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For people with Down syndrome, family members, caregivers and professionals.

Changes in Self-Talk

August 2021 | Brian Chicoine, MD - "Ask Dr. Chicoine" LuMind IDSC Foundation

We received the following question: 

My teenage daughter self-talks. Recently, it has taken over. It’s like there is a continuous narrative involving movie and music stars, family, friends, etc. Previously, she was very sociable and humorous. Her social activities stopped during the COVID-19 pandemic, and we are still not socializing normally yet. I have tried to use distraction to help her, but it only helps temporarily. Are there other strategies I can use to help her?

As you noted, self-talk is both common and typically a normal behavior in people with Down syndrome (DS). 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 issues

  • Consult your health care 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 are available in the Sleep section of our Resource Library. 



  • 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 for but seeking both virtual/video interactions as well as safe in-person options is encouraged.

Stress from a variety of sources


There are other factors we have encountered and some you may have encountered as well. The list above 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 mental health presentation includes some of the physical and mental health problems we consider.

For more information on self-talk, please see this self-talk webinar.

This article was adapted from a Q&A developed in partnership with LuMind IDSC Foundation. This Q&A is available for free along with other Q&As at

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We offer a variety of resources for people with Down syndrome, their families and caregivers and the professionals who care for and work with them. Search our collection of articles, webinars, videos, and other educational materials.

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Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.