Enacted in 1975, the All Handicapped Children Act (Public Law 94-142) was the first ever attempt to acknowledge and support special education services in an academic institution with the prime purpose of helping children with disabilities. This was followed by the Individualized Education Plan (IEP), which perhaps served as the primary foundation for each child's specific educational needs. One may thus observe that the salient aspects of these legislation have paved the path for school-age children with speech-language problems. In turn, researches and developments in medical sciences have provided each child a benefit that suits his or her particular educational and learning requirements. As with other special children, those suffering and diagnosed with Down syndrome are included in these specialized services, and evaluated through a set of guidelines, which focus on the speech and language treatment. A pivotal aspect is the inclusion of immediate family members who play a central role in the entire treatment process. As also mentioned in the opening lines, the Individualized Education Plan (IEP) begins when the child reaches the age of 3 years, and is termed as remediation model of education. The educational plan for those from birth to the age 3 is called the Individualized Family Service Plan (IFSP), and represents a prevention model. The following paper will however strive to present the various effective modes of teaching oral language to students with Down syndrome.

Introduction
Children suffering from Down syndrome exhibit a number of complex challenges for both the parents as well as their teachers. When the same child also has speech and language problems, these challenges take on an extraordinary appearance requiring for a truly comprehensive set of approaches to treat both speech and language disabilities. The following review of different literature will thus focus on the effective means to teach oral language to students with Down Syndrome, as well as strive to cover the treatment of speech and language problems in children with Down Syndrome in a number of different ways. Thus, the principle subject of teaching oral language to students of Down syndrome will be covered from the historical perspective, legislative, financial influence, as well as from the service delivery point of view.

Characteristics of Children With Down Syndrome
Before attempting to present the above said different perspectives, measures and criteria for teaching oral language to students with Down Syndrome, it would only be imperative to present some of the salient characteristics found in children suffering from Down Syndrome.

A brief historical background on children suffering from Down syndrome shows that originally it was found that children with Down syndrome showed tendencies to develop language similar to normal children, yet at a comparatively slower pace. The recent findings however have changed this earlier findings, and have revealed that there is significant evidence to suggest differences in both the language product as well as the language learning process (Stoel-Gammon, 1990).
One of the first characteristics observed in children with Down Syndrome shows that spoken language is generally found in children aged between 2 and half years and 4 years, with exceptional cases of children uttering words as early as 18 months. (Rondal, 1988b)

Secondly, one may also note that at age 3, an average child is expected to utter up to 18 words with a range from 0 to 85 words, which may be comparable with a normal child of 18 months. (Mervis, 1990; Rosenweinkel, 1988)
Third, findings by Mervis in 1990 have noted that children with Down Syndrome fail to enter what we normally assume as a 'vocabulary spurt' at this mental age, thus further delaying the onset of syntax required in the learning of the language. Comparatively, normal children of this age have the tendency to catch on new words every day, and hence their volume of vocabulary increases by each passing day.

Another study by Stoel-Gammon in 1990-1992 showed that normal children exhibit comprehension skills with the development of mental age, a case which is directly opposite in children with Down Syndrome, hence the slow pace of both syntax and vocabulary in the latter group of children. Similar studies also reveal that vocabulary and communicative functions are observed to develop at a faster pace as compared to the level of absorption and comprehension of syntax. (Stoel-Gammon, 1992; Fowler, 1990).

Other studies on the study and comprehension of syntax reveals that syntax has no set pattern of growth, and may vary according to each child. For example some children will continue to develop syntax from childhood to adolescence, while other may show extraordinary development of syntactic structures. This also implies that mental age has no bearing on the absorption of syntax development, and may not be considered a sound predictor. Furthermore, researches have also failed to pinpoint or categorize a specific period of language development, which differs with each child. (Fowler, 1990).

Further studies on the anatomy and physiology of the children with Down syndrome, as noted by Rondal in 1988a show that there is frequent use of routines or stereotyped expressions in speech. The same studies also show that the affect of Down syndrome on the anatomy and physiology of the children too undergoes significant changes. For example there are significant changes in the intelligibility of speech including the development of small oral cavity, an enlarged tongue, an elevated larynx, hypotmia of the speech muscles, and the underdevelopment of the sinunes. The physical and etiological appearance of the brain too witnesses significant changes as the Broca's area and the cerebellum is both smaller compared to the normal children of similar age. These underdevelopment of both Broca's area and the cerebellum in turn lead to deficits in cognitive and processing abilities as well as poor development of motor speech coordination. (Rondal 1988a, 1988b)

Studies carried out by Swift and Rosin in 1990 show that children with Down Syndrome also exhibit difficulty in processing sequential information, an aspect common in both oral-motor planning as well as control and language (Swift & Rosin, 1990).
Some of the commonly observed findings by an equally different number of researchers have revealed that some 60 - 80 percent children suffering with Down Syndrome have hearing deficits, while 20-50 percent have recurring otitis media. The children under discussion exhibit a greater percentage of visual-motor and visual-vocal modalities as compared to their abilities in auditory modalities. Other findings show that personal eye contact as compared with referential eye gaze results in a less response language modeling from both parents and teacher, in turn demanding more emphasis on teaching to the same children. Observation between parents and children with Down syndrome also reveals that there are more spatial and focal set of vocal communications, in particular between a mother and the child, as well as an increased tendency to use signs and motor imitation. This also shows that there is a faster reaction time for visual communication as compared to auditory signals (Pueschel, 1987; Gibson, 1991; Berger, 1990).

Speech and Language Treatment For Varied Group of Children with Down Syndrome.

From the above brief description of characteristics inherent in children with Down syndrome, one may observe that each child inhibits a particularly unique set of personality, and thus demands therapy according to his or her specific nature of deficiencies. It is therefore essential for teachers and parents alike to consider and suggest as well as design specific programs for each child separately, so that maximum benefit may be derived from the time and effort spent strengthening speech and language treatment programs.

One may also observe that though speech and language are two of the most sought after skills needed by an average individual, yet these aspects takes on a particular importance in case of children with Down Syndrome. Hence the need for a more comprehensive set of evaluation and assessment of communications skills, which also includes speech and language. Other skills that are and play an affective role in the treatment of children with Down syndrome include facial expressions, smiles, gestures, pointing, high five signs, and alternative systems including sign language and computer based systems. It would only be true to accept that both children and their parents/teachers can best understand as well as understood, whey they interact with each other in an environment that best suits the adaptability and comprehension skills of children under study. This is indeed possible through coordinated efforts by the parents, teachers, and members of the community, whether in the classroom settings, in the community, or at the recreational facilities.

Another vital aspect in the teaching of children with Down syndrome is the inability or absence of a single and pre-defined set of criteria that may be applicable for all the children with Down syndrome. This is also true for speech and language problems, as also the subject of our present paper, where there exists no single pattern for teaching that may be equally applicable to all the children.

For example, there are a number of children who have difficulty in expressing their thoughts; hence their inability to focus on language skills, yet at the same time the same category of students will exhibit an extraordinary set of skills when it comes to understanding and comprehending speech. Similarly other children with Down syndrome have strong receptive language skills, yet lack the requisite skills in expressing the same language. In similar context, there have been studies on children who have shown greater ease in understanding vocabulary, while at the same time these same children expressed difficulty when it came to grammatical aspects of the language. Similar problems are faced with certain children who have difficulty in understanding sequencing of sounds of words. Then there are certain categories of children who face difficulty in comprehending both speech as well as articulation, while others face problems in fluency. Thus, there are children who may utter words in short spurts, while others may continue and have long conversations. All this then leads us to deduce that there is no unique set of problems in either speech or language which may categorized and treatment offered to that respect. Since each child has his or her own set of individual traits and set of problems, there is an ever-greater need for understanding their specific problems, and addressing them separately and accordingly.

Hence, one may observe that both the speech and language treatment programs need to be designed with respect to the individual needs and careful evaluation of each child's communication patterns and requisite needs. In this context, the assistance and help of parents, teachers, and other members of the family can play an important role in the comprehensive treatment for such children suffering from Down syndrome. The said groups can duly come forward and positively contribute towards the communication needs of the respective child, in turn making him or her move towards a healthy life style. The role of speech-language pathologists too play an ever important role as they can guide, inform, as well as assist the child in upgrading his learning potential to reach a level of effective communication. For most of us, communication may be taken for granted, yet for children suffering from Down syndrome, communication plays an important part in their daily lives, and the only way to instill this vitally important skill is to practice and re-inforce communication as part of a daily life ritual. Only then can one truly accomplish the strenuous task of teaching a child with speech and language problems, while also addressing the respective child's physical, medical, emotional and psychological needs at the same time.

A Comprehensive Speech and Language Treatment Program
Numerous studies by equally different number of researchers, psychologists and pediatricians have concluded that since there is lack of information of a pre-defined or a set pattern of treatment for addressing the needs of children with speech and language problems. There is a requirement of a truly comprehensive set of speech and language treatment strategy/program, which can cater to majority, if not all the children suffering from Down syndrome.

One of the first findings towards this comprehensive set of speech and language programs revealed that the most important intervention begins at home, and during the period when the infant is born to the period when the infant commences to utter the first few words. In this respect, studies carried out by Kumin et al in 1991, and in coordination with the Loyala College coordinated a set of programs, which involved parents and children, and where therapy sessions showed a cent percent turnover. During these therapy session, parents and clinical advisors provided by the Loyal College interacted, and discussed each single activity of their respective child. These families were then provided with a set of skills to be practiced at home, so that the speech and language therapy sessions initiated at the college may be continued within the ease and vicinity of the homes.
In one of the first lessons provided by Kumin et al in their writings of 1991, it was suggested that treatment programs should be pursued with an emphasis on sensory stimulation. This includes for example such aspects as provision of activities and experiences to assist children in developing their auditory, visual, as well as tactile skills. This also included such skills as sensory explorations and sensory feedback and memory. As a result of such exercises, the studies revealed that the children learn to differentiate between the sounds of a bell for example, or the sensations of touching 'velvet or sandpaper'. An important aspect is to focus on the hearing status as the child with a Down syndrome is at a higher risk for developing otitis media with effusion. (Roberts and Medley, 1995).

In yet another recent findings by a group of researchers, there was a strong relationship observed between otitis media with effusion (OME), or fluid in the middle ear without any signs or symptoms of ear infection, language development, and academic achievement in typically developing children. These were found to be somewhat responsible for the inordinate delay in language that one may observe in Down syndrome. To overcome such problems, the pediatricians, otolaryngologists as well as the audiologist can monitor and assess the hearing status, and accordingly treat fluid accumulation in the ear. (Gravel and Wallace, 1995)

It need not be emphasized that the mode of learning is perhaps most successful, where thee is ample evidence of matching a child's preferred learning style, including both perception and processing. However, with children suffering from Down syndrome, the child has to move a step ahead and utilize his or her strengths in the visual modalities. This implies that the use of gestures and signs by parents and teachers prior to the linguistic period as well as during the learning stages serves as a 'bridge' for the respective child's transition to speech. Numerous researches have thus concluded that parents must make use of the sign language introducing it in the first year, and initiate for stopping the same when the child reaches the age of five years. It was further emphasized and recommended that the 'Total Communication Approach' should use the sign language through the first year, as also reiterated in the preceding lines. This should be followed by the use of oral responses together with the signs, and finally ending by allowing the child to use the actual words (Kouri, 1989; Simons Derr, 1983; Rosenwinkel, 1986; Swift and Rosin, 1990; Kumin, 1994; Jago et al, 1984; Clarke et al, 1986).

Further studies and importance of oral language preceded with signs showed that children suffering from Down syndrome and aged between 1 and 9 years yielded a number of positive results. For example parents of children between the stated years showed that more than 87 percent strongly recommended the use of signs, and that the signs proved to be beneficial. Some of the reasons cited for this immense percentage of success in parents using signs included the fact that signs provided an impetus for oral language. It also provided for means of communication as well as a positive measure for alleviating the child's moods of frustration. It was further noted that when the parents stopped using the signs, it was simply because of the fact that their children had developed speech skills, and that they had become more intelligible. This also provided significant evidence that signs served as a bridge to 'speech'. Though visual stimulation did provide for an impetus for faster receptive growth of language skills, the use of signs indeed reaffirmed its place as an important tool in the transition of a child move towards an environment of speaking populations. (ACN, 1992; Rosenwinkel, 1986).

Assisting Parents Make the Best Choice
The above studies on the importance of using sign language, followed by oral language and then moving on towards speech no doubt bears a distinct and clearly defined path for majority of the children suffering from Down syndrome. Yet, by no means is this the only method, and certainly not one that may be rejected altogether. As also proven by researches in the above section, each child exhibits a unique set of traits and characteristics, the assessment and evaluation of which is left to decide for by the clinicians, pediatricians, and physicians, as well as the parents. Hence, if the evaluation so demands that the child be pursued with a 'Total Communication approach', one that gives emphasis to sign vocabularies rather than oral vocabularies, there are certain rules to that respect.

However, it is most appropriate that parents, teachers and clinicians pursue a three-pronged strategy. These are for example, the use of signs must be introduced at an early age with all children. Or that the decision of using either sign language or oral language must be pursued on an purely individual basis keeping in view the child's respective needs. Or, lastly, strict compliance and adherence must be made for the use of oral-only approach. It is therefore the decision of the said caretakers to best decide, the appropriate course of action, and one that best suits the needs and abilities of the respective child.
To provide some evidence, as to why signs may not be at all suitable for children with speech and language problems, one may assess that a child may be in need of more frequent communication, thus bypassing the primary stage of using sign language. Second, parents may be willing to spend extraordinary attention and time, in turn providing their children general facilitation skills, once again bypassing the need to pursue a sign language strategy. These also prove that overall circumstances surrounding the choice for an appropriate mode of treatment for children, and teaching them skills to overcome their speech and language problems is truly an uncertain area of expertise, best judged only by the parents, teachers and physicians of the respective children.