Is the good-imitator-poor-talker profile syndrome-specific in Down syndrome?: evidence from standardised imitation and language measures

The Feasibility of an Online Language Program Delivered Through Music and the Impact of Dosage on Vocabulary Outcomes in Young Children With Down Syndrome

BACKGROUND

Few studies have explored the feasibility of online language interventions for young children with Down syndrome. Additionally, none have manipulated dose frequency or reported on the use of music as a medium through which language and sign can be learned.

PURPOSE

The purpose of this study was to (a) examine the feasibility and acceptability of an online language through music intervention for young children (1-3;6 years) with Down syndrome and (b) compare effectiveness at two intervention dose frequencies.

METHOD

The study was carried out in two phases using a mixed-methods design. Phase 1: Qualitative data were gathered from parents to examine feasibility when implementing a video-based language intervention. Phase 2: Seventy-six families participated in an online language intervention at home. Effectiveness was examined comparing two groups, randomly assigned to a high and low dose frequency. The Down Syndrome Education (DSE) checklists (combined) were the primary outcome measure. Process data were gathered to determine intervention acceptability in practice and to identify factors that would improve successful future implementation. Acceptability data were analyzed with reference to the theoretical framework of acceptability (Version 2).

RESULTS

Forty-three parents completed the Phase 1 scoping questionnaire, five of whom took part in focus groups. Once weekly morning sessions were indicated as the preferred scheduling choice. Phase 2 quantitative data were analyzed using beta regression adjusted for baseline scores and indicated no additional benefit to receiving the higher dose. However, exploratory interaction models suggested that the efficacy of the high-dose intervention was higher (than low-dose intervention) in participants with higher baseline DSE performance. Parents perceived the intervention to be effective and positive for the family.

CONCLUSION

The results add to our knowledge of real-world effective online interventions and suggest that a critical minimum language level is required for children with Down syndrome to benefit optimally from a higher intervention dose frequency.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25979704.

Embedding key word sign prompts in a shared book reading activity: The impact on communication between children with Down syndrome and their parents

BACKGROUND

Children with Down syndrome have speech and language difficulties that are disproportionate to their overall intellectual ability and relative strengths in the use of gesture. Shared book reading between parents and their children provides an effective context in which language development can be facilitated. However, children with Down syndrome often take a passive role in shared book reading and the use of key word signing (KWS) as a shared book reading technique has never been investigated.

AIMS

This study aimed to compare children with Down syndrome's participation and use of KWS across two methods of shared book reading - one in which a book had key-word sign prompts embedded (signed condition) and the other in which a book was read as normal (unsigned condition). Measures of child and parent communicative behaviour were taken in each condition to establish if differences emerged.

METHODS & PROCEDURES

A total of 36 children with Down syndrome (aged between 18 and 61 months) and their mothers took part in the study. Parent-child dyads were videoed at home reading two books, one in a signed and one in an unsigned condition. Child measures included total number of signs produced in each condition and levels of attention and initiation as measured by the Pivotal Behaviour Rating Scale. Parent measures included total number of utterances, mean length of utterance (MLU) in morphemes and vocabulary diversity (VOCD). Parental measures were transcribed using the Codes for Human Analysis Transcripts (CHAT) software and analysed by the Computerised Language Analysis software (CLAN). Contrasts in outcomes between the signed and unsigned conditions were estimated using Poisson and linear mixed-effects models, determined by the type of data.

OUTCOMES & RESULTS

Results showed that children attempted to sign significantly more in the signed than unsigned condition, as well as showing significant increases in their levels of attention and initiation. There was also a significant increase in the total number of utterances used by parents in the signed versus unsigned condition and a decrease in MLU. VOCD was similar in both conditions.

CONCLUSIONS & IMPLICATIONS

This study shows that the simple act of embedding key word signs into commercially available books, during shared book reading between parents and young children with Down syndrome, positively affects children's participation (initiation and attention) and use of KWS. The use of KWS as a core shared book reading technique may therefore be a fruitful avenue to facilitate growth in the language abilities of young children with Down syndrome.

WHAT THIS PAPER ADDS

What is already known on this subject Most children with Down syndrome have significant speech and language difficulties, with relative strengths in the use of gesture. Shared book reading is an activity reported to positively affect language. However, children with Down syndrome are reported to take a passive role in shared book reading and are therefore more dependent on their parents to use techniques that facilitate their levels of participation, in order to maximise potential benefits. To the best of our knowledge, the communicative effects of embedding key word signing (KWS) in shared book reading have never been examined with children with Down syndrome. What this paper adds to existing knowledge This is the first study to investigate the communicative impact of parents embedding KWS in a shared book reading activity with their young children with Down syndrome. Our findings show that this relatively simple manipulation resulted in Increase in children's sign attempts. Increase in children's overall participation in shared book reading (indicated by levels of attention and initiation). Increase in the number of utterances produced by parents (primarily as a result of repetitions). Decrease in parental mean length of utterance. These findings suggest that embedding KWS in shared book reading is likely to facilitate increased language abilities in this cohort. What are the potential or actual clinical implications of this work? Shared book reading is part of the daily routine for many parents and their children with Down syndrome. Integrating KWS is a relatively simple adaptation to this activity which is likely to enhance children's language skills. Therapists can encourage parents to do this at home to support work carried out at school and in a clinical setting.

Influence of gestures on the intelligibility and comprehensibility of utterances with stuttering events in individuals with Down syndrome

INTRODUCTION

Individuals with Down syndrome (DS) often stutter, which can affect their speech intelligibility. Previous research has shown that manual signs can enhance speech intelligibility and comprehensibility. It remains unclear to what extent spontaneous hand gestures, such as iconic and beat gestures, may enhance intelligibility and/or comprehensibility during utterances with stuttering events.

METHODS

Eleven individuals with DS who stutter provided video-recorded speech samples. From these samples, 60 utterances containing a stuttering event were selected. In half of them, the stuttering events were accompanied by gestures; in the other half, the stuttering events were not accompanied by gestures. The samples were shown to 250 assessors who were blind to the study's goals. Each sample was shown in three visibility conditions: 1) video-with-audio, 2) video-with-audio but with the speaker's mouth covered and 3) audio-only. The assessors rated speech intelligibility on a 7-point Likert scale and transcribed the speech sample. The effect of gesture production, gesture type and the visibility conditions on comprehensibility and intelligibility was examined with a hierarchical multiple linear regression.

RESULTS

When a speaker had used a gesture during a stuttering event, the Likert scale score increased with 0.47 and the accuracy of transcription with 9.07%. There was no difference in effect between the different gesture types. Despite the effect from gesture use, there was no effect of the visibility conditions on the Likert scale or transcription score.

CONCLUSIONS

Gestures positively affect intelligibility and comprehensibility of utterances with stuttering events in individuals with DS by altering the speech production. The possibility of beat gestures as a therapy method should be examined, with caution for the development of maladaptive behaviours.

Motor functions

Motor development includes the evolution from reflexive to voluntary and goal-directed motor actions. These motor actions are never performed in isolation but always in a varying physical environment, often requiring object and social interaction. For a child to function within this context, they require the ability to demonstrate skillful, efficient, and voluntary postures and movement patterns. Furthermore, these movement patterns or motor skills need to be performed in interaction with the environment and in response to diverse stimuli, an ability that is defined as praxis. In this chapter, definitions are provided for the different components of motor function, motor skills, and praxis. The close interaction between perception, cognition, and (motor) action is discussed. Furthermore, crucial periods of typical development of motor and praxis abilities are highlighted, by means of the metaphorical "mountain of motor development," that is rooted in the dynamic systems perspective on motor development, as a starting point. The chapter ends with a discussion on the evaluation of motor function and praxis, highlighting benefits, and possible pitfalls.

Sleep problems and recall memory in children with Down syndrome and typically developing controls

BACKGROUND

Research conducted with typically developing (TD) infants and children generally indicates that better habitual sleep and sleep after learning are related to enhanced memory. Less is known, however, about associations between sleep and recall memory in children with Down syndrome (DS).

AIMS

The present study was conducted to determine whether parent-reported sleep problems were differentially associated with encoding, 1-month delayed recall memory, and forgetting over time in children with DS and those who were TD.

METHODS AND PROCEDURES

Ten children with DS (mean age = 33 months, 5 days) and 10 TD children (mean age = 21 months, 6 days) participated in a two-session study. At each session, recall memory was assessed using an elicited imitation paradigm. Immediate imitation was permitted at the first session as an index of encoding, and delayed recall was assessed 1 month later. In addition, parents provided demographic information and reported on child sleep problems.

OUTCOMES AND RESULTS

Although parents did not report more frequent sleep problems for children with DS relative to TD children, regression-based moderation analyses revealed that more frequent sleep problems were associated with increased forgetting of individual target actions and their order by children with DS. Evidence of moderation was not found when examining encoding or delayed recall.

CONCLUSIONS AND IMPLICATIONS

Although group differences were not found when considering parent-reported sleep problems, more frequent sleep problems were positively associated with increased forgetting by children with DS relative to those who were TD. Although future experimental work is needed to determine causality, these results suggest that improved sleep in children with DS might reduce forgetting, ultimately improving long-term recall memory.

A Qualitative Analysis of Imitation Performances of Preschoolers With Down Syndrome

A number of studies suggest that imitation is a characteristic strength in children with Down Syndrome (DS). The present study aims to discover whether imitation performances are qualitatively phenotypical in DS. Eight preschoolers with DS were matched on chronological, mental, language and imitation age with 8 preschoolers with intellectual disability of undifferentiated etiology (ID-UND). Imitation performances on the Preschool Imitation and Praxis Scale were videotaped for blind scoring on 30 possible errors. Children with DS made fewer production errors (synkinesias, OR 0.3 [0.1-0.7]), but more conceptual errors (substitution, OR 2.5 [1.6-3.9]) compared to children with ID-UND. This finding is in line with the view of a cognitive phenotype in DS, which is characterized by preserved visuospatial and impaired language abilities.

Recall memory in children with Down syndrome and typically developing peers matched on developmental age

BACKGROUND

Whereas research has indicated that children with Down syndrome (DS) imitate demonstrated actions over short delays, it is presently unknown whether children with DS recall information over lengthy delays at levels comparable with typically developing (TD) children matched on developmental age.

METHOD

In the present research, 10 children with DS and 10 TD children participated in a two-session study to examine basic processes associated with hippocampus-dependent recall memory. At the first session, the researcher demonstrated how to complete a three-step action sequence with novel stimuli; immediate imitation was permitted as an index of encoding. At the second session, recall memory was assessed for previously modelled sequences; children were also presented with two novel three-step control sequences.

RESULTS

The results indicated that group differences were not apparent in the encoding of the events or the forgetting of information over time. Group differences were also not observed when considering the recall of individual target actions at the 1-month delay, although TD children produced more target actions overall at the second session relative to children with DS. Group differences were found when considering memory for temporal order information, such that TD children evidenced recall relative to novel control sequences, whereas children with DS did not.

CONCLUSIONS

These findings suggest that children with DS may have difficulty with mnemonic processes associated with consolidation/storage and/or retrieval processes relative to TD children.

Teaching Adults With Intellectual Disability Manual Signs Through Their Support Staff: A Key Word Signing Program

PURPOSE

The goal of this study was to evaluate a key word signing (KWS) program in which adults with mild to severe intellectual disability (ID) were taught manual signs through their support staff. Our hypothesis was that spontaneous manual sign production of participants would increase significantly after 12 months of implementation of the KWS program.

METHOD

A KWS immersion program was implemented in a facility for adults with ID. First, 8 support workers received 8 hr of training. These KWS ambassadors then taught 2 manual signs per week to their colleagues, who modeled the use of the signs throughout the day in natural interactions with their clients. KWS use in 15 adults with ID and 15 of their support staff was evaluated before the start of the program and at a 12-month follow-up using a narrative task and during spontaneous conversation.

RESULTS

Manual sign production of support workers and adults with ID had increased significantly 12 months after the start of the program. The adults with ID were able to express significantly more communicative functions in their narrative language after the intervention and when using KWS.

CONCLUSION

The KWS program was successful and can be applied in similar clinical settings.

Measuring procedural imitation aptitude in children: further validation of the Preschool Imitation and Praxis Scale (PIPS)

The Preschool Imitation and Praxis Scale (PIPS) was developed to measure bodily and procedural imitation aptitude in young children. However, the investigation of procedural imitation is more complex than that of bodily imitation. The procedural imitation tasks of the PIPS mainly consisted of unusual acts upon objects (for example, switching on a lamp in a toy animal with the forehead). This study assessed the suitability of these tasks by ruling out nonimitative learning in 15 typically developing children between 12 and 55 mo. of age (6 girls, 9 boys). Results indicated that the tasks seem novel and unlikely to be performed spontaneously by the children. In addition, the number of target acts performed by the children in the imitation condition was significantly higher than in the baseline, investigator-manipulation, and imitation-enhancement nonimitative control conditions. Finally, the tasks elicited more frequently imitative behaviour than end-state emulation. Therefore, the tasks appear appropriate to measure procedural imitation, and the findings support the theoretical validity of the PIPS.

How much change is true change? The smallest detectable difference of the Preschool Imitation and Praxis Scale (PIPS) in preschoolers with intellectual disabilities of heterogeneous aetiology

The teaching of imitation skills is often the first step in interventions for young learners with intellectual disabilities. The main goal of this study was to determine the smallest detectable difference (SDD) at 95% confidence of the Preschool Imitation and Praxis Scale (PIPS) in preschoolers with intellectual disabilities. Two raters independently scored videotapes of the imitation performance of 44 preschoolers (27 with Down syndrome, 10 with Non-Specific Mental Retardation and 7 with Low-functioning Autism) between 13 and 58 months of age (mean age 39.6 months, SD 11.9 months). Results revealed that the PIPS demonstrated acceptable interrater reliability on item level (weighted kappa values ranged from 0.52 to 0.96) and scale level (ICC = 0.986; 95% CI: 0.975-0.993). The SDD of the PIPS was 7.2%, indicating that the change score rated by different raters for an individual child with an intellectual disability is valid and that the PIPS can be used by early interventionists and researchers as an outcome measure to determine children's maturation or improvement.