Language Delay and Disorders 19Case Study 1-7: Language Therapy in a Teenager With
Down Syndrome
In many ways, Elroy is a typical teenager. That he was born with Down syndrome does not
detract from his teenage ways. In fact, his easygoing, pleasant personality, typical of individuals
with this chromosome disorder, is an antidote to the surly ways of many 17- year- old boys. Elroy
still has the typical male teenage angst, aggressiveness, and misdirected energy, but he seems more
responsible than many of his peers.
Elroy works in a sheltered environment. Friendship Industries employs many teen agers and
adults with special needs, and at this shop there are three persons with Down syndrome. At 17,
Elroy is one of the youn gest employees, and he has worked there for 4 years. He is assigned to the
Day Old Bread Store. Teddy’s Bread Com pany, a local bakery and distributor of breads and pastries
to grocery stores, restaurants, and fast- food establishments, generously donates their older and
nearly stale bakery products to Friendship Industries. They are sold in a small free-standing red
building on the grounds of the sheltered workshop. The products sold in the store are discounted
by more than half of their retail price, and many people in the community purchase bread there.
Occasionally, customers return a loaf of bread when they discover spots of green mold, but usually
they are satisfied.
Twice a week, two student clinicians and their supervisor from the university come to
Friendship Industries to provide speech and language therapy to the employees. Elroy’s student
clinician works on language pragmatics, counting change, and teaching him to follow the instruc-
tions on how to rotate the loaves of bread. Elroy is having trou ble with the concept of bread rota-
tion. Each loaf of bread is sealed with a small colored tab. Few customers realize that the color of
the tab indicates when the loaf was baked. These tabs tell the bread distributor when a loaf of bread
is getting old and needs to be pulled from the shelves. They also tell Elroy what loaves should be at
the front of the shelf so that the oldest bread is sold first, reducing the number of loaves that need
to be discarded.
Elroy has learned to count change well enough to work behind the counter, even during the
busiest times. Largely due to what he has learned in language therapy, he carefully computes the
change customers receive. The clinicians taught him how to use the cash register and to double-
check his figures. Only once has a customer reported being short- changed, and the supervisor
found that Elroy was correct. Another customer complained about how long it took to serve her,
but Elroy’s slow, meticulous handling of money is encouraged.
The student clinicians are teaching Elroy to follow written instructions for bread rotation.
They have given him a laminated sheet of paper showing which day the bread was baked and
the color of the tab that denotes it. To help Elroy understand bread rotation, the clinicians have
placed colored marks on a large calendar. In language therapy, they have taught Elroy to examine
the calendar to learn the day of the week. Once this is determined, he notes the color mark next
to it. Although Elroy knows the colors, it has taken him several months to learn the relationship
between the numbers on the calendar and the days of the week. Now that he has mastered the
calendar, the clinicians have written on another laminated sheet of paper: “If today is ‘blue,’ then
‘black’ should be at the front of the shelf. If today is ‘yellow,’ then ‘purple’ should be at the front
of the shelf.” Each rotation schedule is identified accordingly. In addition, the words referring to
colors are written in appropriately colored ink, and the procedure is illustrated.
Today, Elroy is “ going solo,” as the clinicians call it. He has achieved all of the therapy objec-
tives in the clinical situation, and now he is to put into practice his hard- won education about
bread rotation. With both clinicians trailing him, Elroy walks to the Day Old Bread Store. A new
delivery of bread has recently arrived, and in the stock room he sorts the loaves onto trays by the
color of the tabs. He looks to the clinicians for approval, which is given by a thumbs-up gesture.