Key Points
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Self-talk is talking aloud to oneself or an imaginary friend.
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Many adults with Down syndrome (and adults without Down syndrome) talk to themselves.
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Talking to oneself is usually not concerning and can have many beneficial functions.
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A change in self-talk can be a symptom of a change in physical, mental, or social health.
What is self-talk?
Self-talk is talking aloud to oneself or an imaginary friend. It is a common finding in young children (without Down syndrome) but usually by age 7 or 8 years, children will shift to having these conversations silently or in their own head. However, research has shown that many adults (without Down syndrome) still talk to themselves at times. For example, studies find that many athletes talk aloud to themselves as a form of self-motivation, to spur themselves to greater achievement. In adults without Down syndrome, self-talk and imaginary friends have been found to be linked. Those that had an imaginary friend in childhood tend to self-talk more in adulthood.
Self-talk has many functions including being used to:
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process information
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learn new skills
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solve problems
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review the day's events
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cope with or escape from challenging situations
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manage anxiety or self-regulate
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direct behavior
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become self-aware
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counter boredom and/or entertain oneself
Although talking to oneself may sometimes be viewed as inappropriate and/or concerning, self-talk is usually neither of those but rather an effective strategy to learn, to cope, and to manage one’s tasks and life events.
Why is self-talk important in Down syndrome?
Self-talk is very common in adolescents and adults with Down syndrome. It is used by people with Down syndrome for the same reasons as noted above. Many people with Down syndrome also have an imaginary friend or friends and seem to use interactions with those individuals like they use self-talk. In 1997, we reviewed the histories of individuals evaluated at the Adult Down Syndrome Center and found that 81 percent of those adults with Down syndrome engaged in conversations with themselves or imaginary companions. Our particular interest in self-talk at that time was that many of those individuals had been prescribed an anti-psychotic medication by a previous health professional. Based on the finding that they talked to themselves, many had been diagnosed with psychoses or schizophrenia because the self-talk was often being equated with “hearing voices and replying to those voices.” That practice of prescribing anti-psychotics based solely on self-talk was (and still is) concerning and often inappropriate.
Preventing misinterpretation of self-talk as a sign of psychosis in adults with Down syndrome was and is a major motivation for our researching and sharing information about self-talk. In addition, there are many positive aspects of self-talk including use in the promotion of physical, mental, and social health. For example, many people with Down syndrome describe coming home from work, going into their room, and talking to themselves about the events of the day. It can reduce stress and anxiety, help them learn from the events of the day, and plan for the next day’s work. Many families describe encouraging (or at least not discouraging) this behavior because it has mental health benefits as well as improving the individual’s ability to do their job and manage their lives.
Response to self-talk
While self-talk is usually a healthy behavior, it may be necessary at times to discuss self-talk with an individual with Down syndrome because of a problem or challenge. For example, some individuals with Down syndrome have been asked by others not to talk to themselves in certain settings because it is disruptive (e.g., in a classroom). Self-talk is appropriate, but the individual may need to learn social skills on when and where self-talk can be used effectively without being disruptive. Our recommendations include:
It may also be appropriate to provide information or educate those individuals who are interacting with the person with Down syndrome. Sometimes it is not about changing the person with Down syndrome but rather (or in addition) educating others as to the nature of self-talk in people with Down syndrome - that it is usually not concerning, it is common, and it can have many benefits.
What if there is a change in self-talk?
Most individuals with Down syndrome can use self-talk in positive ways and learn how to deal with the social implications of self-talk with regards to time and place. However, sometimes the self-talk will change and become less functional, angrier, and/or more frequent. It might have aspects of self-flagellation (excessively telling themselves they are wrong or “bad”). Often, the person can no longer follow the lessons of appropriate time and place and, therefore, they may become more disruptive to others. Self-talk may increase or change when the person is socially isolated, when under stress, or when they experience an episode of “cognitive disruption” (they are having difficulty explaining or understanding personal events or experiences). A change in self-talk can be a sign of physical, mental, or social stressors and should be investigated.
There are many reasons self-talk may change in a person with Down syndrome. These may include physical and/or mental health issues as well as social stressors. The following are some examples of factors that may contribute to a change in self-talk and some possible responses:
Change in physical or mental health
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Consult your health care provider. Additional information on when a change in behavior (such as self-talk) occurs can be found in our Behavior Change article.
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Sometimes the self-talk will become quite intense, efforts to redirect the individual back to his or her usual activities are not successful, and/or the individual becomes very “lost” in his or her world of self-talk and imaginary friends. While it can be difficult to decide where self-talk ends and psychotic behavior begins, it may be necessary to get further evaluation and treatment. Additional information is available in chapter 20 of our Mental Wellness book.
Change in routine
Stressful social situations
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Many people find certain social situations stressful, and this is true for some people with Down syndrome as well. These may include:
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Large social gatherings
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The need to perform a task (particularly one that the person finds difficult) in front of others. For example, some individuals find answering questions difficult and, during a doctor appointment, will try to quickly defer to have their family answer.
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Situations or places that remind the individual of a previous sad or difficult event. For example, if they became ill after going to a place, they may get anxious anytime they go even close to that location.
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Acknowledge that a person with Down syndrome may find these situations to be stressful.
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Help them develop strategies to manage or avoid these situations.
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Sensory strategies and relaxation strategies can be helpful for managing day-to-day stresses.
When others around the individual are under stress
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Many people with Down syndrome have what we call "empathy radar." They "pick up" on the feelings of others and may respond to them. If people around the individual with Down syndrome are experiencing a lot of anxiety, the person with Down syndrome may sense and experience that stress.
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Acknowledge this issue and seek ways to reduce the stress of the person with Down syndrome as well as the stress of those near him. See links above to sensory and relaxation strategies.
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More information on empathy radar is available in chapter 4 of our Mental Wellness book.
Sleep disturbance
Isolation
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Isolation can be a significant stress. We note this particularly as people with Down syndrome complete school and their connection to a wide variety of peers and activities may change. This can be more challenging to find solutions for but seeking virtual/video interactions, safe in-person options, and other activities is encouraged. Resources are available in the next section.
Resources
Activities You Can Do at Home
Addressing Challenges with Falling or Staying Asleep
Behavior Change
Fun Activities for Promoting Health
The Groove in People with Down Syndrome
Mental Wellness in Adults with Down Syndrome: A Guide to Emotional and Behavioral Strengths and Challenges, 2nd Edition
Recreational and Social Opportunities
Resources on Healthy Ways to Manage Stress and Strong Emotions
Self-Talk in People with Down Syndrome Webinar Recording
Self-Talk Visual
Sensory Processing and Down Syndrome
References
Glenn SM, Cunningham CC. Parents' reports of young people with Down syndrome talking out loud to themselves. Ment Retard. 2000;38(6):498-505. doi:10.1352/0047-6765(2000)038<0498:PROYPW>2.0.CO;2
Hurley AD. The misdiagnosis of hallucinations and delusions in persons with mental retardation: A neurodevelopmental perspective. Semin Clin Neuropsychiatry. 1996;1(2):122-133. doi:10.1053/SCNP00100122
McGuire D, Chicoine B, Greenbaum E. Self-talk in adults with Down syndrome. Disabil Solut. 1997;2(2):1-5.
Patt PJ, Tsiouris JA, Pathania R, Beldia G. Emotional and behavioural disturbances in adults with Down syndrome. In: Prasher VP, Davidson PW, Santos FH, eds. Mental Health, Intellectual and Developmental Disabilities and the Ageing Process. Springer; 2021:115-135. doi: 10.1007/978-3-030-56934-1_8