Sunday, May 17, 2009

Memory Development

Memory is the storage system for all information and new learning. Researchers have observed and suggested that the long-term memory function (skills learned and events recalled) for children with Down syndrome is good. Therefore we will focus on the short-term memory abilities and how to improve them.

The short-term memory can be compared to a computer CPU (central processing unit) that has two distinct hard drives, one for verbal/auditory information (called the phonological loop) and one for visual information (called the visuo-spatial scratchpad). More good news; the visuo-spatial short-term memory spans for our children is comparable to those of typically developing children of similar non-verbal mental age (mental age as determined through non-verbal skills).

However, verbal short-term memory spans, which play a critical role in learning to talk, are specifically impaired. There are several contributing factors to this phenomenon and studies continue to explore how and why these factors influence the phonological loop function.

The first thing to remember is that brain functions usually show dynamic development, meaning they are positively influenced by input and activity. Over time, with consistent intervention, a child with Down syndrome can improve his phonological loop function, thereby increasing his working memory function. This is important for many thinking skills but especially for the development of expressive language (speaking).

Keys to Increasing the Phonological Loop Functionality
After studying the factors that influence the development of the phonological loop, researchers have found several ways parents can help their babies, starting in infancy.

Good Hearing
It is imperative that your child be able to accurately hear words in order to differentiate between them. You can maintain good hearing ability by vigilantly protecting your child’s ears. Your baby should have a hearing test at birth, 3 months, 1 year old, and every year thereafter, and at any other time you think your baby is showing signs of hearing loss. Ear infections are the main contributor to hearing loss in children with Down syndrome.

To avoid ear infections as much as possible:

  • Do not nurse or bottle feed your baby when he is lying down, as the milk can flow into his ear canals from that position and cause infections.

  • Wash your hands, and make everybody else in the house do it too, often. Get some Purell, or another anti-bacterial hand sanitizer and use it prior to touching your baby. Clean your baby’s hands with Purell and then a baby wipe anytime he has been out in public touching stuff other people/children have touched. Be a germaphobe, it’s ok.

  • Do not expose your baby to any second hand smoke. This includes smoke residue on someone’s clothes, hands, face, and in their hair. Someone smoking outside and then coming in and holding your child is still second hand smoke exposure, according to the pediatric cardiologist that attended the babies in the PICU we were in. I heard him give the "talk" to many parents (he had a nose for cigarette smoke!)

  • Stay up on your baby’s vaccinations. Don’t let the controversy over some vaccines keep you from protecting your baby. You can ask for the flu shot that does not contain thiomersal (which has mercury in it) and you can hold off on the MMR until your baby is 2 or even 3 years old. (The MMR is the vaccine that has been questioned for its possible link to autism.) But do consider getting the pneumococcal conjugate vaccine and the influenza vaccine (the flu shot), since they protect against illnesses that are known to bring on ear infections. (Read the comments for this post to hear other parents' thoughts on vaccines.)

Instill a Love of Reading

Research has shown that children who are better readers show bigger gains in short-term memory ability. Daily reading instruction has a huge influence on the capacity of the phonological loop. In preparation for a preschool reading program, it is important for your child to be motivated by picture and story books. Reading picture books to your baby also provides visual support for learning language. Remember that your baby’s visual hard drive is one of his strengths and can be used to aid the development of the verbal hard drive. So go ahead and read to your infant for at least a few minutes everyday. Make it a special time that is comfortable and enjoyable.

Exposure to a Good Spoken Language Environment
Speak often and very clearly to your baby using child-directed speech. If you are not sure what to talk about with a newborn, you can describe what you are doing to her, or describe the things in her view. Do not use baby talk when speaking to your baby, as it is very important that she hear correctly spoken words from the beginning.

Also, try to include children’s songs that have sequencing in your repertoire of songs you sing to your baby (i.e. One, Two, Buckle My Shoe and There Was An Old Lady Who Swallowed a Fly) This helps to lay the groundwork for learning activities associated with phonological loop development that will become important in primary school.

This also means inclusion for your baby right from birth. If you have to make choices about your new baby’s environment (daycare or other programs) consider that a natural speaking environment is more stimulating and will provide more accurate language feedback for your baby than an environment where there are many children with delayed or impaired speech.

Play Babble Games
It is important to play babble games with your baby to encourage speech sound discrimination. Babble (i.e. ma, ma, ma or bla bla bla, etc.) to your baby and then give her a chance to babble back to you. Make sure you give your baby some extra time to reply since it often takes a baby with Down syndrome a little longer to process and organize responses. In the first months of her life you won’t get a babble response but starting as early as the 7th or 8th month, you will start to hear your baby babble back to you. (For us it was around 9 months old and only after she started eating puffs, which got her mouth moving in a new way.)

Evidence has shown that it is important to begin speech work in the first year of a baby’s life. There is a speech sound program, in book form, by Swedish speech and language therapist, Irene Johansson, that details how to provide specific ranges of speech sounds and combinations for your baby. The book follows a week to week format and is aimed at children with Down syndrome and/or autism. (If the expense of keeping up with all the latest books on Down syndrome is overwhelming, consider asking your local Down syndrome support group if they have a library and if they would include this book in it. Then go borrow it!)

Play Auditory Discrimination Games
To build on speech sound recognition you will want to move up to word recognition when your baby is ready. As soon as your baby is able to point and has comprehension for 50-100 words you can begin playing word discrimination games using pairs of picture cards or objects whose names rhyme or sound similar (i.e dog and frog, chair and bear.) You can ask your child "Which one is the chair, the dog, etc.? Then have your child point to the object.

Keep It Up
The activities I have mentioned are specific to improving your baby’s short-term memory function, attention span, and memory’s processing capacity. Research has found that these gains will not last over time if training and support for memory skills are not continued. Improving the short-term memory and all that comes along with it is a life-long endeavor, but the proven benefits are well worth the effort.

Straight From the Source
If you are interested in understanding the details of short-term memory or in reading the research I used (um, even somewhat plagiarized for your edification), you can read the publication Memory Development for Individuals with Down Syndrome by Sue Buckley and Gillian Bird online. The publication details strategies for increasing memory function for children up through the teenage years, so for those of you with toddlers and older children, it might be worth reading for the information I did not cover here.

Picture Credit
Lily from A Walk in Lily's Garden


  1. What an awesome resource with some great ideas, thanks for sharing it. I have read to my daughter since she was a baby and she absolutely loves books and loves to read. These certainly are ideas that have been proven to work.

  2. Lots of good information, as usual, but I have to take issue with the blurb on vaccinations. Every parent, whether of "typical" or "enhanced" children should do their own research and make their own infored decision on this. I don't believe at all that the risks associated with vaccines should be characterized as "hype." There is real risk associated with vaccines. If there weren't, there would not be a Vaccine Court whose sole purpose is to deal with vaccine-related lawsuits, and there would not be a fund set up by the government to pay out to persons harmed by vaccines. I'm not saying that those things prove a correlation between vaccines and injury, but it certainly proves that there is a possibility of a correlation. The problem, as I see it, is that some kids are genetically predisposed to suffering injury from vaccines, and some are not, and there is no way to weed out who is and who isn't. Every parent needs to weigh the risks for themselves. As for us, we had all of our kids vaccinated on schedule, but by the time our fifth baby was born I was questioning a lot of the vaccines. I won't do newer vaccines, and I won't do flu shots. When I was pregnant with Finn, I agonized over whether we would do vax with the new baby or not (and this was before we knew he had Ds). When we received his Ds diagnosis, it muddled things even more. Apparently he has a compromised immune system because he has Ds - which on the one hand is a strong argument in favor of having him vaccinated. On the other hand, it's interesting to me that if your child is ill (i.e., their immune system is temporarily compromised), the doc won't give shots until s/he is well. I also know that Finn is at a higher risk of developing autism because he has Ds - one of the many things he's at higher risk for. In the end, after a lot of reading and a lot of soul searching, we decided not to have him vaccinated. The risk of him contracting something he would be vaccinated for are pretty slim, and I just couldn't live with the risk of him developing some neurological injury from a vaccine on top of his having Ds. I am completely at peace with this decision, and our pediatrician has supported us in this decision. We may do selective vaccinations when he's a little older, but for now, none. So all I'm saying is that every parent should do their homework on this and make an informed decision.

  3. Lisa,
    Well spoken. I have vacillated on this issue since my first was born six years ago. I held off on, and split up, every vaccine he got. My 2 1/2 yo still hasn't had the MMR. I do believe that the mercury in vaccines is what is causing the problems.

    Sadly though, my daughter contracted bacterial meningitis in the hospital and suffered some neurological damage from it. I saw other babies who had viral meningitis who were not so lucky as her. It really scared me. Since we live near a large city and my children attend school with little-world-travelers, I did decide to have my daughter vaccinated with everything except the MMR.

    You are right that it is a very personal decision that must be weighed individually for each child given his or her particular circumstances. My use of the word hype is not really appropriate and so I will have to rewrite that paragraph! Thank you for pointing that out and for sharing your seasoned thoughts on this subject.

  4. Good information! I called the local Down syndrome association and they don't have Language Development in "Children with Special Needs" on their current list. They did say that they had just ordered several books for their library and have not updated the list yet. In any case, they said they were going to order the Language Development book if it's not in amongst their new arrivals. Thanks for the suggestion! By the way, the book costs $31.95 on

  5. Sandra, not to belabor the vaccination issue (and thanks for addressing my initial comment!), but I wanted to share that both of my twins contracted viral meningitis when they were two months old, and ended up in the hospital for 5 days. Fortunately they did not suffer any long-term damage from it (although my understanding is that bacterial meningitis is much more dangerous than viral). At the time, we were vaccinating on schedule, but they had not yet received their meningitis vax, and I wondered/agonized for a long time afterwards if they would have avoided contracting meningitis if they had received the vaccine. It's been a long time since that all happened (the twins are now 4 1/2 years old), and I've since learned that even receiving the vaccine possibly would not have protected them because the vaccine only protects against certain strains of meningitis, not all strains, and there are many. Same with the flu vaccine - my understanding is that it is developed each year in anticipation of what strain the experts think is going to be present a year down the line. It's a lot of guesswork - I don't doubt that a ton of research goes into it - but a lot of times the flu vaccine is not effective because they're wrong about the strain, and sometimes they just don't develop a strong enough vaccine to actually ward off the correct strain.

    Anyway, these are all things that go into my own personal decision-making process. And like I said, I am not completely anti-vaccination (all of my kids except Finn are fully vaccinated except we don't do flu shots or rotovirus, and I'm very wary of any new vaccines that are offered).

    I would add to the list you posted of things to do to improve a child's memory, cognitive ability, and speech: breastfeed! In a lot of cases, nursing a baby with Ds comes with unique challenges, but I would encourage parents to make every effort to breastfeed, because the benefits (including natural immunity boosters, benefits to brain function, development of oral-facial muscles that will aid in speech development which bottle feeding does not provide) to children with Ds are unique and important.

  6. Hello Sandra, you give some good advice, especially about the ears and speech. You sound like my speech therapist. I think Gaby is going to need ear tubes. I have listed my therapists as authors on my blog, so they should be giving some solid tips for babies as well. Thanks for all your help. xox Jasmine

  7. Hi Lisa,
    That's my next post... breastfeeding... and I have been debating listing the benefits for fear of bringing too much pressure to the decision. It is such a touchy subject and with the sometimes added difficulty of ds-related issues, it is too hard for some. I am going to try hard not to come across like the BF Police!

    I am appreciative of you sharing your opinion and your experiences. That kind of dialogue is what will make this blog really helpful to new parents.

    How'd you get your therapists to agree to write on your blog??? I am jealous ;-) I will be looking out for those tips.

  8. Great blog! I just wanted to mention the new research linking the pneomocoocal vax to an increase in pneumonia cases. I read that it's killing the weaker strains which allows the stronger ones to thrive. I vax selectively, but my dd already had this one. I would also love to read about breastfeeding. I am a staunch supporter and worry that it can be a "turn-off" to some.

  9. Wow I totally love this blog. Thank you for your recent post on mine, becasue now I've had the chance to read yours and it is so informative and interesting!! I have to pace myself and not go crazy with all the great ideas! What you say here...the purpose of your blogging in the first place, is the very reason why I had the desire to blog too. I believe we are making a difference. We are a part of the movement that will change the hearts and attitudes of our neighbors, our community, our nation and the world in which we live. Thank you for your passion to inform, share and educate!

  10. Sandra...THANK YOU so much for the great blog! I have a one year old, Jack, with DS. I work in the medical field, so I try to read all the research articles I can get my hands on, but I am left unsatisfied. I love that your blog comes from your experience, which is so much more useful! This post just sucked me in and gave me something to focus on and work on with Jack. I am a very goal oriented person that likes direction and I LOVED the suggestions!

  11. Hello. I'm back. I forgot to mention in my recent comment that another good book to read is "Early Communication Skills for Children with Down Syndrome" by Libby Kumin. That might also give you more ideas for future posts. ;-)
    Keep up the good work. You, Jill and myself and other bloggers are making a difference within our communities as we share the same purpose for starting our blogs and pour our hearts and souls into our writing.


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