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

Prosodic skills in Spanish-speaking adolescents and young adults with Down syndrome

BACKGROUND

Down syndrome (DS) is a neurodevelopmental disorder of genetic origin with a cognitive-behavioural profile that distinguishes it from other syndromes. Within this profile, language difficulties are particularly marked, having been more studied in childhood than in adulthood. More generally, there is a paucity of research on the prosodic skills of individuals with DS, despite the relevance of this linguistic component for effective communication.

AIMS

This study aimed to analyse, for the first time, the prosodic profile of Spanish-speaking teenagers and young adults with DS. We hypothesized that participants with DS would show significantly lower skills for the perception and production of prosodic functions and forms when compared to peers with intellectual disability (ID) of unknown origin. We also hypothesized that teenagers and young adults with DS would have better prosody perception than prosody production.

METHODS & PROCEDURES

The final sample included in the study comprised 28 Spanish-speaking teenagers and young adults with DS and 29 teenagers and young adults with other ID matched on chronological age and nonverbal cognition. Their prosodic skills were tested by means of the Profiling Elements of Prosody for Speech and Communication battery. This battery allows for the separate evaluation of the comprehension and expression of the communicative functions of prosody and the discrimination and production of the forms that carry out such functions.

OUTCOMES & RESULTS

In the prosody function tasks, which are the most adaptive tasks for the communicative process, we found, as expected, significantly lower scores on the turn-end, chunking, and focus tasks in the group with DS. However, no significant between-group differences were found for the affect tasks. Participants with DS also had significantly lower scores on the prosodic form tasks than participants with other ID. The results of the comparison between prosodic perception and production skills showed that a generalization about a better profile in comprehension versus production is not possible and that there is a dependence on the demands of the prosodic task undertaken.

CONCLUSIONS & IMPLICATIONS

The findings contribute to the ongoing development of the language profile of teenagers and young adults with DS and imply the need to design prosodic intervention programs based on their specific profile.

WHAT THIS PAPER ADDS

What is already known on the subject Prosody is a fundamental element of language, and its mastery affects the effectiveness of communication. However, research on prosody in Down syndrome (DS) that offers a holistic view from a psycholinguistic approach is still scarce. To date, studies focused on providing a detailed profile of prosodic skills in individuals with DS have been mainly conducted with a few English-speaking children. These studies have shown that the comprehension and production of prosody is severely impaired, especially when considering affect and focus production, as well as the perception and production of prosodic forms. During childhood, greater efficacy is found in prosody comprehension than in prosody expression. What this study adds This is the first study analysing the prosodic profile of a large group of Spanish-speaking teenagers and young adults with DS. Poorer performance in the perception and production of both prosodic functions and forms was observed in participants with DS compared to participants with intellectual disability of unknown origin matched on chronological age and nonverbal cognition. Unlike what has been previously found in children, teenagers and young adults with DS performed at the same level as the control group on the understanding and expression of affect through prosodic cues. Results also showed that a generalization about a better prosody profile in comprehension versus production is not possible. What are the clinical implications of this work? This study provides new data on the prosodic skills of Spanish-speaking teenagers and young adults with DS. Given the impact of prosody on effective communication and the pattern of difficulties found in this study, speech and language therapists working with individuals with DS should consider including prosodic skills in interventions not only in childhood but also in adolescence and adulthood. Therefore, the prosodic profile of strengths and weaknesses in individuals with DS found in this research has direct implications for clinical practice.

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.

Unraveling Down Syndrome: From Genetic Anomaly to Artificial Intelligence-Enhanced Diagnosis

Down syndrome arises from chromosomal non-disjunction during gametogenesis, resulting in an additional chromosome. This anomaly presents with intellectual impairment, growth limitations, and distinct facial features. Positive correlation exists between maternal age, particularly in advanced cases, and the global annual incidence is over 200,000 cases. Early interventions, including first and second-trimester screenings, have improved DS diagnosis and care. The manifestations of Down syndrome result from complex interactions between genetic factors linked to various health concerns. To explore recent advancements in Down syndrome research, we focus on the integration of artificial intelligence (AI) and machine learning (ML) technologies for improved diagnosis and management. Recent developments leverage AI and ML algorithms to detect subtle Down syndrome indicators across various data sources, including biological markers, facial traits, and medical images. These technologies offer potential enhancements in accuracy, particularly in cases complicated by cognitive impairments. Integration of AI and ML in Down syndrome diagnosis signifies a significant advancement in medical science. These tools hold promise for early detection, personalized treatment, and a deeper comprehension of the complex interplay between genetics and environmental factors. This review provides a comprehensive overview of neurodevelopmental and cognitive profiles, comorbidities, diagnosis, and management within the Down syndrome context. The utilization of AI and ML represents a transformative step toward enhancing early identification and tailored interventions for individuals with Down syndrome, ultimately improving their quality of life.

Sentence Length Effects on Intelligibility in Two Groups of Older Children With Neurodevelopmental Disorders

PURPOSE

The purpose of this study was to examine the impact of sentence length on intelligibility in two groups of older children with neurodevelopmental disabilities.

METHOD

Nine children diagnosed with cerebral palsy (CP) and eight children diagnosed with Down syndrome (DS), between the ages of 8 and 17 years, repeated sentences varying in length from two to seven words. Three hundred forty adult listeners (20 listeners per child) provided orthographic transcriptions of children's speech, which were used to calculate intelligibility scores.

RESULTS

There was a significant main effect of sentence length on intelligibility for children with CP. Intelligibility significantly increased from two- and three-word sentences to four-, five-, and six-word sentences, then significantly decreased from four-, five-, and six-word sentences to seven-word sentences. There was a main effect of sentence length on intelligibility for children with DS. Intelligibility significantly increased from two-word sentences to four-, five-, and six-word sentences.

CONCLUSIONS

The primary findings of this study include the following: (a) Unlike in typically developing children, sentence length continues to influence intelligibility well into adolescence for children with neurodevelopmental disorders, and (b) sentence length may influence intelligibility differently in children with CP than in children with DS; however, other factors besides the type of neurodevelopmental disorder (e.g., severity of speech motor involvement and/or cognitive-linguistic impairment) could play a role in the relationship between sentence length and intelligibility and must be investigated in future studies.

Consistency and reliability of automated language measures across expressive language samples in autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with substantial clinical heterogeneity, especially in language and communication ability. There is a need for validated language outcome measures that show sensitivity to true change for this population. We used Natural Language Processing to analyze expressive language transcripts of 64 highly-verbal children and young adults (age: 6-23 years, mean 12.8 years; 78.1% male) with ASD to examine the validity across language sampling context and test-retest reliability of six previously validated Automated Language Measures (ALMs), including Mean Length of Utterance in Morphemes, Number of Distinct Word Roots, C-units per minute, unintelligible proportion, um rate, and repetition proportion. Three expressive language samples were collected at baseline and again 4 weeks later. These samples comprised interview tasks from the Autism Diagnostic Observation Schedule (ADOS-2) Modules 3 and 4, a conversation task, and a narration task. The influence of language sampling context on each ALM was estimated using either generalized linear mixed-effects models or generalized linear models, adjusted for age, sex, and IQ. The 4 weeks test-retest reliability was evaluated using Lin's Concordance Correlation Coefficient (CCC). The three different sampling contexts were associated with significantly (P < 0.001) different distributions for each ALM. With one exception (repetition proportion), ALMs also showed good test-retest reliability (median CCC: 0.73-0.88) when measured within the same context. Taken in conjunction with our previous work establishing their construct validity, this study demonstrates further critical psychometric properties of ALMs and their promising potential as language outcome measures for ASD research.

Using weighted communication scoring procedures in naturalistic play samples: Preliminary validation in preschool-aged boys with autism or fragile X syndrome

In the present study, we provide a preliminary evaluation of the validity and reliability of using weighting procedures to measure communication in play samples for preschool-aged boys with autism or fragile X syndrome (FXS). Because weighting procedure communication scores (WPCSs) reflect growth in both communicative frequency and complexity, establishing the psychometrics of the component scores, in addition to the overall metric, affords investigators the opportunity to describe growth within and across skills. Results, for both groups, provide support regarding the psychometric appropriateness (i.e., convergent validity, divergent validity, and internal consistency) for all WPCSs. That said, a trend was observed for reliability scores to be slightly lower or more variable in boys with autism than in boys with FXS. Finally, although significant associations were observed in the associations between WPCSs across play contexts, contexts effects were observed for all three WPCSs. Together, results from this study provide promising preliminary data indicating the utility of using WPCSs in children with neurodevelopmental disabilities. Lay Summary: Language supports long-term positive outcomes; it is important to identify accurate and flexible ways of measuring language in children over time. We considered the effectiveness of using a procedure that considers changes in the number of communication acts and the types of acts produced during a play session by preschool-aged boys with autism or fragile X syndrome. These procedures were found to be valid and reliable.

Morphosyntactic abilities in young children with Down syndrome: Evidence from the Greek language

Down syndrome is the most common genetic syndrome of intellectual disabilities with a distinct linguistic profile. Language research so far has come mainly from the English language, a language with different syntax and morphology from many other languages, including Greek, indicating a paucity of research findings in the Greek language. Given the rich morphology and distinct syntactic characteristics of the Greek language, the present study evaluated the performance of children with Down syndrome (N = 45) who are native Greek speakers in syntax and morphology and compared it with the performance of children with typical development (N = 45) matched for chronological age. The paper also analysed the items of each task in terms of the performance of the two groups in subject-verb agreement, noun conversion from singular to plural, and verb conversion from present to past and future tenses. All children were tested in four subscales of a standardized test, including morphosyntactic comprehension, morphosyntactic completion and articulation (parts 1 and 2). The results showed that children with Down syndrome lag behind in syntax and morphology compared with children of typical development and present difficulties in specific aspects of morphology and syntax inherent in the Greek language. WHAT THIS PAPER ADDS: What is already known on this subject Morphosyntactic skills are severely impaired in Down syndrome, and research so far has come mainly from the English language, a language with different syntax and morphology from many other languages. What this paper adds to existing knowledge This research adds more information about morphosyntactic skills in children with Down syndrome compared with typically developing children in the Greek language, a language with rich morphology and syntax. What are the potential or actual clinical implications of this work? Children with Down syndrome face difficulties in morphosyntactic skills in the Greek language, especially in subject-verb agreement and in converting nouns from singular to plural.

Tell or Retell? The Role of Task and Language in Spanish-English Narrative Microstructure Performance

PURPOSE

This study examined performance of dual language learners (DLLs) on Spanish- and English-language narrative story retells and unique tells. Transcription and analysis focused on comparisons of common microstructural language sample measures in Spanish and English across tasks. Each language sample measure was evaluated for its possible convergence with norm-referenced standardized assessments for DLL children.

METHOD

Spanish-English DLLs (N = 133) enrolled in English-only kindergarten or first-grade classrooms completed two-language sample tasks (one in each language), which were transcribed and analyzed using Systematic Analysis of Language Transcripts (Miller & Iglesias, 2017) for measures of syntactic complexity (mean length of utterance [MLU] in words), lexical diversity (number of different words [NDW]), and grammaticality (percent grammatical utterances [PGU]). Students also completed a norm-referenced sentence repetition task (Peña et al., 2014) and expressive vocabulary assessment (Martin, 2013).

RESULTS

Comparison of story retells and unique stories revealed similar performance on MLU, NDW, and PGU across elicitation techniques, with one exception: NDW in Spanish was higher in the story retell condition. Predictive models revealed several differences in the relations between the microstructure measures and norm-referenced language measures by elicitation technique, although neither context demonstrated a consistent advantage across all metrics.

CONCLUSIONS

Measures derived from story retells and unique tells offer practical findings for speech-language pathologists and other educators to use in assessment of early grade DLLs. This work increases knowledge of procedural differences across narrative assessments and their influence on language variables, supporting school-based speech-language pathologists in making assessment decisions for DLLs on their caseload.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19191278.

Autistic preschoolers' engagement and language use in gross motor versus symbolic play settings

Background and aims: Although adjustment of the environment is recommended as a support strategy in evidence-based interventions for children with autism, the impact of doing so (and the how and why) is not well understood. One essential environmental factor to consider when providing supports for preschool-aged autistic children is the play setting, specifically, the materials available in the child's play context. The aim of this study was to compare engagement states and number of utterances produced by preschool-aged autistic children within symbolic vs. gross motor play settings. Examining the relationship between gross motor play settings and children's social engagement and spoken language use is particularly important to explore for autistic children given differences in their sensory processing, motor skill development, and choice of and interaction with toys relative to neurotypical peers. Methods: Seventy autistic children aged 25-57 months were videotaped during natural play interactions with a parent. Children's social engagement and number of spoken utterances were examined in five minutes each of play with symbolic toys and play with gross motor toys. Continuous time-tagged video coding of the child-caregiver engagement states was conducted, and the child's frequency of spoken language was identified using language sample analysis. The specific variables examined were; (a) engagement with caregiver, (b) engagement with objects only, (c) unengaged (no evident engagement with objects or people), and (d) total number of spoken utterances. The relationship between play setting (symbolic vs gross motor) and child language and engagement state variables was examined with linear mixed effects modelling. Results: Significant main effects were revealed for the interaction between play setting and autistic children's engagement. Young autistic children were more likely to engage with caregivers in play environments with gross motor toys (moderate effect) and also were more likely to have periods of unengaged time (not overtly directing their attention to objects or people; small effect) in this setting. Further, when in a setting with symbolic toys, autistic children were more likely to spend their time focusing attention solely on objects (large effect). No interaction was found between play setting and total number of utterances spoken by autistic children. Conclusions and implications: This study confirmed the importance of continued research focused on understanding the relationship between children's play settings and their social engagement and language use. Although preliminary, findings support the idea that there is an interaction between preschool-aged autistic children's social engagement and their play settings. Further, our results suggest that there can be value in clinicians differentiating children's play settings (i.e., gross motor vs symbolic) when assessing and supporting social engagement capacities of young autistic children.

Spoken language outcome measures for treatment studies in Down syndrome: feasibility, practice effects, test-retest reliability, and construct validity of variables generated from expressive language sampling

BACKGROUND

The purpose of this study was to evaluate expressive language sampling (ELS) as a procedure for generating spoken language outcome measures for treatment research in Down syndrome (DS). We addressed (a) feasibility, (b) practice effects across two short-term administrations, (c) test-retest reliability across two short-term administrations, (d) convergent and discriminant construct validity, and (e) considered comparisons across the conversation and narration contexts.

METHOD

Participants were 107 individuals with DS between 6 and 23 years of age who presented with intellectual disability (IQ < 70). The utility of ELS procedures designed to collect samples of spoken language in conversation and narration were evaluated separately. Variables of talkativeness, vocabulary, syntax, utterance planning, and articulation quality, derived from transcripts segmented into C-units (i.e., an independent clause and its modifiers), were considered. A 4-week interval was used to assess practice effects and test-retest reliability. Standardized direct assessments and informant report measures were collected to evaluate construct validity of the ELS variables.

RESULTS

Low rates of noncompliance were observed; youth who were under 12 years of age, had phrase-level speech or less, and had a 4-year-old developmental level or less were at particular risk for experiencing difficulty completing the ELS procedures. Minimal practice effects and strong test-retest reliability across the 4-week test-retest interval was observed. The vocabulary, syntax, and speech intelligibility variables demonstrated strong convergent and discriminant validity. Although significant correlations were found between the variables derived from both the conversation and narration contexts, some differences were noted.

CONCLUSION

The ELS procedures considered were feasible and yielded variables with adequate psychometric properties for most individuals with DS between 6 and 23 years old. That said, studies of outcome measures appropriate for individuals with DS with more limited spoken language skills are needed. Context differences were observed in ELS variables suggest that comprehensive evaluation of expressive language is likely best obtained when utilizing both contexts.

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.

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.

The Influence of Language Context on Repetitive Speech Use in Children With Autism Spectrum Disorder

Purpose Although repetitive speech is a hallmark characteristic of autism spectrum disorder (ASD), the contributing factors that influence repetitive speech use remain unknown. The purpose of this exploratory study was to determine if the language context impacts the amount and type of repetitive speech produced by children with ASD. Method As part of a broader word-learning study, 11 school-age children with ASD participated in two different language contexts: storytelling and play. Previously collected language samples were transcribed and coded for four types of repetitive speech: immediate echolalia, delayed echolalia, verbal stereotypy, and vocal stereotypy. The rates and proportions of repetitive speech were compared across the two language contexts using Wilcoxon signed-ranks tests. Individual characteristics were further explored using Spearman correlations. Results The children produced lower rates of repetitive speech during the storytelling context than the play-based context. Only immediate echolalia differed between the two contexts based on rate and approached significance based on proportion, with more immediate echolalia produced in the play-based context than in the storytelling context. There were no significant correlations between repetitive speech and measures of social responsiveness, expressive or receptive vocabulary, or nonverbal intelligence. Conclusions The children with ASD produced less immediate echolalia in the storytelling context than in the play-based context. Immediate echolalia use was not related to social skills, vocabulary, or nonverbal IQ scores. These findings offer valuable insights into better understanding repetitive speech use in children with ASD.

Syntactic Ability of Girls With Fragile X Syndrome: Phonological Memory and Discourse Demands on Complex Sentence Use

This study was designed to establish the extent of delay in complex sentence use by females with fragile X syndrome (FXS) and to identify sources of variability among individuals. Females with FXS (n = 16; 10;2-15;7) and younger typically developing girls (n = 17; 4;1-8;11) were group-wise matched on nonverbal cognition and receptive syntax. Language samples (conversation and narration) yielded syntactic complexity in terms of mean length of C-unit (MLCU) and Developmental Level sentence coding (DLevel; Rosenberg & Abbeduto, 1987 ). Complex syntax was not weaker than developmental expectations; however, MLCU was lower than expected for age. Phonological memory and verbal working memory correlated with measures of syntactic complexity in narration. Discourse demands may play an important role in the language produced by females with FXS.

Language Samples From Children Who Use Speech-Generating Devices: Making Sense of Small Samples and Utterance Length

PURPOSE

Mean length of utterance in morphemes (MLUm) is underreported in people who use augmentative and alternative communication (AAC). MLUm is difficult to measure in people who use AAC because of 2 challenges described in literature: the challenge of small language samples (difficulty collecting representative samples) and the challenge of transcribing short utterances (difficulty transcribing 1-morpheme utterances). We tested solutions to both challenges in a corpus of language samples from children who use speech-generating devices.

METHOD

The first challenge was addressed by adjusting the length of the sampling window to obtain representative language samples. The second challenge was addressed by using mean syntactic length (MSL) as an alternative to MLUm.

RESULTS

A 24-hour sample window consistently failed to yield representative samples. An extended 1-month sample window consistently yielded representative samples. A significant positive prediction of MLUm by MSL was found in a normative sample. Observed measures of MSL were used to predict MLUm in representative language samples from children who use AAC.

CONCLUSIONS

Valid measures of utterance length in people who use AAC can be obtained using extended sampling windows and MSL. Research is needed to characterize the strengths and limitations of both solutions.

Complex sentence profiles in children with Specific Language Impairment: Are they really atypical?

Children with Specific Language Impairment (SLI) have language difficulties of unknown origin. Syntactic profiles are atypical, with poor performance on non-canonical structures, e.g. object relatives, suggesting a localized deficit. However, existing analyses using ANOVAs are problematic because they do not systematically address unequal variance, or fully model random effects. Consequently, a Generalised Linear Model (GLM) was used to analyze data from a Sentence Repetition (SR) task involving relative clauses. seventeen children with SLI (mean age 6;7), twenty-one Language Matched (LM) children (mean age 4;8), and seventeen Age Matched (AM) children (mean age 6;5) repeated 100 canonical and non-canonical sentences. ANOVAs found a significant Group by Canonicity interaction for the SLI versus AM contrast only. However, the GLM found no significant interaction. Consequently, arguments for a localized deficit may depend on statistical methods which are prone to exaggerate profile differences. Nonetheless, a subgroup of SLI exhibited particularly severe structural language difficulties.

Clinical impact of wordless picture storybooks on bilingual narrative language production: A comparison of the 'Frog' stories

BACKGROUND

Language sampling, recognized as a gold standard for expressive language assessment, is often elicited using wordless picture storybooks. A series of wordless storybooks, commonly referred to as 'Frog' stories, have been frequently used in language-based research with children from around the globe.

AIMS

To examine the impact that differences in stories have on narrative output by comparing narrative productions across a series of five storybooks produced by 831 bilingual (Spanish-English) children in kindergarten through third grade.

METHODS & PROCEDURES

Each participant produced oral narratives using one of the five Frog storybooks in both English and Spanish. The narratives were recorded, transcribed and coded for a variety of measures of language production.

OUTCOMES & RESULTS

Negligible differences were observed in language measures when comparing groups of children who told different stories, with the exception of lexical diversity.

CONCLUSIONS & IMPLICATIONS

The implications of using different storybooks to elicit narrative language samples from children are discussed from the perspectives of research and clinical practice.

A Spoken-Language Intervention for School-Aged Boys With Fragile X Syndrome

Using a single case design, a parent-mediated spoken-language intervention was delivered to three mothers and their school-aged sons with fragile X syndrome, the leading inherited cause of intellectual disability. The intervention was embedded in the context of shared storytelling using wordless picture books and targeted three empirically derived language-support strategies. All sessions were implemented through distance videoteleconferencing. Parent education sessions were followed by 12 weekly clinician coaching and feedback sessions. Data were collected weekly during independent homework and clinician observation sessions. Relative to baseline, mothers increased their use of targeted strategies, and dyads increased the frequency and duration of story-related talking. Generalized effects of the intervention on lexical diversity and grammatical complexity were observed. Implications for practice are discussed.

Reporting child language sampling procedures

PURPOSE

Despite the long history of language sampling use in the study of child language development and disorders, there are no set guidelines specifying the reporting of language sampling procedures. The authors propose reporting standards for use by investigators who employ language samples in their research.

METHOD

The authors conducted a literature search of child-focused studies published in journals of the American Speech-Language-Hearing Association between January 2000 and December 2011 that included language sampling procedures to help characterize child participants or to derive measures to serve as dependent variables. Following this search, they reviewed each study and documented the language sampling procedures reported.

RESULTS

The authors' synthesis revealed that approximately 25% of all child-focused studies use language samples to help characterize participants and/or derive dependent variables. They found remarkable inconsistencies in the reporting of language sampling procedures.

CONCLUSION

To maximize the conclusions drawn from research using language samples, the authors strongly encourage investigators of child language to consistently report language sampling procedures using the proposed reporting checklist.

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.

Event narratives in 11-14 year olds with autistic spectrum disorder

BACKGROUND

Children with autistic spectrum disorder (ASD) are known to have difficulties in narrative language and especially with use of evaluative enrichment devices. However, little is known about their production of event narratives.

AIMS

To establish if children with ASD differ from typically developing peers in their production of general and specific event narratives, and, if so, how this might be affected by levels of oral language.

METHODS & PROCEDURES

Performance on general and specific event narrative tasks of 27 high-functioning children with ASD, aged 11-14 years, was compared with that of language- and age-matched groups of typically developing children. Narratives were coded for structural and evaluative language measures.

OUTCOMES & RESULTS

The general and specific event narratives of the ASD group differed from those of both comparison groups in structural language measures. They were shorter, contained fewer different word roots and had shorter mean length of utterances. In evaluative measures they differed from those of the typically developing age match group but not the younger language match group in the number of causal statements made in both event conditions, and in mental state references and evaluative devices in the specific event narrative condition.

CONCLUSIONS & IMPLICATIONS

Children with ASD display specific difficulties with the use of grammar and vocabulary in event narratives which cannot be explained in terms of language levels. However, the use of evaluative devices was commensurate with oral language levels. Implications for intervention are discussed.

Behavioral inhibition and childhood stuttering

PURPOSE

The purpose of this study was to assess the relation of behavioral inhibition to stuttering and speech/language output in preschool-age children who do (CWS) and do not stutter (CWNS).

METHOD

Participants were preschool-age (ages 36-68 months), including 26 CWS (22 males) and 28 CWNS (13 males). Participants' behavioral inhibition (BI) was assessed by measuring the latency to their sixth spontaneous comment during conversation with an unfamiliar experimenter, using methodology developed by Kagan, Reznick, and Gibbons (1989). In addition to these measures of BI, each participant's stuttered and non-stuttered disfluencies and mean length of utterance (in morphemes) were assessed.

RESULTS

Among the more salient findings, it was found that (1) there was no significant difference in BI between preschool-age CWS and CWNS as a group, (2) when extremely high versus low inhibited children were selected, there were more CWS with higher BI and fewer CWS with lower BI when compared to their CWNS peers, and (3) more behaviorally inhibited CWS, when compared to less behaviorally inhibited CWS, exhibited more stuttering.

CONCLUSIONS

Findings are taken to suggest that one aspect of temperament (i.e., behavioral inhibition) is exhibited by some preschool-age CWS and that these children stutter more than CWS with lower behavioral inhibition. The present results seem to support continued study of the association between young children's temperamental characteristics and stuttering, the diagnostic entity (i.e., CWS versus CWNS), as well as stuttering, the behavior (e.g., frequency of stuttered disfluencies).

EDUCATIONAL OBJECTIVES

After reading this article, the reader will be able to: (a) summarize the salient empirical findings in the extant literature with regard to the association between temperament and childhood stuttering; (b) describe the concept of behavioral inhibition (BI) as well as the methods to measure BI; and (c) discuss the association between behavioral inhibition and childhood stuttering in preschool-age children.

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.

Effects of sampling context on spontaneous expressive language in males with fragile X syndrome or Down syndrome

PURPOSE

In this study, the authors examined the impact of sampling context on multiple aspects of expressive language in male participants with fragile X syndrome in comparison to male participants with Down syndrome or typical development.

METHOD

Participants with fragile X syndrome ( n = 27), ages 10-17 years, were matched groupwise on nonverbal mental age to adolescents with Down syndrome ( n = 15) and typically developing 3- to 6-year-olds ( n = 15). Language sampling contexts were an interview-style conversation and narration of a wordless book, with scripted examiner behavior. Language was assessed in terms of amount of talk, mean length of communication unit (MLCU), lexical diversity, fluency, and intelligibility.

RESULTS

Participants with fragile X syndrome had lower MLCU and lexical diversity than did participants with typical development. Participants with Down syndrome produced yet lower MLCU. A differential effect of context among those with fragile X syndrome, Down syndrome, and typical development emerged for the number of attempts per minute, MLCU, and fluency. For participants with fragile X syndrome, autism symptom severity related to the number of utterances produced in conversation. Aspects of examiner behavior related to participant performance.

CONCLUSION

Sampling context characteristics should be considered when assessing expressive language in individuals with neurodevelopmental 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.

General and specific effects of lexicon in grammar: determiner and object pronoun omissions in child Spanish

PURPOSE

This study explores the hypothesis that vocabulary growth can have 2 types of effects in morphosyntactic development. One is a general effect, where vocabulary growth globally determines utterance complexity, defined in terms of sentence length and rates of subordination. There are also specific effects, where vocabulary size has a selective impact on the acquisition of grammatical markers and where lexicon is a prerequisite for typological convergence. The study compares the differential effects of vocabulary in 2 measures of morphosyntactic development: omissions of object clitic pronouns and definite articles.

METHOD

Correlation analysis and structural equation models were used to analyze the statistical effects of measures of vocabulary and grammatical development in 110 Spanish-speaking monolingual children ages 3-5 years.

RESULTS

The data revealed general effects of vocabulary growth on utterance length and subordination rates and on the use of definite determiners and object pronouns. Specific effects of vocabulary growth were identified for object pronouns but not for determiners.

CONCLUSIONS

The study found support for a 2-dimensional model separating lexicon and syntax and for 2 types of relationships. Vocabulary development generally determines sentence complexity and further evidence for specific effects in object pronoun use.

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.

[Mean length utterance (MLU) as a measure of language development of children with Down syndrome]

PURPOSE

To characterize the mean length utterance in morphemes (MLU-m) and words (MLU-w) produced by children with Down syndrome (DS), and to verify the effectiveness of using EME-w as a measure of general language development of children with DS.

METHODS

Participants were 15 children with ages between 5 and 12 years, who were submitted to a free interaction situation. They were divided into three groups, according to chronological and mental age, as established by the results of the Primary Test of Nonverbal Intelligence. The first 100 utterances were analyzed considering: number of grammatical morphemes (GM) for articles, nouns and verbs (GM-1), and pronouns, prepositions and conjunctions (GM-2); mean length utterance for morphemes (MLU-m) and words (MLU-w).

RESULTS

The between-groups comparison showed that the MLU averages were higher for older groups, and differences were found for all variables, except for GM-2. The same results were obtained in the within-group comparison, for all variables. There was a strong correlation between MLU-m and MLU-w.

CONCLUSION

MLU-w can be used as an identification measure of general linguistic development. However, it is emphasized that the use of all MLU variables provides more efficacy in the characterization of linguistic development and the analysis of language impairments.

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.

Eye-movement patterns of readers with down syndrome during sentence-processing: an exploratory study

Eye movements were examined to determine how readers with Down syndrome process sentences online. Participants were 9 individuals with Down syndrome ranging in reading level from Grades 1 to 3 and a reading-level-matched control group. For syntactically simple sentences, the pattern of reading times was similar for the two groups, with longer reading times found at sentence end. This "wrap-up" effect was also found in the first reading of more complex sentences for the control group, whereas it only emerged later for the readers with Down syndrome. Our results provide evidence that eye movements can be used to investigate reading in individuals with Down syndrome and underline the need for future studies.

Expressive language in male adolescents with fragile X syndrome with and without comorbid autism

BACKGROUND

Approximately one-quarter of individuals with fragile X syndrome (FXS) meet diagnostic criteria for autism; however, it is unclear whether individuals with comorbid FXS and autism are simply more severely affected than their peers with only FXS or whether they have qualitatively different profiles of behavioural impairments. To address this issue, variation in the FXS linguistic phenotype was examined in males with FXS with and without autism. The syndrome-specificity of the expressive language impairment of both groups of those with FXS was assessed in relation to Down syndrome. The extent to which different language sampling contexts affected expressive language in each diagnostic group was also examined.

METHOD

Spontaneous language samples were collected from male adolescents with FXS without autism (n = 20), comorbid FXS and autism (n = 8), and Down syndrome (n = 16). Syntactic complexity (indexed by mean length of utterance), expressive vocabulary (indexed by lexical diversity), talkativeness, fluency and intelligibility were assessed in two contexts: conversation and narration. Groups were matched on non-verbal IQ, non-verbal mental age and chronological age to allow the assessment of relative strengths and weaknesses across language variables.

RESULTS

Males with comorbid FXS and autism were less intelligible than males with only FXS; no other differences between these two groups were found. Participants' performance differed across contexts for syntactic complexity, lexical diversity, talkativeness and fluency.

CONCLUSIONS

These findings contribute to existing research on the behavioural profiles of individuals with FXS or FXS with autism who have low cognitive abilities. Although individuals with comorbid FXS and autism may be, as a group, more impaired than those with only FXS, data from this small sample of males with comorbid FXS and autism with low IQs suggest that their relative strengths and weaknesses in spontaneous expressive language are largely comparable and not differentially affected by the context in which their talk occurs.

The utility of school-age narrative microstructure indices: INMIS and the proportion of restricted utterances

PURPOSE

This research investigated the applicability of the index of narrative microstructure (INMIS; L. M. Justice et al., 2006) system for narratives that were elicited through a wordless picture book context. In addition, the viability of an alternative, simpler metric was explored.

METHOD

Narrative transcripts using the Frog, Where Are You? (M. Mayer, 1969) wordless picture book with 48 school-age children with and without language impairment were analyzed using the INMIS productivity and complexity indices and a proportion of restricted utterances metric. Roy-Bargmann stepdown F calculations, effect sizes, confidence intervals, and positive and negative likelihood ratios were analyzed to examine the statistical and clinical significance of each narrative metric.

RESULTS

The INMIS complexity metric and the proportion of restricted utterances metric yielded statistically significant differences between the two language ability groups and are likely to have good potential as research and clinical tools within the wordless picture book narrative elicitation context. The INMIS productivity metric did not differentiate between the language groups.

CONCLUSION

The results support the use of the INMIS complexity metric in a wordless picture book elicitation context and introduce an alternative microstructure analysis metric, the proportion of restricted utterances, which uses a logically transparent scale and may meet research and clinical needs without requiring the use of specialized software or complex calculations.

Maternal control strategies, maternal language usage and children's language usage at two years

The present study determined whether parenting style, defined by control strategies varying in power-assertion mediated the established relation between maternal language usage (grammar and semantics) and child language (grammar, semantics and pragmatics) during toddlerhood (n=60). Based upon their use of control strategies mothers were categorized into continuum-of-control groups (i.e., high guidance (HG), high control (HC) or high negative control (HNC)). Mothers in the high negative control group, who characteristically used high levels of prohibitions and commands, had children who performed relatively poorly overall on the language measures (i.e., MLU, number of bound morphemes, number of different words and use of language functions). In contrast, children of mothers in the HG and HC groups exhibited more advanced language usage overall. The relation between maternal and child language usage was mediated by parenting style for child pragmatics and partially for child grammar.

Setting a public health research agenda for Down syndrome: summary of a meeting sponsored by the Centers for Disease Control and Prevention and the National Down Syndrome Society

On November 8-9, 2007, a meeting entitled "Setting a Public Health Research Agenda for Down Syndrome" was held to review current knowledge, identify gaps, and develop priorities for future public health research related to Down syndrome. Participants included experts in clinical and molecular genetics, pediatrics, cardiology, psychiatry, psychology, neuroscience, epidemiology, and public health. Participants were asked to identify key public health research questions and discuss potential strategies that could be used to address those questions. The following were identified as priority areas for future public health research: identification of risk and preventive factors for physical health and cognitive outcomes, focusing on understanding the reasons for previously recognized disparities; improved understanding of comorbid conditions, including their prevalence, clinical variability, natural history, and optimal methods for their evaluation and treatment; better characterization of the natural history of cognition, language, and behavior; identification of mental health comorbidities and of risk and protective factors for their development; identification of strategies to improve enrollment in research studies; development of strategies for conveying up-to-date information to parents and health professionals; identification of interventions to improve cognition, language, mental health, and behavior; understanding the impact of educational and social services and supports; identification of improved methods for diagnosis of and interventions for Alzheimer disease; and understanding the effects of different types of health care on outcomes. Participants strongly supported the development of population-based resources for research studies and resources useful for longitudinal studies. This agenda will be used to guide future public health research on Down syndrome.

Using a speech-generating device to enhance communicative abilities for an adult with moderate intellectual disability

For adults with disabilities who are unable to speak, the literature recommends that intervention include augmentative and alternative communication (AAC) to improve communication and interactions with others. Some adults with moderate intellectual disabilities who exhibit limited functional speech are often overlooked as candidates for AAC interventions because they have some speech abilities. The perception is that they are too old to improve their language and communication skills. This article presents a case report of a 30-year-old woman with a moderate intellectual disability and a severe expressive language disorder who uses a speech-generating device as a compensatory strategy to facilitate her communicative abilities, independence, and self-determination.

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.

Written and oral narratives of children and adolescents with Down syndrome

PURPOSE

This study describes written and spoken narrative skills of school-age individuals with Down syndrome (DS).

METHOD

Twenty-one students with DS (age 6;6 [years;months]-19;10) and 17 reading-matched, typically developing (TD) controls (age 4;9-10;9) were matched using Word Identification subtest raw scores (Woodcock Reading Mastery Tests-Revised; R. W. Woodcock, 1987; age equivalents: 5;0-9;7 for both groups). Matching on reading resulted in significantly higher mental ages and vocabulary comprehension age-equivalent scores for the controls. Narratives were elicited in 3 modes (oral, handwritten, and word-processed) using single-episode picture sequences. Narratives were analyzed for length, linguistic complexity, narrative structure, spelling, punctuation, and handwriting legibility.

RESULTS

Analyses revealed significant group differences only for measures of narrative length (DS > TD) and handwriting legibility (TD > DS). Oral narratives were longer and more complex than written narratives for both groups. Regression analyses revealed that vocabulary comprehension was the best predictor of narrative skills for the group with DS; age was the best predictor of narrative skills for the TD group.

CONCLUSIONS

These school-age students with DS exhibited many oral and written narrative abilities that were comparable with those of real-word-reading-matched controls. Several findings suggest a possible increased constraint of fine-motor skill in the DS group.

Syntactic complexity during conversation of boys with fragile X syndrome and Down syndrome

PURPOSE

This study compared the syntax of boys who have fragile X syndrome (FXS) with and without autism spectrum disorder (ASD) with that of (a) boys who have Down syndrome (DS) and (b) typically developing (TD) boys.

METHOD

Thirty-five boys with FXS only, 36 boys with FXS with ASD, 31 boys with DS, and 46 TD boys participated. Conversational language samples were evaluated for utterance length and syntactic complexity (i.e., Index of Productive Syntax; H. S. Scarborough, 1990).

RESULTS

After controlling for nonverbal mental age and maternal education levels, the 2 FXS groups did not differ in utterance length or syntactic complexity. The FXS groups and the DS group produced shorter, less complex utterances overall and less complex noun phrases, verb phrases, and sentence structures than did the TD boys. The FXS with ASD group and the DS group, but not the FXS-only group, produced less complex questions/negations than did the TD group. Compared with the DS group, both FXS groups produced longer, more complex utterances overall, but on the specific complexity measures, they scored higher only on questions/negations.

CONCLUSION

Boys with FXS and DS have distinctive language profiles. Although both groups demonstrated syntactic delays, boys with DS showed greater delays.

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.