Communication Development

Communication difficulties are common in individuals with Down syndrome. Charlie's Clinic is committed in supporting total communication for all patients

You can read more about communication development in children with Down syndrome in the following resources:

Speech Therapy

Speech therapy is fundamental in supporting a child's speech and communication development

There are a few ways of obtaining speech therapy services

From 0-3 years old:

  • You can receive speech therapy through your medical insurance
  • If your insurance does not cover the service, or if the insurance cannot provide an adequate network leading to excessive wait times, the Regional Center can provide this service

3 years and up:

  • You can receive speech therapy as part of your IEP, paid for by the school district. Your IEP needs to have speech and communication goals that justify the need for speech therapy services
  • You can ALSO receive speech therapy through your insurance. If your insurance does not have anyone in network, you can request a single case agreement with a provider who is not in network

Need a recommendation?

Our clinic works a lot with a wonderful speech therapist, Dr Bettina Larroudé , Ed,D, CCC- SLP

Dr Larroudé has over two decades of experience working with children with Down syndrome. She is bilingual in English and in Spanish

She is trained in Talk Tools, and integrates oromotor work and total communication into her daily practice

Here is her website

Total Communication

Charlie's Clinic, collaborated with Dr Bettina Larroudé , Ed,D, CCC- SLP (a speech therapist with over two decades of experience working with children with Down syndrome), and Raquel Ramos, RN, BSN, PHN (a nurse and the parent of a lovely young man with Down syndrome), to create a total communication toolkit for families to use as a resource.

You can access the toolkit below. We recommend printing it out and laminating it, to make it easy to use. It includes signs, pictures, and words, to provide your child with numerous options for communication

ASL Communication Tool

There are many other free resources on the internet

Here are some examples:

There is no greater gift than communication.

If you are planning on introducing sign to your child, check out some simple rules here


Oral Motor Skills

• Oral-motor skills: Ability to use the lips, cheeks, jaw, tongue, and palate. Includes oral exploration, feeding, and sound play

• Feeding: Gathering food and preparing to suck, chew, and swallow it

• Speech: Communicating verbally Consists of articulation, voice, and fluency

Oral Placement Therapy (OPT) uses a hierarchical based approach to improve speech clarity and feeding skills in individuals of all ages and across diagnoses. These innovative techniques focus on motor movement activities used to improve phonation, resonation, and speech clarity.

Combined with a tactile-sensory approach, OPT provides a comprehensive solution to a variety of speech and feeding issues. OPT involves the use of therapy tools to train and transition muscle movements for speech production.

Talk Tools is one type of oral placement therapy

Need a recommendation?

Heather Vukelich, MS CCC - SLP works inside the doors of the Down Syndrome Connection of the Bay Area (Non-Profit in Danville, CA). She has extensive experience in speech clarity, oral motor and feeding development. Heather is an Instructor for Talk Tools.

Her areas of focus include:

- Speech development - Apraxia and Dysarthria

- Articulation development - Increasing strength and sensitivity using the TalkTools Hierarchies

- Oral motor development - Facilitation of normalized oral motor skills for speech clarity, feeding and airway development

- Myofunctional Disorders - Treats/evaluates tongue/lip ties, tongue thrust, open mouth resting posture, unwanted oral habits, nasal breathing

- Feeding Therapy - Facilitates successful transitions from bottle to straw, spoon-feeding, and proper chewing development

Heather also collaborates with local dentists, orthodontists, ENTs and physicians regarding oral, facial and airway development.

If you are interested in finding out more about rates and insurance reimbursements, give her a call! The Down Syndrome Connection has some scholarship funds available as well

Her website:

Her Instructor Page on TalkTools:

Here is a seminar given by Heather Vukelich, SLP and a local dentsit, Dr. Brian Hockel ( on Airway, Apnea, Orthodontics, and OPT

Augmentative and Alternative Communication

You may have seen someone write in a notebook to answer a question. Maybe you have seen people using sign language or other gestures. You may have seen someone push buttons on a computer that speaks for them. These are all forms of augmentative and alternative communication, or AAC.

AAC includes all of the ways we share our ideas and feelings without talking. We all use forms of AAC every day. You use AAC when you use facial expressions or gestures instead of talking. You use AAC when you write a note and pass it to a friend or coworker. We may not realize how often we communicate without talking.

People with severe speech or language problems may need AAC to help them communicate. Some may use it all of the time. Others may say some words but use AAC for longer sentences or with people they don’t know well. AAC can help in school, at work, and when talking with friends and family.

Types of AAC

Do you or your loved one have difficulty talking? There are options that might help. There are two main types of AAC—unaided systems and aided systems. You may use one or both types. Most people who use AAC use a combination of AAC types to communicate.

Unaided Systems

You do not need anything but your own body to use unaided systems. These include gestures, body language, facial expressions, and sign language.

Aided Systems

An aided system uses some sort of tool or device. There are two types of aided systems—basic and high-tech. A pen and paper is a basic aided system. Pointing to letters, words, or pictures on a board is a basic aided system. Touching letters or pictures on a computer screen that speaks for you is a high-tech aided system. Some of these speech-generating devices, or SGDs, can speak in different languages.

The Down Syndrome Connection of the Bay Area has a whole page devoted to AAC on their site. It includes multiple presentations on AAC, as well as information on how to access their lending library