Language and verbal short-term memory skills in children with Down syndrome: a meta-analytic review

Speech Recognition and Spatial Hearing in Young Adults With Down Syndrome: Relationships With Hearing Thresholds and Auditory Working Memory

OBJECTIVES

Individuals with Down syndrome (DS) have a higher incidence of hearing loss (HL) compared with their peers without developmental disabilities. Little is known about the associations between HL and functional hearing for individuals with DS. This study investigated two aspects of auditory functions, "what" (understanding the content of sound) and "where" (localizing the source of sound), in young adults with DS. Speech reception thresholds in quiet and in the presence of interferers provided insight into speech recognition, that is, the "what" aspect of auditory maturation. Insights into "where" aspect of auditory maturation were gained from evaluating speech reception thresholds in colocated versus separated conditions (quantifying spatial release from masking) as well as right versus left discrimination and sound location identification. Auditory functions in the "where" domain develop during earlier stages of cognitive development in contrast with the later developing "what" functions. We hypothesized that young adults with DS would exhibit stronger "where" than "what" auditory functioning, albeit with the potential impact of HL. Considering the importance of auditory working memory and receptive vocabulary for speech recognition, we hypothesized that better speech recognition in young adults with DS, in quiet and with speech interferers, would be associated with better auditory working memory ability and receptive vocabulary.

DESIGN

Nineteen young adults with DS (aged 19 to 24 years) participated in the study and completed assessments on pure-tone audiometry, right versus left discrimination, sound location identification, and speech recognition in quiet and with speech interferers that were colocated or spatially separated. Results were compared with published data from children and adults without DS and HL, tested using similar protocols and stimuli. Digit Span tests assessed auditory working memory. Receptive vocabulary was examined using the Peabody Picture Vocabulary Test Fifth Edition.

RESULTS

Seven participants (37%) had HL in at least 1 ear; 4 individuals had mild HL, and 3 had moderate HL or worse. Participants with mild or no HL had ≥75% correct at 5° separation on the discrimination task and sound localization root mean square errors (mean ± SD: 8.73° ± 2.63°) within the range of adults in the comparison group. Speech reception thresholds in young adults with DS were higher than all comparison groups. However, spatial release from masking did not differ between young adults with DS and comparison groups. Better (lower) speech reception thresholds were associated with better hearing and better auditory working memory ability. Receptive vocabulary did not predict speech recognition.

CONCLUSIONS

In the absence of HL, young adults with DS exhibited higher accuracy during spatial hearing tasks as compared with speech recognition tasks. Thus, auditory processes associated with the "where" pathways appear to be a relative strength than those associated with "what" pathways in young adults with DS. Further, both HL and auditory working memory impairments contributed to difficulties in speech recognition in the presence of speech interferers. Future larger-sized samples are needed to replicate and extend our findings.

Focused attention and intrinsic motivation using animations for instruction of fundamental motor skills in children with Down syndrome

BACKGROUND

Children with Down syndrome (DS) demonstrate poorer performance in locomotor and ball skills than children with typical development. During motor assessment, keeping children's attention and motivation is challenging, especially for children with DS, which may affect the test outcomes. This study aimed first to examine the impact of examiner and App-animation demonstrations during the assessment on the performance of fundamental motor skills, focus of attention and intrinsic motivation for children with DS and neurotypical development (NTD). The secondary aim was to examine the differences in those outcomes between children with DS and neurotypical development.

METHODS

A sample of 24 children (10 with DS and 14 with NTD) aged between 3 and 10 years were subjected to two motor performance assessment protocols: a traditional protocol using the Gross Motor Development Test-3 (TGMD-3) and a protocol using animations from an application as support for TGMD-3 (AppP). The focus of attention was obtained from video recordings during protocol instruction (number of eye shifts, eye shift time, instruction focus time, number of instructions required and total instruction time). Intrinsic motivation was assessed by the Intrinsic Motivation Inventory (IMI) at the end of each protocol.

RESULTS

The results showed no significant differences between the protocols for locomotor skills, ball skills and gross motor index. However, children with NTD outperformed those with DS in these skills. When analysing the focus of attention, children with DS showed greater ocular deviations and longer instruction time requested in the traditional protocol compared with AppP, even when compared with NDT children. When comparing protocols in both groups, AppP demonstrated fewer ocular deviations and shorter ocular deviation times. Regarding intrinsic motivation, children with DS in the traditional protocol had lower motivation scores than those with NTD. Regarding the purchase of protocols, in both groups, the AppP presented higher scores for interest/pleasure, perceived competence and general motivation, with lower pressure/tension.

CONCLUSION

The animated application (AppP) proved effective as a visual support during the TGMD-3 assessment, particularly benefiting children with DS by enhancing motivation and attention.

Vocabulary and expressive morpho-syntax in individuals with Down syndrome: Links to narration

BACKGROUND

Narrative ability is crucial for social participation in everyday and school life but involves different language abilities such as vocabulary and morpho-syntax. This is particularly difficult for individuals who display both language and cognitive impairments. Previous research has identified productive vocabulary as a possible key factor for narrative performance in individuals with Down syndrome. Considering a close connection between lexical and morpho-syntactic performance within language acquisition and the distinct impairments that individuals with Down syndrome display concerning their morpho-syntactic skills, the nature of a relation between vocabulary and narrative skills under the influence of grammatical deficits requires further investigation.

METHODS

Narrations were obtained from 28 children and adolescents with Down syndrome (aged 10;0-20;1) using a non-verbal picture book. Narrative abilities were rated using the Narrative Scoring Scheme across seven narrative aspects (including macro- and microstructure). Vocabulary analyses and morpho-lexical context analyses including verb and conjunction enumerations, evaluation of verb position and MLU were conducted. Findings from the transcript analysis have been supplemented with data from standardized language measures evaluating expressive lexical and morpho-syntactic development. A multiple regression analysis was conducted to identify significant predictors for narrative outcome in the participants with Down syndrome.

RESULTS

Lexical analyses revealed a high heterogeneity in production of subordinating conjunctions as a link between lexical and morpho-syntactic abilities. Comparisons of standardized and narrative data demonstrated differences in subordinate clause production depending on the elicitation setting. A multiple regression analysis identified the number of different verbs in the narrative task as the most significant predictor for narrative performance in individuals with Down syndrome.

DISCUSSION AND IMPLICATIONS

The findings of this study contribute to the knowledge regarding factors that influence narrative performance in individuals with language impairment. A differentiated verb lexicon can be identified as the key ability for reaching advanced narrative skills in participants with Down syndrome. These findings are of clinical relevance for therapeutic and educational support and contribute to an understanding of the relation between strengths in vocabulary and morpho-syntactic weaknesses in individuals with Down syndrome within communicative participation.

Non-word repetition and vocabulary in Kuwaiti Arabic-speaking children with down syndrome and typically developing children

OVERVIEW

Non-word repetition (NWR) is one of the most effective predictors of language impairments in children as it has been found to correlate with various language measures and the association between NWR and vocabulary is well documented in typically developing (TD) studies. However, there is a dire need for investigations of language skills in Kuwaiti Arabic individuals with Down Syndrome, and this study set out to fill a gap in this field.

METHOD

In this paper, we compare the vocabulary and NWR skills of a group of 48 individuals with DS aged 6-20 years to a group of 44 TD children aged 3-10 years matched on nonverbal IQ. Furthermore, we investigate the correlations among these language measures in the two groups and examine whether NWR can predict receptive and expressive vocabulary in these two groups.

RESULT

Results found DS participants performed significantly less than the TD group on the three language measures (receptive vocabulary t(90)= -3.17, p < .01, expressive vocabulary t(90)= -3.27, p < .01, and NWR t(90)= -8.32, p < .01). Moreover, there were strong correlations between NWR and vocabulary (receptive and expressive) in the TD group but not the DS group.

CONCLUSION

Findings supported the working memory model and the phonological processing account for the TD group. On the other hand, the poor association between NWR and vocabulary in the DS group might be due to poor phonological discrimination difficulties and speech discrimination difficulties.

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.

The role of imageability in noun and verb acquisition in children with Down syndrome and their peers with typical development

Our main objective was to analyze the role of imageability in relation to the age of acquisition (AoA) of nouns and verbs in Spanish-speaking children with Down syndrome (DS) and their peers with typical development (TD). The AoA of nouns and verbs was determined using the MacArthur-Bates CDIs adapted to the profile of children with DS. The AoA was analyzed using a linear mixed-effect model, including factors of imageability, group, and word class, and controlling for word frequency and word length. This analysis showed that high imaginable and short words were acquired early. Children with DS acquired the words later than TD peers. An interaction between imageability and group indicated that the effect of imageability was greater in the DS group. We discuss this effect considering DS children's phonological memory difficulties. The overall results confirm the role that imageability and word length play in lexical acquisition, an effect that goes beyond word class.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

Stuttering in individuals with Down syndrome: a systematic review of earlier research

The main objective of this systematic review was to synthesize the evidence on the occurrence and characteristics of stuttering in individuals with Down syndrome and thus contribute knowledge about stuttering in this population. Group studies reporting outcome measures of stuttering were included. Studies with participants who were preselected based on their fluency status were excluded. We searched the Eric, PsychInfo, Medline, Scopus, and Web of Science Core Collection databases on 3rd January 2022 and conducted supplementary searches of the reference lists of previous reviews and the studies included in the current review, as well as relevant speech and language journals. The included studies were coded in terms of information concerning sample characteristics, measurement approaches, and stuttering-related outcomes. The appraisal tool for cross-sectional studies (AXIS) was used to evaluate study quality. We identified 14 eligible studies, with a total of 1,833 participants (mean = 131.29, standard deviation = 227.85, median = 45.5) between 3 and 58 years of age. The estimated occurrence of stuttering ranged from 2.38 to 56%, which is substantially higher than the estimated prevalence (1%) of stuttering in the general population. The results also showed that stuttering severity most often was judged to be mild-to-moderate and that individuals with Down syndrome displayed secondary behaviors when these were measured. However, little attention has been paid to investigating the potential adverse effects of stuttering for individuals with Down syndrome. We judged the quality of the evidence to be moderate-to-low. The negative evaluation was mostly due to sampling limitations that decreased the representability and generalizability of the results. Based on the high occurrence of stuttering and the potential negative effects of this condition, individuals with Down syndrome who show signs of stuttering should be referred to a speech and language pathologist for an evaluation of their need for stuttering treatment.

Morphosyntactic development in German-speaking individuals with Down syndrome-longitudinal data

Introduction

The present study provides longitudinal data on the development of receptive and expressive grammar in children and adolescents with Down syndrome and addresses the role of nonverbal cognitive abilities and verbal short-term memory for morphosyntactic development.

Method

Seventeen German-speaking individuals with Down syndrome (aged 4;6-17;1 years at first testing (T1)) were assessed twice, 4;4-6;6 years apart. For a subset of five participants, there was also a third assessment 2 years after the second. Receptive grammar, nonverbal cognition, and verbal short-term memory were tested using standardized measures. For expressive grammar, elicitation tasks were used to assess the production of subject-verb agreement and of wh-questions.

Results

At group level, the participants showed a significant increase in grammar comprehension from T1 to T2. However, progress diminished with increasing chronological age. Notable growth could not be observed beyond the age of 10 years.With respect to expressive grammatical abilities, progress was limited to those participants who had mastered verbal agreement inflection around age 10 years. Individuals who did not master verbal agreement by late childhood achieved no progress in producing wh-questions, either.There was an increase in nonverbal cognitive abilities in the majority of participants. Results for verbal short-term memory followed a similar pattern as those for grammar comprehension. Finally, neither nonverbal cognition nor verbal short-term memory were related to changes in receptive or expressive grammar.

Discussion

The results point to a slowdown in the acquisition of receptive grammar which starts before the teenage years. For expressive grammar, improvement in wh-question production only occurred in individuals with good performance in subject-verb agreement marking, which suggests that the latter might have a trigger function for further grammatical development in German-speaking individuals with Down syndrome. The study provides no indication that nonverbal cognitive abilities or verbal short-term memory performance determined the receptive or expressive development. The results lead to clinical implications for language therapy.

ABRACADABRA literacy instruction for children with Down syndrome via telepractice during COVID-19: A pilot study

BACKGROUND

COVID-19 has resulted in some educators and allied health practitioners transitioning to online delivery of literacy instruction. As far as we are aware, no studies have investigated online delivery of comprehensive literacy instruction for children with Down syndrome.

AIMS

In this pilot study, we explore the efficacy of online delivery of ABRACADABRA (a free literacy web application) for children with Down syndrome, alongside supplementary parent-led shared book reading, during the COVID-19 pandemic.

SAMPLE

Six children with Down syndrome, aged 8-12 years, participated in this within-participants design study.

METHODS

Participants acted as their own controls with outcome variables measured at three timepoints: baseline, pre-instruction and post-instruction. Children participated in 16-18 hrs of one-to-one literacy instruction online over a 6-week instruction phase, along with twice weekly parent-led shared book reading activities.

RESULTS

Outcomes from standardized assessments revealed statistically significant improvements in word- and passage-level reading accuracy skills over the instruction phase (pre-instruction to post-instruction) compared with the no-instruction control phase (baseline to pre-instruction). Improvements in reading comprehension skills were inconsistent across assessment measures and statistical analyses.

CONCLUSION

Children with Down syndrome can benefit from comprehensive literacy instruction delivered via telepractice. Our study provides critical initial evidence of successful service delivery during a global pandemic and beyond.

The effect of manual movements on stuttering in individuals with down syndrome

PURPOSE

Stuttering may disrupt the speech of individuals with Down syndrome (DS), but standard stuttering therapies may be less adapted to these clients' needs. This study examined if their strength in gesture use can lead to the development of a new stuttering therapy.

METHOD

Eighteen individuals with DS who stutter participated in an experimental task. During this task, they produced sentences in three different conditions: once without the ability to use gestures, once while moving the mouth of a hand puppet synchronous with their speech, and once while making beat gestures along their speech. Stuttering frequency was measured and compared between conditions while controlling for the effect of articulation rate.

RESULTS

The experimental hand puppet and beat condition did not affect the stuttering frequency, but the covariate articulation rate did. An exploratory posthoc analysis showed that the articulation rate decreased during the experimental hand puppet and beat condition. Manual movements in the present task might only induce fluency through articulation rate reduction. However, analyses at individual level show significant interindividual variability.

CONCLUSION

Individual analyses show that effect on stuttering frequency cannot be attributed entirely to articulation rate reduction and that beat gestures might still play a role. However, at this point, there is not enough direct evidence to implement beat gestures in current stuttering therapy.

One-year prediction of cognitive decline following cognitive-stimulation from real-world data

Clinical evidence based on real-world data (RWD) is accumulating exponentially providing larger sample sizes available, which demand novel methods to deal with the enhanced heterogeneity of the data. Here, we used RWD to assess the prediction of cognitive decline in a large heterogeneous sample of participants being enrolled with cognitive stimulation, a phenomenon that is of great interest to clinicians but that is riddled with difficulties and limitations. More precisely, from a multitude of neuropsychological Training Materials (TMs), we asked whether was possible to accurately predict an individual's cognitive decline one year after being tested. In particular, we performed longitudinal modelling of the scores obtained from 215 different tests, grouped into 29 cognitive domains, a total of 124,610 instances from 7902 participants (40% male, 46% female, 14% not indicated), each performing an average of 16 tests. Employing a machine learning approach based on ROC analysis and cross-validation techniques to overcome overfitting, we show that different TMs belonging to several cognitive domains can accurately predict cognitive decline, while other domains perform poorly, suggesting that the ability to predict decline one year later is not specific to any particular domain, but is rather widely distributed across domains. Moreover, when addressing the same problem between individuals with a common diagnosed label, we found that some domains had more accurate classification for conditions such as Parkinson's disease and Down syndrome, whereas they are less accurate for Alzheimer's disease or multiple sclerosis. Future research should combine similar approaches to ours with standard neuropsychological measurements to enhance interpretability and the possibility of generalizing across different cohorts.

No need to forget, just keep the balance: Hebbian neural networks for statistical learning

Language processing in humans has long been proposed to rely on sophisticated learning abilities including statistical learning. Endress and Johnson (E&J, 2021) recently presented a neural network model for statistical learning based on Hebbian learning principles. This model accounts for word segmentation tasks, one primary paradigm in statistical learning. In this discussion paper we review this model and compare it with the Hebbian model previously presented by Tovar and Westermann (T&W, 2017a; 2017b; 2018) that has accounted for serial reaction time tasks, cross-situational learning, and categorization paradigms, all relevant in the study of statistical learning. We discuss the similarities and differences between both models, and their key findings. From our analysis, we question the concept of "forgetting" in the model of E&J and their suggestion of considering forgetting as the critical ingredient for successful statistical learning. We instead suggest that a set of simple but well-balanced mechanisms including spreading activation, activation persistence, and synaptic weight decay, all based on biologically grounded principles, allow modeling statistical learning in Hebbian neural networks, as demonstrated in the T&W model which successfully covers learning of nonadjacent dependencies and accounts for differences between typical and atypical populations, both aspects that have not been fully demonstrated in the E&J model. We outline the main computational and theoretical differences between the E&J and T&W approaches, present new simulation results, and discuss implications for the development of a computational cognitive theory of statistical learning.

The association between expressive language skills and adaptive behavior in individuals with Down syndrome

The primary goal of this study was to determine whether expressive language skills contribute to adaptive behavior (e.g., socialization and daily living skills) in children, adolescents, and young adults with Down syndrome (DS) whilst controlling for age and nonverbal cognitive ability. Expressive language was assessed using the psychometrically validated Expressive Language Sampling (ELS) conversation and narration procedures. The language produced was transcribed and analyzed to yield measures of expressive vocabulary, syntax, and intelligibility. Socialization and daily living skills of participants with DS were measured with the Vineland Adaptive Behavior Scales, 2nd edition (VABS-2) parent/caregiver rating form. Our results show that the three ELS measures were significantly correlated with multiple measures from the VABS-2 when controlling for age. Several correlations remained significant even when nonverbal cognitive ability was included as a control variable. Our results suggest that expressive language skills contribute to adaptive behavior in children, adolescents, and young adults with DS regardless of age and some of these associations are not explained solely by overall cognitive delays. Further studies including longitudinal data are needed to extend our results.

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome

PURPOSE

The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome.

METHOD

A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis.

RESULTS

The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not.

CONCLUSIONS

The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

Word prediction using closely and moderately related verbs in Down syndrome

People with Down syndrome (DS) have several difficulties in language learning, and one of the areas most affected is language production. Theoretical frameworks argue that prediction depends on the production system. Yet, people with DS can predict upcoming nouns using semantically related verbs. Possibly, prediction skills in people with DS are driven by their associative mechanism rather than by the prediction mechanism based on the production system. This study explores prediction mechanisms in people with DS and their relationship with production skills. Three groups were evaluated in a preferential-looking task: young adults, children with DS, and a typically developing control group paired by sex and mental age. Participants saw two images, a target and a distractor. They also heard a sentence in one of the three conditions: with a verb that was closely related to the object (e.g., "The woman read the book"), with a verb that was moderately related to the object (e.g., "My uncle waited for the bus"), or with a verb that was unrelated to the object (e.g., "My sister threw a broom"). Their productive vocabulary was then measured. In the young adult and typically developing groups, the results showed prediction in sentences with highly and moderately related verbs. Participants with DS, however, showed prediction skills only in the highly related context. There was no influence of chronological age, mental age, or production on prediction skills. These results indicate that people with DS base prediction mainly on associative mechanisms and they have difficulty in generating top-down predictions.

Emotional Lexicon in Down Syndrome

We studied comprehension of emotion versus concrete/abstract words in Down syndrome (DS). Study 1 compared 26 participants with DS and 26 typically developing (TD) children matched on verbal ability. Results showed no difference between groups. Study 2 assessed whether chronological age (CA) and (non)verbal abilities predicted developmental trajectories of comprehension in 36 children with DS and 143 TD children. For the latter, these variables predicted comprehension of all three word types. For the former, receptive vocabulary predicted comprehension of all word types, but CA and nonverbal reasoning only predicted comprehension of concrete words. This suggests that people with DS have no specific emotional lexicon deficit. Supporting their general lexical development would help them access abstract and emotional meanings.

Evaluating Verbal Fluency Outcome Measures in Children With Down Syndrome

This study evaluates the psychometric properties of a verbal fluency task for potential use as an outcome measure in future clinical trials involving children with Down syndrome. Eighty-five participants attempted a modified version of the Neuropsychological Assessment of Children, Second Edition Word Generation Task at two time points. In the full sample, the measure fell below a priori reliability and feasibility criteria, though feasibility of the semantic trials were higher than feasibility of the phonemic trials. Performance on the measure correlated with chronological age and IQ scores, and no sex-related effects were found. Additional analyses suggested that the semantic verbal fluency trials might be appropriate for children with Down syndrome 10 years of age and older.

Recognition of Basic Emotions with and without the Use of Emotional Vocabulary by Adolescents with Down Syndrome

Background: Children with Down syndrome (DS) often experience behavioral and emotional issues that complicate their socialization process and may lead to psychopathological disorders. These problems may be related to deficits affecting emotional knowledge, particularly emotional vocabulary. Because emotional vocabulary makes it easier for typically developing children to identify emotions, a deficit affecting it in DS could be problematic. Methods: Twenty-eight adolescents with DS matched with typically developing (TD) children for their score on the Benton Facial Recognition Test were asked to recognize six emotional expressions presented in the form of filmed sequences, based on (1) nonverbal cues such as prosody, and (2) an emotional label. Results: The adolescents with DS recognized the six basic emotional expressions at a level comparable to that of the TD children in both conditions (with and without emotional vocabulary), but the facilitating effect of vocabulary was lower in that group. Conclusions: This study does not show a deficit affecting emotion recognition in DS, but it emphasizes the importance of early acquisition of emotional knowledge in this syndrome. Regular and varied use of internal state words should be encouraged in familial interactions, and education should include specifically adapted social and emotional learning programs.

How do students with intellectual disabilities tell stories? An investigation of narrative macrostructure and microstructure

Individuals with intellectual disability may have limited narrative skills. The novelty of this study lies in the examination of strengths and weaknesses which may enable a more facilitative approach to narrative and other storytelling‐based methodologies among adults with intellectual disability who study in an academic enrichment program in comparison to typical students with the same chronological age. Seventeen adult students with intellectual disability and 16 typically developing students, produced narratives which were examined for microstructure (e.g., length, lexis, grammaticality, and complexity) macrostructure (e.g., goals, attempts, and outcomes) and Internal state terms (ISTs). The findings indicate that in spite of weakness of adults with intellectual disability in terms of coherence, syntactic complexity, and grammatical sentences, they exhibit strengths in narrative macrostructure story scheme and use IST. With increasing age, narratives performance of adults with intellectual disability continues to advance possibly due to maturity, life experience and indirect exposure to the environment.

Language comprehension in toddlers with significant developmental delays: An IRT approach

PURPOSE

Language comprehension, or the ability to understand spoken language, is critical to a variety of child outcomes. Effective early intervention relies on valid, reliable language comprehension assessment. The purpose of this study was to explore language comprehension in a sample of toddlers with significant developmental delays associated with varied medical conditions.

METHOD

We investigated language comprehension in a sample of 112 toddlers by applying Item Response Theory (IRT) methods to two measures; one standardized and one flexible.

RESULTS

Data from a standardized measure fit the unidimensional model, whereas the flexible measure did not. The overall pattern of results suggested that items related to early social/contextual comprehension are distinct from linguistic comprehension items.

CONCLUSION

Our findings inform clinical practice by underscoring the importance of comprehensive assessment of language comprehension and considering strengths and weaknesses across social/contextual and linguistic comprehension among toddlers with developmental delays.

Anxiety and Worries of Individuals with Down Syndrome During the COVID-19 Pandemic: A Comparative Study in the UK

The present study explored the effects of the pandemic on individuals with Down Syndrome (DS; n = 67) compared to other groups with Special Education Needs and Disabilities (SEND; n = 48) and their Typically Developing Siblings (TDS; n = 56). In total, 115 caregivers reported on their own anxiety and worries and of their children. Anxiety levels for individuals with DS appeared to be lower compared to other SEND populations and to TDS. In terms of worries, individuals with DS worried more about social-related worries but worried less about family-related aspects compared to the other groups. In sum, individuals with DS might show less anxiety but still worried more about specific aspects related to the impact of COVID-19 pandemic on their lives.

Language and executive functioning in young adults with Down syndrome

BACKGROUND

This study examined the association between executive functioning and language in young adults with Down syndrome (DS).

METHOD

Nineteen young adults with DS (aged 19-24 years) completed standardised measures of overall cognition, vocabulary, verbal fluency and executive function skills.

RESULTS

Friedman's analysis of variance (χ² (3) = 28.15, P < .001) and post hoc comparisons indicated that, on average, participants had a significantly lower overall non-verbal than verbal cognitive age equivalent and lower expressive than receptive vocabulary skills. Using Spearman correlations, performance on a verbal measure of cognition inhibition was significantly negatively related to receptive vocabulary (ρ = -.529, adjusted P = .036) and verbal fluency (ρ = -.608, adjusted P = .022). Attention was significantly positively correlated with receptive (ρ = .698, adjusted-p = .005) and expressive (ρ = .542, adjusted P = .027) vocabulary. Verbal working memory was significantly positively associated with receptive vocabulary (ρ = .585, adjusted P = .022) and verbal fluency (ρ = .737, adjusted P = .003). Finally, visuospatial working memory was significantly associated with receptive vocabulary (ρ = .562, adjusted P = .027).

CONCLUSIONS

Verbal and non-verbal measures of executive functioning skills had important associations with language ability in young adults with DS. Future translational research is needed to investigate causal pathways underlying these relationships. Research should explore if interventions aimed at increasing executive functioning skills (e.g. attention, inhibition and working memory) have the potential to lead to increases in language for young adults with DS.

The nature and causes of children's grammatical difficulties: Evidence from an intervention to improve past tense marking in children with down syndrome

Children with language learning difficulties frequently display problems learning grammar. One such group are children with Down syndrome. This study evaluates the effectiveness of an intervention to teach the use of the regular simple past tense to children with Down syndrome. Trained teaching assistants delivered the intervention for 20 minutes per day for 10 weeks. We conducted a Randomised Controlled Trial, with a waiting list control design in which the Intervention group (N = 26) received the intervention immediately, while the delayed intervention group (N = 26) received the intervention later. Immediately following the intervention, the intervention group showed significantly larger gains in the use of regular simple past tense forms (d = 1.63 on a composite measure of simple past tense formation) as well as generalisation to verbs not explicitly taught. In addition, following the intervention children made overregularisation errors by incorrectly using regular simple past tense marking for irregular verbs; such errors support the claim that children had acquired generative knowledge underlying past tense marking. The delayed intervention control group showed identical benefits from the intervention when they received it, and the gains shown by the intervention group were maintained at follow up testing. This study shows that children with Down syndrome, who display severe language difficulties can be taught to use simple past tense marking. The theoretical and applied implications of these findings for understanding the nature, causes and treatments of children's language difficulties are discussed. This article is protected by copyright. All rights reserved.

Intensive computer-based phonics training in the educational setting of children with Down syndrome: An explorative study

Children with Down syndrome (DS) using intensive computer-based phonics (GraphoGame, GG) were studied. The children's independence and improvement in phonological processing, letter knowledge, word decoding, and reading strategies were investigated. Seventeen children (5-16 years) with DS participated in a crossover design through 8 weeks (one period), with three test sessions separated by 4 weeks. Children were randomly assigned to GG intervention or regular schooling (RS). All children completed one period and eight children completed two periods. A majority gradually became independent in managing GG. At the group level, very little benefit was found from working with GG. At the individual level, several children with mild to severe intellectual disabilities showed increased decoding of trained words. After one period of GG and RS, an increase in alphabetically decoded words was found. The finding suggests that when individual challenges are considered, computer-based phonics may be beneficial for children with DS in their educational setting.

[Formula: see text] The role of distinct executive functions on adaptive behavior in children and adolescents with Down syndrome

Difficulties in executive function are a relatively well-characterized feature of the neuropsychological profile in Down syndrome (DS), yet the impact of these challenges on aspects of daily functioning remain poorly understood. We examined the role of specific executive functions on domains of adaptive behavior in children and adolescents with DS. Participants included 68 children and adolescents with DS between 6-17 years old (mean chronological age = 12.56 years; SD = 3.22) and their caregivers. Parent reported executive function skills were measured using the BRIEF-2 and adaptive behavior was measured using the Vineland Adaptive Behavior Scales-III. Results identified working memory as a significant predictor of Communication, Daily Living, and Socialization skills, and Shifting significantly predicted Daily Living and Socialization. Findings demonstrate the relation between executive functions and adaptive behavior and highlight the effects of working memory on aspects of daily functioning for individuals with DS.

Speech and Language in 5-year-olds with Different Neurological Disabilities and the Association between Early and Later Consonant Production

The primary aim was to describe speech and language abilities in a clinical group of verbal 5-year-old children diagnosed with neurological disability (ND) in infancy, and the secondary aim was to trace precursors to consonant production at age 5 years (T2) in data from 12 to 22 months (T1). The participants (n = 11, with Down syndrome (DS), cerebral palsy, and chromosomal deletion syndromes) were tested with a battery of speech and language tests. Consonant production at T2 was compared to data on consonant use at T1. At T2, two participants had age appropriate speech and language and another three had age-appropriate speech, but low results on language tests. The remaining six participants had severe speech and language difficulties. Participants with DS had significantly lower results on consonant production measures. An association between consonant production at T1 and T2 for participants with DS indicates that number of different true consonants might be a predictive measure when evaluating young children with DS.

The Association between Difficulties with Speech Fluency and Language Skills in a National Age Cohort of Children with Down Syndrome

The present study (a) addressed difficulties in speech fluency in children with Down syndrome and typically developing children at a similar non-verbal level and (b) examined the association between difficulties with speech fluency and language skills in children with Down syndrome. Data from a cross-sectional parent survey that included questions about children's difficulties with speech fluency, as well as clinical tests from a national age cohort of 43 six-year-olds with Down syndrome and 57 young typically developing children, were collected. Fisher's exact test, Student's t-test, linear regression, and density ellipse scatter plots were used for analysis. There was a significantly higher occurrence of parent-reported difficulties with speech fluency in the children with Down syndrome. Higher language scores were significantly associated with a lower degree of difficulties; this association was strongest for vocabulary and phonological skills. Although difficulties with speech fluency were not reported for all children with Down syndrome, a substantially higher occurrence of such difficulties was reported compared to that for typically developing children. The significant association between difficulties with speech fluency and the level of language functioning suggests that speech fluency and language skills should be taken into consideration when planning treatment for children with Down syndrome.

Assessing Phonological Profiles in Children and Adolescents With Down Syndrome: The Effect of Elicitation Methods

In the context of comparing linguistic profiles across neurodevelopmental disorders, Down syndrome (DS) has captured growing attention for its uneven profile. Although specific weaknesses in grammatical and phonological processing have been reported, research evidence on phonological development remains scarce, particularly beyond early childhood. The purpose of this study was to explore the phonological profiles of children and adolescents with Down syndrome. The profiles were based on the frequency and relative proportion of the processes observed by classes, and they were compared to those of typically developing preschool children of similar verbal age. A complementary goal was to assess the effect of two different methods of elicitation: a test of articulation and spontaneous speech sampling. Finally, intergroup and intragroup differences in full match percentages between three positions at syllable-level (complex onset, medial coda, and final coda) were assessed. The results of the present study confirmed that the frequency of phonological processes in children and adolescents with DS is atypically high and is above what is expected for lexical age and at the same level as grammatical age. Highly increased frequency of processes, consistent in all kinds of processes and positions at the syllable-level, and asynchronous with verbal age and mental age suggest atypical developmental trajectories of phonological development in the Down syndrome population.

Occurrence of Reading Skills in a National Age Cohort of Norwegian Children with Down Syndrome: What Characterizes Those Who Develop Early Reading Skills?

Children with Down syndrome are at risk of reading difficulties. Reading skills are crucial for social and academic development, and thus, understanding the nature of reading in this clinical group is important. This longitudinal study investigated the occurrence of reading skills in a Norwegian national age cohort of 43 children with Down syndrome from the beginning of first grade to third grade. Data were collected to determine which characteristics distinguished those who developed early reading skills from those who did not. The children's decoding skills, phonological awareness, nonverbal mental ability, vocabulary, verbal short-term memory, letter knowledge and rapid automatized naming (RAN) performance were measured annually. The results showed that 18.6% of the children developed early decoding skills by third grade. Prior to onset, children who developed decoding skills had a significantly superior vocabulary and letter knowledge than non-readers after controlling for nonverbal mental abilities. These findings indicate that early specific training that focuses on vocabulary and knowledge of words and letters may be particularly effective in promoting reading onset in children with Down syndrome.

Differences and Similarities in Predictors of Expressive Vocabulary Development between Children with Down Syndrome and Young Typically Developing Children

The purpose of this study was to examine potential differences in the predictors of expressive vocabulary development between children with Down syndrome and typically developing children to support preparation for intervention development. An age cohort of 43 children with Down syndrome and 57 typically developing children with similar nonverbal mental age levels were assessed at three time points. Linear mixed models were used to investigate the predictors of expressive vocabulary over time. Both groups achieved progress in expressive vocabulary. The typically developing children had steeper growth than the children with Down syndrome (1.38 SD vs. 0.8 SD, p < 0.001). In both groups, receptive vocabulary, auditory memory, and the home literacy environment were significant predictors of development. In the children with Down syndrome, the phonological awareness and oral motor skills were also significant. Group comparisons showed that receptive vocabulary, auditory memory and oral motor skills were stronger predictors in the children with Down syndrome than in the typically developing children. These results indicate that children with Down syndrome are more vulnerable when it comes to risk factors that are known to influence expressive vocabulary than typically developing children. Children with Down syndrome therefore require early broad-based expressive vocabulary interventions.

Complexity Analysis of the Default Mode Network Using Resting-State fMRI in Down Syndrome: Relationships Highlighted by a Neuropsychological Assessment

Background: Studies on complexity indicators in the field of functional connectivity derived from resting-state fMRI (rs-fMRI) in Down syndrome (DS) samples and their possible relationship with cognitive functioning variables are rare. We analyze how some complexity indicators estimated in the subareas that constitute the default mode network (DMN) might be predictors of the neuropsychological outcomes evaluating Intelligence Quotient (IQ) and cognitive performance in persons with DS. Methods: Twenty-two DS people were assessed with the Kaufman Brief Test of Intelligence (KBIT) and Frontal Assessment Battery (FAB) tests, and fMRI signals were recorded in a resting state over a six-minute period. In addition, 22 controls, matched by age and sex, were evaluated with the same rs-fMRI procedure. Results: There was a significant difference in complexity indicators between groups: the control group showed less complexity than the DS group. Moreover, the DS group showed more variance in the complexity indicator distributions than the control group. In the DS group, significant and negative relationships were found between some of the complexity indicators in some of the DMN networks and the cognitive performance scores. Conclusions: The DS group is characterized by more complex DMN networks and exhibits an inverse relationship between complexity and cognitive performance based on the negative parameter estimates.

A Meta-Analysis of Single-Case Research on Applied Behavior Analytic Interventions for People With Down Syndrome

This systematic review evaluates single-case research design studies investigating applied behavior analytic (ABA) interventions for people with Down syndrome (DS). One hundred twenty-five studies examining the efficacy of ABA interventions on increasing skills and/or decreasing challenging behaviors met inclusion criteria. The What Works Clearinghouse standards and Risk of Bias in N-of-1 Trials scale were used to analyze methodological characteristics, and Tau-U effect sizes were calculated. Results suggest the use of ABA-based interventions are promising for behavior change in people with DS. Thirty-six high-quality studies were identified and demonstrated a medium overall effect. A range of outcomes was targeted, primarily involving communication and challenging behavior. These outcomes will guide future research on ABA interventions and DS.

A meta-analysis of prosody in autism, Williams syndrome, and Down syndrome

Prosody, the rhythm and melody of speech, is an important component of effective communication, and it is an area of difficulty for many populations who struggle with communication. This paper is a meta-analysis of nine studies (and two sets of unpublished data) that assessed prosody using the Profiling Elements of Prosody in Speech-Communication (PEPS-C; Peppé & McCann, 2003) in autism spectrum disorder, Williams syndrome, and Down syndrome. Our original goal was to include studies involving any neurodevelopmental disorder that is commonly associated with intellectual disability, yet our systematic search, which included three databases (i.e., PsychInfo, ERIC, and PubMed), only identified studies involving these three groups. To be included in the meta-analysis, studies had to include a group (n ≥ 3 participants) with a neurodevelopmental disorder commonly associated with intellectual disability and a typically developing comparison group matched on chronological age, nonverbal abilities, or verbal abilities. Studies also needed to report original data using the PEPS-C and be available in English. Study quality was assessed using a checklist adapted from Downes et al. (2016). Results revealed that prosodic form was a weakness for each etiology, while unique patterns of strengths and weaknesses were evident for prosodic functions. Groups with autism (n = 5), all classified as high-functioning or with Asperger's syndrome, exhibited weakness in emotional affect but some relative strengths with turn-end and focus tasks. Groups with Williams syndrome (n = 4) demonstrated weaknesses on phrase/sentence-level tasks and relative strengths on word-level tasks. Groups with Down syndrome (n = 2) had the greatest difficulty overall, though performance was better on receptive (vs. expressive) function tasks. By combining studies and related subtasks of the PEPS-C, we are able to more confidently generalize findings for each population and identify targets for intervention. However, given the limited number of studies identified, this paper also highlights the need for more research on prosody in intellectual disability.

Executive function in Down syndrome: A meta-analysis

BACKGROUND

Executive function (EF) refers to a set of cognitive processes involved in goal-oriented behavior-especially inhibition, attention shifting, and working memory. EF has been identified as a probable area of difficulty in Down syndrome (DS), but the exact nature of the difficulty has not been well-established.

AIMS

The meta-analysis sought to confirm or disconfirm EF as an area of difficulty in DS and elucidate an EF profile.

METHODS AND PROCEDURES

A random-effects meta-analysis was conducted on 57 studies that compared a group with DS to a typically developing (TD) mental age matched group on one or more executive function tasks. Heterogeneity was examined and moderators analyzed.

OUTCOMES AND RESULTS

The overall mean weighted effect size was large (d = -0.87), indicating poorer EF in groups with DS vs TD groups. Heterogeneity was significant, and moderator analysis revealed an EF profile with a very large effect for verbal WM/STM, a large effect for shifting, and moderate effects for inhibition and nonverbal WM/STM. Skewness analysis suggested that mean effect sizes might have been dampened, especially for WM/STM and shifting.

CONCLUSIONS AND IMPLICATIONS

Individuals with DS display a pronounced difficulty in EFs; implications for interventions and future research are discussed.

Expressive language development in adolescents with Down syndrome and fragile X syndrome: change over time and the role of family-related factors

BACKGROUND

It is well known that individuals with Down syndrome (DS) or fragile X syndrome (FXS) demonstrate expressive language difficulties beginning early in childhood. It is less clear, however, whether expressive language skills change during the adolescent period in these individuals, and if any of these changes are syndrome specific. Studying this, as well as the role of maternal and family-related factors in expressive language development, may provide the foundation for efficacious interventions for adolescents with DS or FXS.

METHODS

In this study, we examined expressive language trajectories, assessed through conversation and narration, in 57 adolescent males with intellectual disability (ID) (20 DS and 37 FXS) in relation to the diagnostic group (DS vs. FXS) and family-related factors (maternal IQ, maternal psychological distress, closeness in the mother-child relationship, family income, and maternal and paternal education) after adjusting for chronological age (CA) and nonverbal cognition.

RESULTS

Changes over repeated annual assessments for males with DS or FXS were observed only during conversation, such as an increase in talkativeness, but a decrease in syntax complexity and lexical diversity. We found a diagnosis-related effect in the change over time in conversational talkativeness favoring those with FXS. Finally, a closer mother-child relationship predicted less decrease over time in lexical diversity during conversation, and participants of mothers who graduated college showed a greater increase in conversational talkativeness over time compared to those of mothers with a high school education.

CONCLUSIONS

Our results suggest that, during the adolescent period for males with DS or FXS, there is an increase in the amount of talk produced in conversational contexts, but also a decrease in the quality of the language produced. In addition, our results indicate syndrome-specificity for aspects of expressive language development and reinforce the protective role of family-related factors.

Emotion knowledge in neurotypical children and in those with down syndrome

This research aimed to assess two components of emotion knowledge (EK): receptive EK with face emotion identification and matching tasks, and emotion situation knowledge with the emotion attribution task (EAT). Study 1 assessed the development of EK in 265 neurotypical (NT) children (4-11 years), divided into four age groups. Overall, results showed a significant improvement of EK with age in the NT population for the three tasks, especially between the ages of 4/5 and 6/7. Children were less successful at the EAT in comparison to the other two tasks, indicating that receptive EK develops earlier than emotion situation knowledge. The presence of visual context (EAT) does not help to improve our children's overall facial emotion recognition, especially for anger and sadness, while these emotions are well recognized in isolated facial expressions (emotion identification). Study 2 compared EK between 32 children with Down syndrome (CA: M = 13 years, SD = 2.13) and 32 NT children (CA: M = 5.3 years, SD = 1.36): matched on a vocabulary task. Children with DS had more difficulties in EK than NT children. They had lower performances on the identification and the EAT tasks, while exhibited similar performances to their NT controls on the emotion matching task. Moreover, good abilities to identify emotion expressions seem to be a prerequisite for successful face-context recognition in NT children, but not in children with DS. Difficulties encountered by children with DS could result from executive dysfunction when dealing with complex visual information in addition to emotion processing difficulties.

Children with Down syndrome can benefit from language interventions; Results from a systematic review and meta-analysis

Language disorder is a cardinal challenge for children with Down syndrome, and their learning capacity has been debated. The aim of the current study was to conduct a systematic review and meta-analysis of existing language interventions for children with Down syndrome to reveal knowledge about the effects of these interventions and identify any common characteristics specific to effective or ineffective interventions. A systematic search was conducted in databases relevant for education, speech and language therapy, and psychology. Based on a set of predefined inclusion criteria, the hits were screened and coded. Eight studies were synthesised in a systematic review and four in a meta-analysis. The overall effect of the interventions was large (g = 1.01), but significant transfer effects to untrained aspects of language were rarely found. Interventions showing significant effects varied with regards to numerous characteristics including the age of the target group, the intervention approach, the dosage, and the implementer. The common characteristic across the effective interventions was simply the aim of improving language skills in children with Down syndrome. Overall, there was a moderate to high risk of bias across all studies. To conclude, children with Down syndrome have the potential to respond to language intervention. However, more interventions that reach transfer effects are needed to maximise children's language outcomes. Based on the limited number of studies and a moderate to high risk of bias across the studies, there is a great need for more robust intervention studies to ensure that future interventions are informed by high-quality research.

Do Infants With Down Syndrome Show an Early Receptive Language Advantage?

Purpose The study explored longitudinally the course of vocabulary and general language development in a group of infants with Down syndrome (DS) compared to a group of typically developing (TD) infants matched on nonverbal mental ability (NVMA). Method We compared the vocabulary and general language trajectories of the two groups in two ways: (a) at three time points during a 12-month period and (b) at two time points when the groups had made equal progress in NVMA (a period of 6 months for the TD infants vs. 12 months for the infants with DS). Results The TD group had overtaken the DS group on all general language and vocabulary measures by the end of the 12-month period. However, expressive communication and expressive vocabulary were developing at the same rate and level in the two groups when examined over a period in which the two groups were matched in gains in NVMA. Furthermore, the infants with DS showed a receptive language advantage over the TD group; this group's auditory comprehension and receptive vocabulary scores were superior to those of the TD group at both time points when NVMA was accounted for. Conclusion The results shed light on the widely reported discrepancy between expressive and receptive language in individuals with DS. Although infants with DS appear to be developing language skills more slowly than chronological age TD peers, when NVMA is taken into account, infants with DS do not have expressive language delays, and they seem to show a receptive language advantage.

Cochlear implants in eight children with Down Syndrome - Auditory performance and challenges in assessment

OBJECTIVES

A small proportion of children with Down Syndrome (DS) have severe to profound hearing loss and may potentially benefit from a cochlear implant (CI). Evidence on outcomes in DS is very limited, and there is a need for further investigation to provide a basis for clinical evaluation of candidates and outcomes. This study aims to explore outcomes of CI in children with DS in Norway.

METHODS

Data on all children with DS and CI in Norway were collected from the CI registry and patients' records at the national pediatric CI center. Main outcome measures were: use of CI, Category of Auditory Performance (CAP), Speech Intelligibility Rate (SIR), and parents' and caregivers' views of the benefits of CI.

RESULTS

Eight children with DS have received CI in Norway, all bilaterally. The outcomes varied greatly. All children used their CIs, and all of them responded to environmental sounds. Four children reached CAP score 5 after several years of use, (i.e., they understand phrases without lip reading). All children scored at least 2, (i.e., responds to speech sounds). One child reached a SIR score of 3, (i.e. connected speech is intelligible to experienced listeners). The rest of the children reached SIR scores of 1 or 1-2, (i.e., connected speech is unintelligible). Without exception, parents had an entirely positive attitude to their children using a CI. Co-morbidity and middle ear disease frequently delayed implantation.

CONCLUSIONS

Our experience with CI in children with DS is positive. However, CI cannot replace other types of communication for these children, and it is important to give parents realistic expectations prior to surgery. Outcomes might be considered limited when evaluated with instruments for testing auditory performance and speech intelligibility constructed for children without additional disabilities. We do not believe that such outcomes reflect the benefit in real life.

Verb-mediated anticipatory eye movements in people with Down syndrome

BACKGROUND

Children and adults with neurotypical development employ linguistic information to predict and anticipate information. Individuals with Down syndrome (DS) have weaknesses in language production and the domain of grammar but relative strengths in language comprehension and the domain of semantics. What is not clear is the extent to which they can use linguistic information, as it unfolds in real time, to anticipate upcoming information correctly.

AIMS

To investigate whether children and young people with DS employ verb information to predict and anticipate upcoming linguistic information.

METHODS & PROCEDURES

A preferential looking task was performed, using an eye-tracker, with children and teenagers with DS and a typically developing (TD) control group matched by sex and mental age (average = 5.48 years). In each of 10 trials, two images were presented, a target and a distractor, while participants heard a phrase that contained a semantically informative verb (e.g., 'eat') or an uninformative verb (e.g., 'see').

OUTCOMES & RESULTS

Both DS and TD control participants could anticipate the target upon hearing an informative verb, and prediction skills were positively correlated with mental age in those with DS.

CONCLUSIONS & IMPLICATIONS

This work demonstrates for the first time that children and teenagers with DS can predict linguistic information based on semantic cues from verbs, and that sentence processing is driven by predictive relationships between verbs and arguments, as in children with typical development. Clinicians can take advantage of these prediction skills, using them in therapy to support weaker areas.

Modeling the Relations Among Sustained Attention, Short-Term Memory, and Language in Down Syndrome

Sustained attention (SA) and short-term memory (STM) contribute to language function in Down syndrome (DS). We proposed models in which relations of SA to language in DS are mediated by STM. Thirty-seven youth with DS aged 10-22 years (M = 15.59) completed SA, STM, and language tasks. Cross-sectional mediation analyses were run with the bootstrapping method. We found significant indirect effects of SA separately on vocabulary and syntax through auditory STM with point estimates of -.30 and -.31, respectively. Results suggest lapses in SA compromise auditory STM, which in turn impacts vocabulary and syntax in youth with DS; however, further research is needed to confirm causality. Addressing SA and STM in language therapy with youth with DS could lead to improved outcomes.

Acquisition of Reading and Intellectual Development Disorder

We propose a review of the literature of the studies investigating reading acquisition in intellectual deficiency (ID), with particular focus on the explanatory factors for reading difficulties. Indeed, we explore the role of intellectual efficiency, perceptual abilities, oral language development, phonological processing and memory. The study of reading acquisition in ID is a challenge because of a high degree of heterogeneity in the results which, together with other variables influencing learning and development. This review has allowed us to understand that there are multiple reasons why individuals with ID have difficulty learning to read. More specifically, there is a link between reading skills and certain cognitive skills, such as perception, oral language, phonological processing and working memory.

Use of electropalatography in the treatment of speech disorders in children with Down syndrome: a randomized controlled trial

BACKGROUND

Electropalatography (EPG) records details of the location and timing of tongue contacts with the hard palate during speech. It has been effective in treating articulation disorders that have failed to respond to conventional therapy approaches but, until now, its use with children and adolescents with intellectual/learning disabilities and speech disorders has been limited.

AIMS

To evaluate the usefulness of EPG in the treatment of speech production difficulties in children and adolescents with Down syndrome (DS) aged 8-18 years.

METHODS & PROCEDURES

A total of 27 children with DS were assessed on a range of cognitive and speech and language measures and underwent additional EPG assessment. Participants were randomly allocated to one of three age-matched groups receiving either EPG therapy, EPG-informed conventional therapy or 'treatment as usual' over a 12-week period. The speech of all children was assessed before therapy using the Diagnostic Evaluation of Articulation and Phonology (DEAP) and reassessed immediately post- and 3 and 6 months post-intervention to measure percentage consonants correct (PCC). EPG recordings were made of the DEAP assessment items at all time points. Per cent intelligibility was also calculated using the Children's Speech Intelligibility Measure (CSIM).

OUTCOMES & RESULTS

Gains in accuracy of production immediately post-therapy, as measured by PCC, were seen for all groups. Reassessment at 3 and 6 months post-therapy revealed that those who had received therapy based directly on EPG visual feedback were more likely to maintain and improve on these gains compared with the other groups. Statistical testing showed significant differences between groups in DEAP scores across time points, although the majority did not survive post-hoc evaluation. Intelligibility across time points, as measured by CSIM, was also highly variable within and between the three groups, but despite significant correlations between DEAP and CSIM at all time points, no statistically significant group differences emerged.

CONCLUSIONS & IMPLICATIONS

EPG was an effective intervention tool for improving speech production in many participants. This may be because it capitalizes on the relative strength of visual over auditory processing in this client group. The findings would seem to warrant an increased focus on addressing speech production difficulties in current therapy.

How do maternal interaction style and joint attention relate to language development in infants with Down syndrome and typically developing infants?

Down syndrome (DS) is more detrimental to language acquisition compared to other forms of learning disability. It has been shown that early social communication skills are important for language acquisition in the typical population; however few studies have examined the relationship between early social communication and language in DS. The aim of the current study is to compare the relationship between joint attention and concurrent language skills, and maternal interactive style and concurrent language skills in infants with DS and in typically developing (TD) infants matched for mental age. We also investigated if these relationships differ between children with DS and TD children. Twenty-five infants with DS (17-23 months) and 30 TD infants (9-11 months) were assessed on measures of joint attention, maternal interactive style and language. The results indicated a significant positive relationship between responding to joint attention (RJA) and concurrent language for the DS group, and a significant positive relationship between maternal positive expressed emotion (PEEM) and concurrent language for the TD group. We hypothesise that different social-communication factors are associated with language skills in DS, at least between 17 and 23 months of age compared to TD infants of similar non-verbal and general language abilities.

Language development and intelligence in midlife

Individual differences in early language skills have been found to be associated with other cognitive outcomes in childhood and adolescence. However, research is limited on whether these associations persist into adulthood. In this study, we examined potential associations of the timing of early language milestones with cognitive ability in a prospective cohort study of 938 singletons from the Copenhagen Perinatal Cohort (CPC), who participated in a 50-year follow-up examination in 2009-2011. Later attainment of a number of milestones was associated with lower midlife IQ with the strongest associations found for 'Naming objects/animals in pictures', 'Forming a sentence', and 'Sharing experiences'. Milestones related to language explained 6.7% of the variance in midlife IQ, while milestones related to social interaction explained 3.1%. The study provides evidence that individual differences in language development during the first years of life are associated with intelligence in midlife. Statement of contribution What is already known on this subject? Differences in early language skills are associated with other cognitive skills in childhood and adolescence. No study has examined this association from childhood through midlife in a large community-based sample. What does this study add? Early language development is associated with intelligence in midlife. A total of 6.7% of the variance in midlife IQ is explained by milestones related to language. Adjustment for potentially confounding factors did not change the associations.

Parent-mediated interventions for promoting communication and language development in young children with Down syndrome

BACKGROUND

Communication and language development are areas of particular weakness for young children with Down syndrome. Caregivers' interaction with children influences language development, so many early interventions involve training parents how best to respond to their children and provide appropriate language stimulation. Thus, these interventions are mediated through parents, who in turn are trained and coached in the implementation of interventions by clinicians. As the interventions involve a considerable commitment from clinicians and families, we undertook this review to synthesise the evidence of their effectiveness.

OBJECTIVES

To assess the effects of parent-mediated interventions for improving communication and language development in young children with Down syndrome. Other outcomes are parental behaviour and responsivity, parental stress and satisfaction, and children's non-verbal means of communicating, socialisation and behaviour.

SEARCH METHODS

In January 2018 we searched CENTRAL, MEDLINE, Embase and 14 other databases. We also searched three trials registers, checked the reference lists of relevant reports identified by the electronic searches, searched the websites of professional organizations, and contacted their staff and other researchers working in the field to identify other relevant published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that compared parent-mediated interventions designed to improve communication and language versus teaching/treatment as usual (TAU) or no treatment or delayed (wait-listed) treatment, in children with Down syndrome aged between birth and six years. We included studies delivering the parent-mediated intervention in conjunction with a clinician-mediated intervention, as long as the intervention group was the only group to receive the former and both groups received the latter.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures for data collection and analysis.

MAIN RESULTS

We included three studies involving 45 children aged between 29 months and six years with Down syndrome. Two studies compared parent-mediated interventions versus TAU; the third compared a parent-mediated plus clinician-mediated intervention versus a clinician-mediated intervention alone. Treatment duration varied from 12 weeks to six months. One study provided nine group sessions and four individualised home-based sessions over a 13-week period. Another study provided weekly, individual clinic-based or home-based sessions lasting 1.5 to 2 hours, over a six-month period. The third study provided one 2- to 3-hour group session followed by bi-weekly, individual clinic-based sessions plus once-weekly home-based sessions for 12 weeks. Because of the different study designs and outcome measures used, we were unable to conduct a meta-analysis.We judged all three studies to be at high risk of bias in relation to blinding of participants (not possible due to the nature of the intervention) and blinding of outcome assessors, and at an unclear risk of bias for allocation concealment. We judged one study to be at unclear risk of selection bias, as authors did not report the methods used to generate the random sequence; at high risk of reporting bias, as they did not report on one assessed outcome; and at high risk of detection bias, as the control group had a cointervention and only parents in the intervention group were made aware of the target words for their children. The sample sizes of each included study were very small, meaning that they are unlikely to be representative of the target population.The findings from the three included studies were inconsistent. Two studies found no differences in expressive or receptive language abilities between the groups, whether measured by direct assessment or parent reports. However, they did find that children in the intervention group could use more targeted vocabulary items or utterances with language targets in certain contexts postintervention, compared to those in the control group; this was not maintained 12 months later. The third study found gains for the intervention group on total-language measures immediately postintervention.One study did not find any differences in parental stress scores between the groups at any time point up to 12 months postintervention. All three studies noted differences in most measures of how the parents talked to and interacted with their children postintervention, and in one study most strategies were maintained in the intervention group at 12 months postintervention. No study reported evidence of language attrition following the intervention in either group, while one study found positive outcomes on children's socialisation skills in the intervention group. One study looked at adherence to the treatment through attendance data, finding that mothers in the intervention group attended seven out of nine group sessions and were present for four home visits. No study measured parental use of the strategies outside of the intervention sessions.A grant from the Hospital for Sick Children Foundation (Toronto, Ontario, Canada) funded one study. Another received partial funding from the National Institute of Child Health and Human Development and the Department of Education in the USA. The remaining study did not specify any funding sources.In light of the serious limitations in methodology, and the small number of studies included, we considered the overall quality of the evidence, as assessed by GRADE, to be very low. This means that we have very little confidence in the results, and further research is very likely to have an important impact on our confidence in the estimate of treatment effect.

AUTHORS' CONCLUSIONS

There is currently insufficient evidence to determine the effects of parent-mediated interventions for improving the language and communication of children with Down syndrome. We found only three small studies of very low quality. This review highlights the need for well-designed studies, including RCTs, to evaluate the effectiveness of parent-mediated interventions. Trials should use valid, reliable and similar measures of language development, and they should include measures of secondary outcomes more distal to the intervention, such as family well-being. Treatment fidelity, in particular parental dosage of the intervention outside of prescribed sessions, also needs to be documented.

Longitudinal predictors of early language in infants with Down syndrome: A preliminary study

PURPOSE

Children with Down syndrome (DS) typically have marked delays in language development relative to their general cognitive development, with particular difficulties in expressive compared to receptive language. Although early social communication skills, including gestures and joint attention, have been shown to be related to later language outcomes in DS, knowledge is limited as to whether these factors exclusively predict outcomes, or whether other factors (e.g. perceptual and non-verbal skills) are involved. This study addressed this question.

METHOD

Longitudinal data for a group of infants with DS (n = 14) and a group of typically-developing (TD) infants (n = 35) were collected on measures that have been shown to predict language in TD infants and/or those with developmental delays. These included: non-verbal mental ability, speech segmentation skills, and early social communication skills (initiating and responding to joint attention, initiating behavioural requests).

RESULTS

Linear regression analyses showed that speech segmentation and initiating joint attention were the strongest predictors of later language in the TD group, whereas non-verbal mental ability and responding to joint attention were the strongest predictors of later language for infants with DS.

CONCLUSIONS

Speech segmentation ability may not determine language outcomes in DS, and language acquisition may be more constrained by social communication and general cognitive skills.