Ava is a four-year-old child who has Down syndrome. In which of the following areas would Ava be likely to have the most significant developmental delay?

• A. Social learning
• B. Spatial processing
• C. Visual memory
• D. Speech production

Answer: (D)

The area most affected in many children with Down syndrome is speech production. This family of challenges stems from oral-motor hypotonia, differences in oral structures, and slower development of expressive language. By age four, expressive language often lags behind cognitive and even receptive language in Down syndrome, leading to more noticeable delays in the ability to produce clear, intelligible speech and to form longer sentences. While social interaction can be a relative strength and some children may have good memory for visual information, the motor and linguistic aspects of speech tend to show the most significant delay. Early speech-language therapy, along with supportive strategies (and, when appropriate, augmentative communication), can help Ava develop clearer speech and expressively convey her thoughts.