. Each chapter builds a picture of a communication system under pressure. This book opens up the discussion and invites the reader to consider the fact that dysfluent speech comes from comprehension, processing, grammatical, speech and pragmatic difficulties. To highlight this further the author uses the bucket theory, which may be familiar to Speech and Language Therapists but possibly less familiar to other readers. The theory compares a person’s language system to a bucket which, as we deal with day to day communication activities, gets filled up by the amount of processing we have to do to understand, find the words, build sentences, find the sounds, articulate words etc. The harder the system works the fuller the bucket becomes until it overflows and speech becomes dysfluent. Bray’s skill in dealing with complex theoretical models, research evidence and experiences and converting them into clear, easy to read chapters is wonderful and allows the reader to feel confident in approaching such material.

Throughout the discussions of theories and research about communication breakdown, Bray uses examples of real children, teenagers and adults with Down Syndrome. This helps the content make sense and gives it a ‘real life’ perspective, which can’t help but encourage the reader to consider the people they know and work with who have Down Syndrome. To capture the fine detail of these extracts, Bray uses phonetic transcription. This may appear daunting and difficult to interpret for a reader who is not familiar with this system. However, bear with it, the examples are all followed by a thoughtful and accessible discussion of what each one shows about the communication difficulties experienced by the people involved in the conversation. Also you can listen to the audio CD, which makes it less important to read and understand the detailed transcriptions.  By using these examples the reader builds up an understanding of the multidimensional nature of fluency difficulties in Down Syndrome. The same children come up throughout the book which leaves the reader feeling as if they know these children in some way, and gives a deeper understanding of just why talking may be difficult for them.

The same children come up throughout the book which leaves the reader feeling as if they know these children in some way

The book ends with a discussion of what can be done to help people with Down Syndrome move towards easier communication. Rather reassuringly this is not about ‘fixing’ stammering. There is an overview to remind us that fluency should be viewed as part of a whole communication system under pressure, and Bray encourages us to address these pressures rather than fix the stammering. Traditional approaches to working with people who stammer often include working on the covert features of stammering, which Bray suggests do not exist in people with Down Syndrome in the same way and are therefore unhelpful to consider within this context. Likewise dealing with fluency modification head on is likely to increase the demand on an already overloaded system. The responsibility for helping people with Down Syndrome speak more fluently lies with all of us; specialist Speech and Language Therapists for stammering, generalist Speech and Language Therapists, support staff, parents, family members etc. In fact Bray gives a very clear message that we all have a role to play in supporting people with Down Syndrome to talk more easily and not necessarily have to meet the high standards that we as a society set as far as talking is concerned. The outcome is not necessarily complete fluency, but helping people with Down Syndrome enjoy talking, and feel that they are good at it.

This book is hugely useful

This book is hugely useful and I doubt it will be far from my desk from now on. Whether you are a Speech and Language Therapist working with a specialist fluency caseload, people with Down Syndrome or a generalist role this book helps to develop a deeper understanding of the communication difficulties of people with Down Syndrome and how these impact on fluency. It also provides parents with a valuable source of information to help develop their own understanding of what to expect, and how to help, their children enjoy communication, whilst gently helping to manage expectations. I would heartily recommend this book to anyone who has an interest in Down Syndrome, fluency difficulties, or both together. Whether you are knew to the topic or have years of experience this book will add to your knowledge and shape your thinking.

Ben Bolton, Clinical Lead, The Stammering Support Centre, Leeds.