Narrative content as described by individuals with Down syndrome and typically developing children

How to Assess Oral Narrative Skills of Children and Adolescents with Intellectual Disabilities: A Systematic Review

Children and adolescents with intellectual disabilities (ID) often encounter difficulties with narrative skills. Yet, there is a lack of research focusing on how to assess these skills in this population. This study offers an overview of the tools used for assessing oral narrative skills in children and adolescents with ID, addressing key questions about common assessment tools, their characteristics, and reported evidence. A systematic review was conducted of the literature published between 2010 and 2023 in the PsycINFO, ERIC, Education, and Psychology databases. An initial 1176 studies were reviewed by abstract, of which 485 were read in full text, leading to the selection and analysis of 22 studies. Most of the identified tools involve analyzing language samples obtained using wordless picture story books. Three common tools are emphasized. Studies have primarily identified inter-rater reliability and test-criterion evidence for validity. The main tools and their characteristics are discussed in depth to aid readers in discerning suitable options for research or practical applications. The importance of reporting diverse sources of evidence for validity and reliability within this population is highlighted.

Comprehension of active, passive, and causative sentences by Japanese-speaking children with intellectual disabilities and typical development

This study aimed to identify the comprehension strategies employed for active, passive, and causative sentences and the involvement of phonological memory, which is a subsystem of working memory, in the comprehension skills of Japanese-speaking children with intellectual disability (ID) compared to those with typical development (TD). The participants were 29 children with ID and 18 children with TD who were matched according to mental and vocabulary ages and phonological memory scores. A picture selection method was employed as a sentence comprehension task. The stimulus sentences were grouped into four patterns of word order: subject (S) - object (O) - verb (V), OSV, SV, and OV. For example, in active sentences, the subject and object are assigned to agent and patient, respectively. The results indicated that children in both groups made comprehension errors for sentences that lacked information regarding the agent and sentences in which the two-noun sequence inverts the typical agent - patient or instructor - instructed order. Phonological memory's involvement in sentence comprehension varied according to the combination of participant groups, sentence types, and patterns. The results suggest that both children with ID and TD relied on agent bias, whereby children consider the first noun to denote the actor and a word order strategy of interpreting a sequence of two noun phrases followed by the transitive verb as agent - patient - act. Furthermore, phonological memory underpins understanding of the relationships among arguments, particularly in the case of sentences for which agent bias or word order strategy may result in misinterpretation.

A longitudinal investigation of pragmatic language across contexts in autism and related neurodevelopmental conditions

Background

Pragmatic language, or the use of language in social contexts, is a critical skill in daily life, supporting social interactions and the development of meaningful social relationships. Pragmatic language is universally impacted in autism spectrum disorder (ASD) and pragmatic deficits are also common in other neurodevelopmental conditions, particularly those related to ASD, such as fragile X syndrome (FXS). This study used a multi-method, longitudinal approach to characterize potentially unique pragmatic profiles across different neurodevelopmental disabilities, and across contexts that varied in degree of social demand. The utility of computational linguistic analyses, as an efficient tool for capturing pragmatic abilities, was also explored.

Methods

Pragmatic skills of boys with idiopathic ASD (ASD-O, n = 43), FXS with and without ASD (FXS-ASD, n = 57; FXS-O, n = 14), Down syndrome (DS, n = 22), and typical development (TD, n = 24) were compared using variables obtained from a standardized measure, narrative, and semi-naturalistic conversation at up to three time points.

Results

Pragmatic language was most significantly impacted among males with ASD-O and FXS-ASD across all three contexts, with more difficulties in the least structured context (conversation), and also some differences based on FXS comorbidity. Patterns of group differences were more nuanced for boys with FXS-O and DS, with context having less of an impact. Clinical groups demonstrated minimal changes in pragmatic skills with age, with some exceptions. Computational language measurement tools showed some utility for measuring pragmatic skills, but were not as successful as traditional methods at capturing differences between clinical groups.

Conclusion

Overlap and differences between ASD and other forms of neurodevelopmental disability in general, and between idiopathic and syndromic ASD in particular, have important implications for developing precisely tailored assessment and intervention approaches, consistent with a personalized medicine approach to clinical study and care in ASD.

The effects of incorporating extended conversations into video-based story retelling instruction on oral narrative skills in adolescents with intellectual disability in China

BACKGROUND/AIMS

Oral narrative language is a persistent area of language difficulty for individuals with intellectual disability (ID). This study aims to explore the effectiveness of a comprehensive intervention program that incorporates extended conversations into video-based story retelling instruction with a novel visual support strategy, Story Hand, to develop oral narrative skills in adolescents with ID in China.

METHODS

Using a single-case multiple-probe across participants design, the researchers examined whether the comprehensive intervention program could improve participants' oral narrative skills both microstructurally and macrostructurally.

RESULTS

All three participants demonstrated moderate to high treatment effects in the microstructural narrative outcomes (i.e., the mean length of utterance in morphemes [MLU-M] and the number of different words [NDW]) and one of the macrostructural narrative outcomes (i.e., the complexity of story grammar [SG-complexity]) in response to the comprehensive intervention program, and these acquired effects were maintained at a high level for up to one month. However, all three participants demonstrated limited treatment effects in one of the macrostructural narrative outcomes (i.e., cohesion) in response to the comprehensive intervention program.

CONCLUSIONS/IMPLICATIONS

The comprehensive intervention program that incorporates extended conversations into visually supported video-based story retelling instruction offers an option for teachers to develop oral narrative skills in adolescents with ID. However, the relative effectiveness of the different components of the intervention needs to be further explored.

Development of narratives in Tamil-speaking preschool children: A task comparison study

‘Narrative’ can be simply defined as a spoken or written account of connected events or experiences. The present study records the development of microstructure elements of narratives in 200 typically developing Tamil-speaking children aged between three years and six years and eleven months. It then compares their narrative productivity across two elicitation contexts: story retelling (SR) and story generation (SG). The samples thus obtained are analyzed for three narrative microstructure parameters, namely total number of words (TNW) in the narrative, mean length of utterances (MLU) and the number of utterances. The results reveal an increasing trend in all three microstructure parameters across both contexts. All three parameters are found to be quantitatively high in SR than in SG. Variation in the performance in these narrative tasks has been explained with behavioural observations from literature, cognitive architecture and a working memory model. It was found that gender differences do not follow a uniform pattern across age groups and elicitation contexts. Since the study has generated normative data for microstructure parameters of narratives, the observations can be used to analyze language deviance and help plan the narrative intervention protocol for language therapy.

Language Ideologies, Practices, and Kindergarteners’ Narrative Macrostructure Development: Crucial Factors for Sustainable Development of Early Language Education

This paper explored crucial factors to achieve sustainable development of early language education by examining the relationship between two dimensions of family language policy—language ideologies and language practices—as well as the relationship between family language policy and the development of children’s narrative macrostructure. Data were collected via a language performance test and a questionnaire survey of 131 kindergartners from 10 kindergartens in a Chinese city. Structural equation modeling corroborated the relationship between family language ideologies and family language practices proposed by family language policy theorists. Results showed that family language policy significantly predicted kindergarteners’ development of narrative macrostructure. In addition, age was shown to be a significant predictor of narrative macrostructure development, whereas gender was not. Implications for early intervention of children’s narrative macrostructure development were discussed.

Narrative and prosodic skills in children and adolescents with Down syndrome and typically developing children

PURPOSE

Children with Down Syndrome (DS) show difficulties in language development, in both basic and complex abilities, as narratives. Less is known about the prosodic competence in DS, but the few available studies highlighted the presence of some deficits. Considering the importance of narratives and prosody in communication, the main aim of this study is to investigate these two competencies in participants with DS.

METHOD

13 children with DS participated (Mean age: 13;04, years; months). Their narrative and prosodic abilities, collected through a storytelling task, were compared with those of two control groups of typically developing (TD) children, one matched for nonverbal mental age (MA, Mean age: 5;03) and the other matched for the mean length of utterance (MLU, Mean age: 5;05). For the narrative competence, we considered both the macrostructural (i.e. quantity of information and story structure) and the microstructural level (i.e. verbal productivity, lexical diversity, syntactic complexity). For the prosodic competence, we took into account acoustic measures linked to intonation (i.e. mean fundamental frequency (f0), pitch range, final speech profile, and speed of speech).

RESULT

The results of the Mann-Whitney test showed that participants with DS produced stories comparable to those of TD children in nearly all the variables considered, except for the syntactic complexity when compared with children of the same MA. Differences between participants with DS and TD children were found in the f0 and the final pitch profile used.

CONCLUSION

Considering the small size of the samples, these preliminary results should be taken with caution. Nonetheless, this study confirms the presence of difficulties in the prosody of speech and in the syntactic competence of children with DS. These difficulties could have consequences on the possibility to communicate efficiently and should be taken into account in rehabilitation programmes.

Language Development Disorder in Fetal Alcohol Spectrum Disorders (FASD), a Case Study

Prenatal alcohol exposure can cause developmental damage in children. There are different types and ranges of alterations that fall under the name of fetal alcohol spectrum disorders (FASD). Disabilities in learning, cognition, and behavior are observed. Environmental conditions are an influencing factor in this population since they are generally adverse and are either not diagnosed at an early stage or given the appropriate support and approach. We present a case study of a 9-year-old child, in which all the variables affecting his development (FASD diagnosis and socioenvironmental conditions) were observed and analyzed. His early childhood under institutional care, the move to a foster home at the age of 6, and several measures of evaluation from foster care to the present are described. Difficulties in vocabulary, access to vocabulary, morphology, syntax, grammar, oral narrative, pragmatics, speech, and communication were observed, along with cognitive difficulties in memory, perception and executive functioning, social adaptation, learning, and behavior. An early diagnosis and approach enable this population to develop skills in different dimensions to address early adversity despite their neurological and behavioral commitment. Speech-language pathologist services are crucial for the diagnosis and treatment of the language and communication difficulties that characterize this syndrome.

Narrative Abilities of Adults' With Down Syndrome as a Window to Their Morphosyntactic, Socio-Cognitive, and Prosodic Abilities

Down syndrome (DS) is the most common developmental disorder characterized by mild to moderate intellectual disability. Several studies have reported poor language and prosodic skills and contradictory results regarding individuals’ with DS socio-cognitive skills, whereas most of them have focused on children with DS. The present study attempts to explore adults’ with DS language, socio-cognitive and prosodic abilities via the use of story-retellings. Twenty adults with DS and two groups of TD children, one matched to their expressive vocabulary (TD-EVT) and the other matched to their non-verbal mental age (TD-RCPM), took part in the present study. Participants listened to a story while viewing a wordless picture PowerPoint presentation on a computer screen, and then, they were instructed to retell the story while viewing the pictures for a second time. Each participant listened to two stories, one with “lively” and one with “flat” prosody. Results revealed that adults’ with DS performance was comparable with the one presented by the TD-RCPM group, whereas the TD-EVT group performed significantly better in almost all variables. Individuals’ with DS re-narrations, however, contained significantly less complement clauses and internal state terms (related or not related to Theory of Mind–ToM) compared to the re-narrations of both control groups. In contrast, the group with DS performed similarly to both control groups in comprehension questions related to main characters’ internal state terms and significantly better compared to the TD-RCPM group in questions related to ToM. In terms of prosody, all three groups performed significantly better on story structure and comprehension questions when prosody was “lively” compared “flat” prosody. DS group’s re-narrations did not contain enough internal state terms, not due to their inability in recognizing them, but due to their poor morphosyntactic abilities, which did not allow them to find the proper means to express the main characters’ internal states. Prosody facilitated participants with DS in the comprehension and re-narration. This suggests that intervention programs based on prosody could support the language skills of adults with DS.

Cross-Sectional Trajectories of Mental State Language Development in Children With Down Syndrome

Purpose This article (a) examined the cross-sectional trajectories of mental state language use in children with Down syndrome (DS) and (b) identified developmental factors associated with its use. Method Forty children with DS aged 6-11 years generated stories from a wordless picture book and completed an assessment battery of other linguistic, cognitive, and social-emotional skills. Their narratives were coded for mental state language density (the proportion of utterances containing mental state references) and diversity (the number of different mental state terms used). Results The emergence of mental state language use during narrative storytelling was observed across the sample; 0%-24% of children's utterances included references to mental states, and a variety of mental state terms were produced. Cross-sectional developmental trajectory analysis revealed that expressive vocabulary and morphosyntax were significantly related to increased mental state language density and diversity. Nonverbal emotion knowledge was significantly related to greater diversity of mental state terms used. Age and nonverbal cognition were not significant factors. Conclusions This first in-depth, within-syndrome characterization of mental state language use by school-age children with DS provides an important next step for understanding mental state and narrative development in this population. By identifying skills associated with the development of mental state language, this study provides an avenue for future longitudinal research to determine causal relationships, ultimately informing intervention efforts.

Syntactic development in children with intellectual disabilities - using structured assessment of syntax

BACKGROUND

Children with intellectual disabilities (IDs) have a severe delay in syntactic development compared with other language abilities. This study investigated conditions of syntactic development in native Japanese-speaking children with ID.

METHODS

Children with ID [N = 51; 18 autism spectrum disorders (ASD), 18 Down syndrome (DS) and 15 ID without ASD and DS] were compared with typically developing children (N = 78) with the same mental age (MA). The development of syntax in spoken language was examined by receptive and production tasks.

RESULTS

The development of syntax in children with ID was significantly delayed than in typically developing children with the same MA. However, when reaching the MA of 7-9, syntax abilities started to develop remarkably. Moreover, children with ASD had significant difficulties in acquiring passive voice, whereas children with DS showed a significant delay in syntactic development.

CONCLUSIONS

The development of syntax in children with ID might be affected by MA and the type of disability. Moreover, it is necessary to exceed an MA of 7-9 years for children with ID to develop syntax abilities.

Spoken fictional narrative and literacy skills of children with Down syndrome

BACKGROUND

Children with Down syndrome (DS) exhibit below average nonverbal intelligence and impaired language skills; however, their spoken narrative production is a relative strength.

AIMS

We examined expressive language skills produced during fictional narrative retells and analyzed the unique contribution of expressive language skills to word-level reading and reading comprehension of children with DS.

METHODS AND PROCEDURES

The microstructure and macrostructure of fifteen, 8- to 18-year-old children with DS's narrative retells were analyzed. Receptive vocabulary, word-level reading, and reading comprehension also were measured.

RESULTS

Narrative microstructure analyses revealed restricted syntactic and semantic diversity. Further analyses of sentence complexity revealed that children with DS predominately produced prepositional phrases and produced more verbs than nouns. Narrative macrostructure analysis revealed participants use of episodic components; however, their stories did not include mental state references. Narrative microstructure contributed unique variance to word-level reading, whereas narrative macrostructure contributed unique variance to word-level reading and reading comprehension. Additionally, strong correlations were found between narrative skills and literacy skills.

CONCLUSIONS AND IMPLICATIONS

Findings from this study support the use of narrative microstructure and macrostructure analyses as a valuable clinical tool to guide assessment and intervention planning for school-aged children with DS.

Desempenho de falantes do português brasileiro no “Test of Narrative Language (TNL)”

RESUMO Objetivo Investigar o desempenho de falantes do português brasileiro no Test of Narrative Language e correlacionar o desempenho nas tarefas de produção e compreensão da narrativa. Método Participaram 140 indivíduos, entre 5 e 11 anos e 11 meses de idade com desenvolvimento típico de linguagem, divididos de acordo com a faixa etária. Resultados Diferença significativa foi encontrada entre o grupo de 5 anos e todos os demais grupos etários, bem como para o grupo de 6 anos quando comparado ao grupo de 8, 9, 10 e 11 anos. O grupo de 7 anos não diferiu estatisticamente dos grupos de 6 e 8 anos. Metade do grupo de 7 anos cursava o primeiro ano e a outra metade, o segundo ano, o que pode ter contribuído para a não diferenciação do grupo com as faixas etárias fronteiriças. Não foi encontrada diferença estatisticamente significante entre os grupos a partir dos 8 anos. Observou-se correlação positiva entre o desempenho de compreensão e produção nos grupos etários de 5, 6 e 7 anos, o que não ocorreu para os demais grupos. Conclusão O teste diferenciou as faixas etárias de 5, 6 e 7 anos, o que não ocorreu nas faixas etárias a partir dos 8 anos. Também, a partir dos 8 anos, não foi encontrada correlação entre a produção e a compreensão narrativa, sinalizando o domínio de ambas as habilidades a partir desta faixa etária.

Inferential language use by youth with Down syndrome during narration

We examined inferential language use by youth with Down syndrome (DS) in the context of narrative storytelling relative to younger typically developing (TD) children and same-aged peers with fragile X syndrome (FXS) matched on nonverbal cognitive ability level. Participants' narratives were coded for the use of different types of inferential language. Participants with DS used proportionately less inferential language overall relative to their counterparts with TD or FXS, although mean length of utterance accounted for group differences observed for the DS-TD group comparison only. Patterns of inferential language use varied across inferential subtypes and across participant groups, with mean length of utterance playing a significant role in group differences. These findings suggest potential syndrome specificity to the DS phenotype regarding impairments in inferential language use that can be partially explained by level of expressive syntactic ability and should be considered in future research. Clinical interventions within the DS population, therefore, should target to some extent the use of inferential language and complex sentence structure.

Cognitive stimulation of pupils with Down syndrome: A study of inferential talk during book-sharing

In the education of pupils with Down syndrome, "simplifying" literal talk and concrete stimulation have typically played a dominant role. This explorative study investigated the extent to which teachers stimulated abstract cognitive functions via inferential talk during book-sharing and how pupils with Down syndrome responded. Dyadic interactions (N=7) were videotaped, transcribed and coded to identify levels of abstraction in teacher utterances and to evaluate the adequacy of pupil responses. One-third of the teachers' utterances contained high levels of abstraction and promoted inferential talk. Six of the seven children predominantly responded in ways which revealed inferential thinking. Dialog excerpts highlighted individual, contextual and interactional factors contributing to variations in the findings. Contrary to previous claims, the children with Down syndrome in the current sample appear able to draw inferences beyond the "here-and-now" with teacher support. This finding highlights the educational relevance and importance of higher-order cognitive stimulation of pupils with intellectual disabilities, to foster independent metacognitive skills.

Narrative language competence in children and adolescents with Down syndrome

This study was designed to examine the narrative language abilities of children and adolescents with Down syndrome (DS) in comparison to same-age peers with fragile X syndrome (FXS) and younger typically developing (TD) children matched by nonverbal cognitive ability levels. Participants produced narrative retells from a wordless picture book. Narratives were analyzed at the macrostructural (i.e., their internal episodic structure) and the microstructural (i.e., rate of use of specific word categories) levels. Mean length of utterance (MLU), a microstructural metric of syntactic complexity, was used as a control variable. Participants with DS produced fewer episodic elements in their narratives (i.e., their narratives were less fully realized) than the TD participants, although MLU differences accounted for the macrostructural differences between participant groups. At the microstructural level, participants with DS displayed a lower rate of verb use than the groups with FXS and typical development, even after accounting for MLU. These findings reflect both similarities and differences between individuals with DS or FXS and contribute to our understanding of the language phenotype of DS. Implications for interventions to promote language development and academic achievement are discussed.

Assessing cognitive improvement in people with Down syndrome: important considerations for drug-efficacy trials

Experimental research over just the past decade has raised the possibility that learning deficits connected to Down syndrome (DS) might be effectively managed by medication. In the current chapter, we touch on some of the work that paved the way for these advances and discuss the challenges associated with translating them. In particular, we highlight sources of phenotypic variability in the DS population that are likely to impact performance assessments. Throughout, suggestions are made on how to detect meaningful changes in cognitive-adaptive function in people with DS during drug treatment. The importance of within-subjects evaluation is emphasized.

Evaluation of language and communication skills in adult key word signing users with intellectual disability: advantages of a narrative task

The evaluation of language and communication skills in adults who use augmentative and alternative communication (AAC) in general and key word signing (KWS) in particular, can be an elaborate task. Besides being time-consuming and not very similar to natural communication, standard language tests often do not take AAC or KWS into account. Therefore, we developed a narrative task specifically for adults with intellectual disability (ID) who use KWS. The task was evaluated in a group of 40 adult KWS users. Outcome measures on the narrative task correlated significantly with measures of standard language and communication tests for verbal language, but not for use of manual signs. All narrative measures, for both verbal language and manual signing, correlated highly with similar measures from a conversation sample. The developed narrative task proved useful and valid to evaluate the language and communication skills of adults with ID taking into account both their verbal language and manual sign use.

Linguagem narrativa e fluência na síndrome de down: uma revisão

A síndrome de Down é uma condição na qual os indivíduos apresentam comprometimento intelectual e alterações de linguagem oral. A disfluência de fala está presente tanto durante a conversa espontânea como em produções orais de narrativas direcionadas. Este estudo teve como principal objetivo revisar a literatura sobre a disfluência e a narrativa em indivíduos com a síndrome de Down, publicada entre 2002 e 2012, em bases de dados eletrônicos. Foram encontrados 17 artigos e selecionados oito, de acordo com os critérios de inclusão e exclusão. Destes, dois discorriam especificamente sobre a disfluência na síndrome de Down, e seis sobre a narrativa nesta população. A deficiência intelectual é parte do fenótipo dos indivíduos com SD e, em decorrência do comprometimento intelectual, prejuízos na aquisição e no desenvolvimento da linguagem. Estudos específicos, principalmente sobre a fluência/disfluência; e, sobre o desempenho na tarefa da narrativa, ainda são escassos e inconclusivos. A disfluência não aparece na maioria das descrições do fenótipo de linguagem dos indivíduos com esta condição, que mereceria, estudos clínicos adicionais.

Longitudinal profiles of expressive vocabulary, syntax and pragmatic language in boys with fragile X syndrome or Down syndrome

BACKGROUND

Fragile X syndrome (FXS) and Down syndrome (DS) are the two leading genetic causes of intellectual disability, and FXS is the most common known genetic condition associated with autism. Both FXS and DS are associated with significant language impairment, but little is known about expressive language across domains over time or the role of autism in language development in FXS.

AIMS

To compare three domains of language production (vocabulary, syntax, pragmatics) over time within and across groups of boys with FXS with and without autism spectrum disorder (FXS-ASD, FXS-O), boys with DS, and typically developing (TD) boys.

METHODS & PROCEDURES

Twenty-nine boys with FXS-O, 40 boys with FXS-ASD, 34 boys with DS, and 48 younger TD boys of similar non-verbal mental age living in the United States participated in the study. The Antonyms, Syntax Construction and Pragmatic Judgment subtests of the Comprehensive Assessment of Spoken Language were administered annually over 3 years.

OUTCOMES & RESULTS

TD boys scored higher than all other groups on all three subtests; boys with FXS-O and FXS-ASD scored higher than boys with DS in Syntax Construction; and boys with FXS-O scored higher than boys with FXS-ASD in Pragmatic Judgment. Within-group patterns varied between groups. Overall, the TD group showed significantly more change over time than all other groups.

CONCLUSIONS & IMPLICATIONS

Findings suggest that expressive language skills and growth across various domains are more impaired in boys with FXS and DS than would be expected based on non-verbal mental age, that for boys with DS syntax is more impaired than would be expected based on intellectual disability, and that autism status affects pragmatic language in boys with FXS. Findings suggest that language production across domains should be addressed during assessment and intervention for boys with FXS and boys with DS, with differing group profiles also suggesting potentially different areas of focus.

Narrative discourse and sociocognitive abilities of a child with Cri-du-Chat syndrome

The authors investigated narrative competence, sociocognitive abilities and emotion comprehension in a 9-year-old child (FS) with Cri-du-Chat Syndrome (CdCS) who had only a mild mental delay and relatively preserved language. Considering that the production of narratives is a major step in development and in the acquisition of learning skills related to conceptual, linguistic, structural, and pragmatic knowledge, and in the development of psychological lexicon, that is, the ability to use theory of mind (ToM) processes also in atypical development, this case provided an opportunity to study aspects of this genetic syndrome never investigated before. The authors found that the child's performance on different stories was comparable to that of chronological age controls for several narrative and emotional competences and even better than that of mental age controls. However, her ability to reason was still incomplete according ToM; in fact, FS was able to express her mental states, but she was unable to understand emotions, specifically mixed emotions. This finding suggests that in CdCS children with a well-developed language narrative and emotional competence could be a point of strength for improving their social skills with important effects on their familiar and school life. Also in CdCS children with the typical poor developed language, the narrative discourse could be introduced in their communication by means of any type of alternative language (i.e., sign language or augmentative and alternative communication) to improve their social abilities and to reduce behavioral disorders due to the difficulty in expressing their personal experiences.

Five Principles to Consider When Providing Narrative Language Intervention to Children and Adolescents With Developmental Disabilities

For many verbally expressive children and adolescents with developmental disabilities, it is important for speech-language pathologists to target narrative language skills in intervention. Although relatively little empirical evidence exists examining the narrative language profiles of children and adolescents with developmental disabilities, even less evidence exists evaluating narrative interventions for this population. Despite these limitations, drawing from research primarily involving adolescents with Down syndrome (DS), the author highlights five research-supported principles for clinicians to consider when designing and implementing narrative-focused interventions for individuals with developmental disabilities.

A longitudinal study of narrative development in children and adolescents with Down syndrome

The present study examined narrative development in children and adolescents with Down syndrome longitudinally. Narratives were collected from 32 children and adolescents with Down syndrome three times over a 1-year period. Both micro- and macrolevel analyses were conducted. Significant growth over the 1-year period was seen in semantic complexity and narrative structure. However, there was no evidence of growth in syntactic complexity or narrative length. Mental age and comprehension skills at Time 1 predicted scores in all 4 areas at Time 3. Expressive language skills added further to the prediction of syntactic complexity and story length.

Macrostructural narrative language of adolescents and young adults with Down syndrome or fragile X syndrome

PURPOSE

To gain a better understanding of language abilities, the expressive macrostructural narrative language abilities of verbally expressive adolescents and young adults with Down syndrome (DS) and those with fragile X syndrome (FXS) were examined.

METHOD

The authors evaluated 24 adolescents and young adults with DS, 12 male adolescents and young adults with FXS, and 21 younger children with typical development (TD). Narrative samples were assessed at the macrostructural level using the narrative scoring scheme (Heilmann, Miller, Nockerts, & Dunaway, 2010). Three group comparisons were made using (a) the full sample matched on nonverbal mental age, (b) a subset of the participants individually matched on nonverbal mental age, and (c) a subset of participants individually matched on mean length of utterance.

RESULTS

Study analyses revealed that the DS and FXS groups significantly outperformed the TD group on a limited number of narrative scoring scheme measures. No significant differences emerged between the DS and FXS groups.

CONCLUSIONS

The study's results suggest that some aspects of macrostructural narrative language may be relative strengths for adolescents and young adults with DS and those with FXS. These results can be used to create more nuanced and informed approaches to assessment and intervention for these populations.

Personal narrative skills of school-aged children with Down syndrome

BACKGROUND

Personal narratives are descriptions of past events experienced by the speaker and are one of the most commonly found forms of narration in children. The ability to tell personal narratives is considered critical for socio-emotional wellbeing and academic performance.

AIMS

This study investigated the personal narrative skills of 25 children with Down syndrome (age 5;11-13;1 years) who attended predominantly mainstream primary schools in New Zealand and were classified as beginning readers.

METHODS & PROCEDURES

Personal narrative samples were elicited by the children's speech-language therapists using a standard protocol commonly used with New Zealand children. Children were shown a series of 11 photographs with scripted introductory prompts and were asked if anything like that ever happened to them. Transcribed samples were analysed on measures of mean length of utterance in morphemes (MLU-M), semantics (number of different words; NDW), and personal narrative quality (PNQ).

OUTCOMES & RESULTS

Consistent with previous research, results showed wide variability in performance. Although 92% of the children produced at least 50 utterances in response to the prompts, in general MLU-M was very low (mean = 2.67, SD = 1.04). NDW ranged from 19 to 126 (mean = 61.52, SD = 25.39). Regression analyses showed no significant effect for age on MLU-M (p= 0.094), nor on PNQ. There was a significant effect for age on NDW (p= 0.03), with performance improving with age. Analysis of PNQ revealed that only four children (ages 9;11-12;7) were able to relate a personal narrative containing a high point. Correlational analyses indicated significant correlations between PNQ, MLU-M, NDW and performance on a standardized reading test.

CONCLUSIONS & IMPLICATIONS

The findings highlight the difficulties children with Down syndrome have in producing personal narratives, despite exposure to a national English curriculum that encourages children to develop and convey 'personal voice'. Clinical implications of these findings will be presented.

Communicative performance of children with Down syndrome in two different situations

BACKGROUND

analysis of the pragmatic aspects of language in children with Down syndrome.

AIM

to verify the influence of environmental and contextual variables in the pragmatic aspects of language of Down syndrome (DS) children when interacting with their caregivers and therapist, and to compare their performance in both situations.

METHOD

participants were 15 children with DS with ages ranging from 4 to 6.11 years. Data were obtained through anamnesis, the protocol of functional communicative profile, and a socioeconomic questionnaire. Data obtained from both interaction situations (with the caregiver and with the therapist) were compared, and submitted to statistical analysis.

RESULTS

Caregiver's socioeconomic and educational levels were the variables that most had an influence on the pragmatic aspects of the child in both interaction situations. Children presented proportional rates of functional communication when compared to the data obtained for their caregivers and the communicative functions more frequently used by them were recognition of others, comment and performative. Comparisons between the interaction situations indicated no statistically significant differences concerning the children's communicative performance.

CONCLUSION

caregivers' socioeconomic and educational levels might be considered risk factors for the development of the pragmatic aspects of language in children with DS and special attention should be given to these families during the speech-language therapeutic process. Independently of the interlocutor, these children were able to initiate and maintain communication, using communicative means and functions in a similar fashion.

Needs and challenges of daily life for people with Down syndrome residing in the city of Rome, Italy

BACKGROUND

Population-based surveys on the quality of life of people with Down syndrome (DS) are difficult to perform because of ethical and legal policies regarding privacy and confidential information, but they are essential for service planning. Little is known about the sample size and variability of quality of life of people with DS living in the city of Rome, which has a population of 2.7 million inhabitants. The aim of the present study is to explore the needs and challenges in health, social integration and daily life, of people with DS living in Rome.

METHODOLOGY

A cross-sectional, census-based survey was conducted in 2006. All family doctors (3016 in total) of the National Health Service were involved by the Statistical Bureau of the Municipality of Rome. As per the census, every resident citizen is registered with a family doctor and every person with disabilities is coded. Associations for Down Syndrome encouraged their members to participate in the research. Questionnaires were completed by families of people with DS, in accordance with privacy laws.

FINDINGS

An initial survey, conducted via a letter and a telephone contact with family doctors, identified 884 people with DS residing in the city of Rome. Data on the medical and social conditions of 518 people with DS, ranging in age from 0 to 64 years, were collected. Some 88% of these were living with their original family; 82.1% had one or more siblings, and 19.5% had lost one or both parents. A full 100% of children with DS were enrolled in the public school system. This ensures that they are fully occupied and entirely integrated in society. After secondary school there is a lack of opportunities. Thus, only 10% of adults were working with a regular contract. A mere 42.2% of people with DS aged 25-30 were involved in some form of regular activity (although not always on a daily basis). After the age of 30, the percentage of people demonstrating decline in function increased sharply, while disability-related support decreased. In other words, as people with DS age, daily life evolves increasingly around the home, with only occasional outdoor activities.

CONCLUSION

The health, employment and social needs of the majority of people with DS in the city of Rome are not being met. The findings of this study underscore the urgent need for more comprehensive inclusion in society of adults with DS and for the provision of support services to create an enabling environment for inclusion. Because of the variability of performance among individuals with DS, there is a need to create more case-specific options in terms of work, living arrangements, social networking and medical services. Schooling and social inclusion in childhood alone do not guarantee a satisfactory quality of life in adulthood. It is argued herewith that policy of inclusion and support should extend over the entire lifetime of people with DS.

Role of verbal memory in reading text comprehension of individuals with Down syndrome

This study analyzed the relationship between verbal memory and reading text comprehension in individuals with Down syndrome. The hypothesis that verbal memory provides unique contribution to reading text comprehension after controlling for verbal skills was tested. Twenty-three individuals with Down syndrome (ages 11 years, 2 months-18 years, 1 month) were matched on reading text comprehension, which was the primary variable of interest, with 23 typically developing children (ages 6 years, 2 months-7 years, 1 month). The two groups were compared on verbal skills and verbal memory. The results showed that working memory (concurrent storage and processing functions), but not short-term memory, predicted unique variance in reading text comprehension, after the verbal skills were controlled for. No group differences emerged in the relationship between verbal memory and reading text comprehension.

Narrative Skill in Boys with Fragile X Syndrome with and without Autism Spectrum Disorder

We examined recalled narratives of boys with fragile X syndrome with autism spectrum disorder (FXS-ASD; N=28) and without ASD (FXS-O; N=29), and compared them to those of boys with Down syndrome (DS; N=33) and typically developing boys (TD; N=39). Narratives were scored for mentions of macrostructural Story Grammar elements (Introduction, Relationship, Initiating Events, Internal Response, Attempts/Actions, and Ending). We found that narrative recall is predicted by short-term memory and nonverbal mental age levels in almost all groups (except TD), but not by expressive syntax or caregiver education. After adjusting for these covariates, there were no differences between the three groups with intellectual disability (ID). The FXS-ASD group, however, had significantly poorer performance than the TD group on the overall Story Grammar score, and both the FXS-O and FXS-ASD groups had lower Attempts/Actions scores than the TD group. We conclude that some form of narrative impairment may be associated with FXS, that this impairment may be shared by other forms of ID, and that the presence of ASD has a significantly detrimental effect on narrative recall.

Atypical semantic knowledge and autobiographical memory disorder in a young adult with Downs syndrome

A study of lexical semantic knowledge and autobiographical memory is described in PQ, a 22-year-old male with Downs syndrome. Performance is compared with younger typically developing verbal mental age controls. PQ's lexical stores contained a normal number of items, however, he was impaired at naming both pictures and item descriptions. PQ's own descriptions of items contained a normal volume of information, but the pattern of information differed from normal as he produced less 'sensory' and more 'thematic' and 'functional' information. PQ has an autobiographical memory deficit. His ability to recall 'specific' memories was significantly impoverished. It is suggested that both PQ's naming difficulties and his autobiographical memory disorder may reflect atypical knowledge specification with absence of distinctive featural knowledge and increased conceptual overlap and looser networks pervasive across both semantic and autobiographical memory systems.

Properties of the narrative scoring scheme using narrative retells in young school-age children

PURPOSE

To evaluate the clinical utility of the narrative scoring scheme (NSS) as an index of narrative macrostructure for young school-age children.

METHOD

Oral retells of a wordless picture book were elicited from 129 typically developing children, ages 5-7. A series of correlations and hierarchical regression equations were completed using microstructural measures of vocabulary and grammar to predict NSS scores.

RESULTS

While the NSS was significantly correlated with age and each of the microstructural measures, the hierarchical regression analyses revealed a unique relationship between vocabulary and narrative macrostructure.

CONCLUSION

The NSS is an efficient and informative tool for documenting children's development of narrative macrostructure. The relationship between the NSS and microstructural measures demonstrates that it is a robust measure of children's overall oral narrative competence and a powerful tool for clinicians and researchers. The unique relationship between lexical diversity and the NSS confirmed that a special relationship exists between vocabulary and narrative organization skills in young school-age children.

Text comprehension in Down syndrome: the role of lower and higher level abilities

The contribution of lower level linguistic abilities (study 1) and a higher level capacity, namely the use of context, (study 2), on text comprehension was studied. Participants were 16 individuals with Down syndrome aged between aged between 8 years 11 months and 16 years 10 months, and 16 children with typical development, aged between 5 years 11 months and 7 years 3 months, matched for the level of text comprehension. In study 1 the two groups were compared for receptive vocabulary and sentence comprehension: both of them were shown to play a role in text comprehension in Down syndrome. Since participants with Down syndrome had very low scores in sentence comprehension, study 2 tested the hypothesis that when sentences were presented within a brief context, individuals with Down syndrome would perform better. This hypothesis was confirmed and it was shown that contextual facilitation was closely related to text comprehension skills.

Modo comunicativo utilizado por crianças com síndrome de Down

TEMA: a comunicação das crianças com síndrome de Down (SD) é muitas vezes prejudicada devido a dificuldades nos aspectos fonológico, sintático e semântico da linguagem. Para compensar essas dificuldades, muitas crianças utilizam os gestos por um tempo mais prolongado do que as crianças com desenvolvimento típico (DT). OBJETIVO: verificar o desempenho de crianças com SD no que diz respeito ao modo comunicativo (verbal, vocal e gestual) utilizado na interação espontânea com um adulto em situação de brincadeira. MÉTODO: 28 crianças com SD foram estudadas em duas situações distintas: brincadeira com o terapeuta e brincadeira com o cuidador. Foram consideradas as teorias pragmáticas para análise dos resultados. Para determinar a significância estatística foram usados os testes Kuskal-Wallis, Mann-Whitney e Wilcoxon e determinado o nível de significância em 5%. RESULTADO: houve maior utilização do meio comunicativo verbal na interação com o cuidador e do meio gestual na interação com o terapeuta. CONCLUSÃO: considerando que o meio comunicativo mais utilizado socialmente é o verbal, podemos considerar que a comunicação, nesse ponto de vista, foi mais efetiva na situação de brincadeira com o cuidador. No entanto, embora tenham sido produzidos menos atos comunicativos verbais na interação com o terapeuta, a criança utilizou o gesto para se comunicar, ou seja, a falta ou pouca comunicação verbal não impediu que a criança se comunicasse com seu interlocutor.

Fragile X syndrome: Neural network models of sequencing and memory

A comparative framework of memory processes in males with fragile X syndrome (FXS) and Typically Developing (TYP) mental age-match children is presented. Results indicate a divergence in sequencing skills, such that males with FXS recall sequences similarly to TYP children around five and a half years of age, but eth males with FXS recall significantly worse when compared to TYP children around seven and a half years of age. Performance on one working memory measure, an n-back card task, is modeled with a neural network. To date, no network models explicate the sequencing and memory processes in those with FXS. Noise was added to various levels (weight matrices) in the FXS model and outputs approximated human FXS performance. Three models were compared: 1) FXS; 2) younger mental age-TYP matches; and 3) older reading level-TYP matches. Modeling can help to reify conceptualizations of deficits and to guide in the creation of more valid, science-based remediations. The FXS model suggests that the levels of phonological representation and sequencing in memory are candidates for targeted therapies in males with FXS.

Linguistic profile of individuals with Down syndrome: comparing the linguistic performance of three developmental disorders

An increasing number of studies, addressing the linguistic abilities of individuals with Down syndrome (DS) suggest that they exhibit strengths and weaknesses within the linguistic domain. This article critically reviews the literature on the linguistic profile of individuals with DS, with particular emphasis on the expression and reception of vocabulary and grammar, including nonverbal linguistic expression during infant development. In doing so, attention is given to recent comparative studies of the linguistic abilities of individuals with DS, Specific Language Impairment (SLI), and Williams syndrome (WS). The possibility that deficits in one cognitive system may have consequences in another cognitive system, and that these consequences may define the nature of the impairment in each clinical syndrome is further discussed with suggestions for future research.

Language development in Down syndrome: from the prelinguistic period to the acquisition of literacy

Down syndrome (DS) is associated with abnormalities in multiple organ systems and a characteristic phenotype that includes numerous behavioral features. Language, however, is among the most impaired domains of functioning in DS and, perhaps, also the greatest barrier to independent meaningful inclusion in the community. In this article, we review what is known about the extent, nature, and correlates of the language and related problems of individuals with Down syndrome. In doing so, we focus largely on the syndrome-specific features of the language phenotype, although we also consider within-syndrome variation. The review focuses on the prelinguistic foundations of language and the major components of language (i.e., vocabulary, syntax, and pragmatics). We also consider two topics in the treatment and education of individuals with DS: prelinguistic communication intervention and the acquisition of literacy skills.

A emergência da comunicação expressiva na criança com síndrome de Down

TEMA: a comunicação expressiva na criança com síndrome de Down (SD). OBJETIVO: este trabalho teve por objetivo o estudo qualitativo e quantitativo das diferentes formas de expressões comunicativas em crianças com SD; a emergência da sua expressão oral e sua relação com os gestos; a evolução dos gestos e a sua qualificação. Também se pesquisou a efetividade da terapia fonoaudiológica na criança com SD segundo o método dialético-didático, fundamentado no método clínico de Piaget. MÉTODO: participaram deste estudo oito crianças com SD (faixa etária entre trinta e três e cinqüenta e dois meses, no início da pesquisa), quatro constituindo o grupo pesquisa (GP) e quatro o grupo controle 1 (GC1); e quatro com desenvolvimento típico (DT) (faixa etárias entre quatorze e dezesseis meses, no início da pesquisa), ou grupo controle 2 (GC2). Todas apresentavam desenvolvimento cognitivo entre o final do período sensório-motor e início do pré-operatório, e foram avaliadas três vezes: inicial, após seis meses e após doze meses. As avaliações foram filmadas e transcritas. Os materiais utilizados foram brinquedos apropriados para a fase de desenvolvimento cognitivo apresentado pelas crianças. O processo terapêutico, apenas para o GP, constou de quarenta sessões terapêuticas, com materiais semelhantes aos das avaliações. RESULTADOS: verificou-se que GP teve melhor evolução que GC1. Os sujeitos que melhor conseguiram se expressar foram os que apresentaram melhor evolução no desenvolvimento cognitivo. CONCLUSÃO: foi possível confirmar a eficácia do método dialético-didático como processo terapêutico, demonstrada na evolução do desenvolvimento da linguagem do GP em relação ao GC1.

Language and communication development in down syndrome

Although there is considerable variability, most individuals with Down syndrome have mental retardation and speech and language deficits, particularly in language production and syntax and poor speech intelligibility. This article describes research findings in the language and communication development of individuals with Down syndrome, first briefly describing the physical and cognitive phenotype of Down syndrome, and two communication related domains-hearing and oral motor skills. Next, we describe language development in Down syndrome, focusing on communication behaviors in the prelinguistic period, then the development of language in children and adolescents, and finally language development in adults and the aging period. We describe language development in individuals with Down syndrome across four domains: phonology, semantics, syntax, and pragmatics. Wethen suggest strategies for intervention and directions for research relating to individuals with Down syndrome.

Down syndrome: Cognitive phenotype

Down syndrome is the most prevalent cause of intellectual impairment associated with a genetic anomaly, in this case, trisomy of chromosome 21. It affects both physical and cognitive development and produces a characteristic phenotype, although affected individuals vary considerably with respect to severity of specific impairments. Studies focusing on the cognitive characteristics of Down syndrome were reviewed, and while performance in most areas could be predicted based upon overall intellectual disability, relative weaknesses were consistently found to be associated with expressive language, syntactic/morphosyntactic processing, and verbal working memory. This profile of uneven deficits could result from a failure to develop typically automatic processing for speech perception and production, and this possibility is discussed along with its implications for intervention.

Sampling context affects MLU in the language of adolescents with Down syndrome

PURPOSE

The authors describe the procedures used to explain an unexpected finding that adolescents with Down syndrome (DS) had a lower mean length of utterance (MLU) than typically developing (TD) children in interviews without picture support, but not in narratives supported by wordless picture books. They hypothesize that the picture support of the narrative context increased the MLU for the group with DS alone.

METHOD

Adolescents with DS (n = 14) and TD children (n = 14) matched for receptive syntax narrated picture storybooks and participated in interviews. Transcription reliability, intelligibility/fluency, grammatical errors, discourse and sampling contexts, and discourse characteristics were examined for their effects on MLU.

RESULTS

The DS group showed a greater responsiveness to adult questions than the TD group; an alternate MLU without yes/no responses showed the same interaction of group and context as the original finding. An additional comparison of MLUs, obtained from narratives present in the interview and narratives elicited using picture books, showed that picture support in narrative increased MLUs only for the group with DS.

CONCLUSION

Picture support, rather than narrative context alone, increased MLUs for the group with DS. Clinical use of narratives and picture support in assessment and intervention with individuals with DS is discussed.

Predicting longitudinal change in language production and comprehension in individuals with Down syndrome: hierarchical linear modeling

Longitudinal change in syntax comprehension and production skill, measured four times across a 6-year period, was modeled in 31 individuals with Down syndrome who were between the ages of 5 and 20 years at the start of the study. Hierarchical Linear Modeling was used to fit individual linear growth curves to the measures of syntax comprehension (TACL-R) and mean length of spontaneous utterances obtained in 12-min narrative tasks (MLU-S), yielding two parameters for each participant's comprehension and production: performance at study start and growth trajectory. Predictor variables were obtained by fitting linear growth curves to each individual's concurrent measures of nonverbal visual cognition (Pattern Analysis subtest of the Stanford-Binet), visual short-term memory (Bead Memory subtest), and auditory short-term memory (digit span), yielding two individual predictor parameters for each measure: performance at study start and growth trajectory. Chronological age at study start (grand-mean centered), sex, and hearing status were also taken as predictors. The best-fitting HLM model of the comprehension parameters uses age at study start, visual short-term memory, and auditory short-term memory as predictors of initial status and age at study start as a predictor of growth trajectory. The model accounted for 90% of the variance in intercept parameters, 79% of the variance in slope parameters, and 24% of the variance at level 1. The some predictors were significant predictors of initial status in the best model for production, with no measures predicting slope. The model accounted for 81% of the intercept variance and 43% of the level 1 variance. When comprehension parameters are added to the predictor set, the best model, accounting for 94% of the intercept and 22% of the slope variance, uses only comprehension at study start as a predictor of initial status and comprehension slope as a predictor of production slope. These results reflect the fact that expressive language acquisition continues in adolescence and is predicted by syntax comprehension and its growth trajectory.