Question:
My daughter Eve is 19, she began self talk about 2 years ago and that was ok, given that self talk is a normal way for people with DS to process their issues. However, it has recently taken over, she never stops, it’s like a narrative involving, movie and music stars, family and friends, she is generally giving out to people but not aggressive. Previously she had been so easy to parent, sociable , humorous, mainstream schooling. Her social outlet stopped with COVID, we moved house and we are still not socialising normally yet. Are there any strategies I can use, distraction is very temporary. We live in Ireland and it is very difficult to find professionals that understand the cognitive workings of people with DS.
Answer:
As you noted, self-talk is both common and typically a normal behavior in people with Down syndrome (DS). Please see this article and this article for more information on self-talk.
When self-talk changes, it deserves further investigation. For example, the frequency or volume of speech may increase, or the self-talk may start to include negative comments about oneself or become angry. It may also become that the individual is not talking to their own self but rather more to people not present. While talking to imaginary friends is also common in people with DS and often not of concern, assessing when there is a change in this aspect is also important.
One of the benefits of self-talk is that the individual can use it to manage or evaluate stress. People with DS will often “talk through” a concern where someone else may “think through” the concern. However, it should be noted, that more recent research indicates many people without DS also “talk through” (out loud) issues rather than or in addition to “thinking through” them.
Since it can be a way of managing stress, it is not surprising that it often increases or changes during times of stress. The stress may be related to changes in routine due to the COVID-19 pandemic that many people with and without DS are experiencing. It may be a physical health or mental health issue. It may be due to an interpersonal conflict. In general, any reason that one might feel stressed or challenged may result in a change in self-talk.
The first step is to assess for causes. What stressor(s) might be contributing? Below are some possible stressors and some possible solutions. During the COVID-19 pandemic, many people with (and without) DS have experienced stress for a variety of reasons. The pandemic has highlighted certain stressors, but they are not unique to the pandemic and they were issues for some before the pandemic and will be issues for some after as well.
| Health issue | – Consult your healthcare provider |
| Change in routine | – Develop new routines – Use visual aids to promote the development and implementation of new routines |
| Anxiety around constant news reports | – Acknowledge that a person with DS may find this stressful – Watch or listen to different programming – Limit the amount of time listening to or watching the news |
| The stress of those around her | – Many people with DS have what we call “empathy radar.” They “pick up” on the feelings of others and may respond to them. If you are experiencing a lot of anxiety, the person with DS may also. Acknowledge this issue and seek ways to reduce your own stress. |
| Sleep disturbance | – The stress of events and people around her may cause sleep disturbance that exacerbates the problem. Review and strengthen sleep hygiene. Additional resources on sleep can be found at this link. |
| Isolation | – Certainly, isolation has been a significant stress during the pandemic but may be at other times, too. We note this particularly as people with DS complete school and their connection to a wide variety of peers may change. This can be more challenging to find solutions to but seeking both virtual/video interactions as well as safe in-person options is encouraged. |
| Stress from a variety of sources | – Sensory strategies and relaxation strategies can be helpful for managing day-to-day stresses. |
There are other factors we have encountered and some you may have encountered as well. The table does contain some suggestions for addressing the problems. As you mentioned, distraction or redirection is another option. We generally find redirecting someone “to something” rather than “away from something” is more effective. In other words, rather than directing her away from self-talk, direct her to another activity.
If those methods are not successful, the concern increases, or the self-talk increasingly limits or impedes a person participating in life’s activities, we recommend considering a medical and possibly psychological assessment. This link takes you to a presentation we did on mental health that includes some of the physical and mental health problems we consider.