“…While not all of these differences have a direct effect on speech production, they offer a starting point for discussing speech production abilities in individuals with Down syndrome. For example, absent and/or reduced bone growth in the bones of the head and face has implications for attachment locations and support of muscles used during speech production (Frostad, Chleall, & Melosky, 1971; Kisling, 1966; Roche, Roche, & Lewis, 1972; Sanger, 1975). Poorly differentiated midface muscles and/or additional facial muscles may contribute to difficulties with articulation (Bersu, 1976, 1980).…”