Social cognition in children with Down's syndrome: challenges to research and theory building

Spatial exploration and navigation in Down syndrome and Williams syndrome

We know little about the ability to explore and navigate large-scale space for people with intellectual disability (ID). In this cross-syndrome study, individuals with Down syndrome (DS), individuals with Williams syndrome (WS) and typically developing children (TD; aged 5-11 years) explored virtual environments with the goal of learning where everything was within the environment (Experiment 1) or to find six stars (Experiment 2). There was little difference between the WS and DS groups when the goal was simply to learn about the environment with no specific destination to be reached (Experiment 1); both groups performed at a level akin to a subset of TD children of a similar level of non-verbal ability. The difference became evident when the goal of the task was to locate targets in the environment (Experiment 2). The DS group showed the weakest performance, performing at or below the level of a subset of TD children at a similar level of non-verbal ability, whilst the WS group performed at the level of the TD subset group. The DS, WS and TD group also demonstrated different patterns of exploration behavior. Exploration behaviour in DS was weak and did not improve across trials. In WS, exploration behavior changed across trials but was atypical (the number of revisits increased with repeated trials). Moreover, transdiagnostic individual difference analysis (Latent Profile Analysis) revealed five profiles of exploration and navigation variables, none of which were uniquely specific to DS or to WS. Only the most extreme profile of very poor navigators was specific to participants with DS and WS. Interestingly, all other profiles contained at least one individual with DS and at least one individual with WS. This highlights the importance of investigating heterogeneity in the performance of individuals with intellectual disability and the usefulness of a data-driven transdiagnostic approach to identifying behavioral profiles.

BENDI: Improving Cognitive Assessments in Toddlers and Children with Down Syndrome Using Stealth Assessment

Cognitive assessment is a fundamental step in diagnosing intellectual and developmental disabilities, designing interventions, and evaluating their impact. However, developed and developing countries have different access to tools designed for these purposes. Our goal was to develop a battery for cognitive assessment mediated by digital technology that allows the exploration of cognitive domains (inhibitory control, attention, motor ability, and context memory) in children with Down Syndrome (DS) in Chile. Four tasks, based on established experimental paradigms modified to provide a game-like experience, were tested in 68 children with DS from 20 months to 12 years of age. We present evidence of reliability based on internal consistency and split-half analyses, with results ranging from adequate to excellent. Regarding validity, factorial and correlational analyses show evidence consistent with what was theoretically expected of internal structure, convergence, and divergence with other measures. Expected age trajectories were observed as well. Our data offer evidence that supports the use of tasks based on touch-screen devices for cognitive assessment in the population with DS. The tasks also have a low cultural load, so they could be validated and used in other contexts without the need for an adaptation process.

Evaluating an adapted reverse categorisation task to assess cognitive flexibility in young children with Down syndrome

BACKGROUND

Accurate measurement of cognitive skills is necessary to advance both developmental and intervention science for individuals with Down syndrome (DS). This study evaluated the feasibility, developmental sensitivity and preliminary reliability of a reverse categorisation measure designed to assess cognitive flexibility in young children with DS.

METHODS

Seventy-two children with DS ages 2.5-8 years completed an adapted version of a reverse categorisation task. Twenty-eight of the participants were assessed again 2 weeks later for retest reliability.

RESULTS

This adapted measure demonstrated adequate feasibility and developmental sensitivity, and preliminary evidence for test-retest reliability when administered to children with DS in this age range.

CONCLUSIONS

This adapted reverse categorisation measure may be useful for future developmental and treatment studies that target early foundations of cognitive flexibility in young children with DS. Additional recommendations for use of this measure are discussed.

Using the Social Skills Improvement System (SSiS) Rating Scales to assess social skills in youth with Down syndrome

Introduction and Methods

This study provides preliminary data on the Social Skills Improvement System (SSiS) Rating Scales Parent Form to measure social skills in a sample of 124 children and adolescents with Down syndrome (DS) ages 6–17 years.

Results

Overall, participants demonstrated relatively mild symptoms, with the sample’s average standard score falling within 1 standard deviation from the mean of the normative sample for the social skills (M = 92, SD = 15) and problem behaviors (M = 104, SD = 12) domains (normative sample M = 100, SD = 15 for both domains). However, a wide range of scores was observed across the sample for the composite and subscale scores. Differential patterns were also observed by subscale. For some subscales (i.e., Cooperation, Assertion, Responsibility, Engagement, Externalizing, Hyperactivity/Inattention, and Autism Spectrum), a disproportionate number of participants scored in the below average (i.e., lower levels of social skills) or above average (i.e., more symptomatic in problem behaviors or autism spectrum) range relative to the normative sample; for other subscales (i.e., Communication, Empathy, Self-Control, Bullying, and Internalizing), participants’ score distribution aligned more closely to that of the normative sample. SSiS composite scores correlated in the expected directions with standardized measures of autism characteristics, executive function, and expressive language.

Discussion

This study provides some of the first evidence validating the use of the SSiS in youth with DS, filling a gap in standardized measures of social functioning in this population.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Communication and Social Interaction Experiences of Youths With Congenital Motor Speech Disorders

PURPOSE

The purpose of this study was to explore the communication and social interaction experiences of adolescents with congenital motor speech disorders due to cerebral palsy or Down syndrome, with the aim of identifying clinical and research needs to support the development and implementation of speech-language interventions.

METHOD

Five male youths (ages 14-18 years) with congenital motor speech disorders and one of their parents participated in face-to-face, semistructured interviews designed to understand communication and social experiences in daily life. Interviews were audio-recorded and orthographically transcribed offline. Content was coded according to topic areas emerging in the data. Themes were developed to illustrate the most salient and representative aspects of participants' experiences according to the phenomenological tradition that recognizes that participants are experts in their "lived experience."

RESULTS

Participants described the youths' day-to-day communication experiences, including facilitators and barriers to successful social interactions. Thematic analysis revealed three main themes: (a) strong core relationships amidst sparse, superficial interactions in daily life; (b) the complicated picture of why; and (c) how speech-language pathologists can help.

CONCLUSIONS

Participants reported that the impact of congenital motor speech disorders on social interactions and experiences became more apparent in adolescence than in earlier childhood. Addressing communication challenges to meet the unique social demands of this period requires tailored interventions that target multiple contributing factors beyond speech impairment, such as social communication skills, negative communication partner attitudes, and participation opportunities. Shifting practice toward a life participation approach to communication intervention stands to substantially improve the long-term social outcomes of adolescents with motor speech disorders.

Mental State Language Development in Children With Down Syndrome Versus Typical Development

This study compared mental state language (talk about emotions, thoughts, intentions, etc.) used by 6- to 11-year-old children with Down syndrome (DS) to a younger typically developing (TD) comparison group matched by nonverbal cognition. We aimed to determine (1) whether mental state language use is delayed in DS relative to developmental expectations, and (2) if there are differences between groups in the association between mental state language and developmental factors (emotion knowledge, expressive language). Rate of mental state language use was significantly lower in the group with DS, but the number of different mental state terms was not significantly different. Nuanced patterns of similarity and difference emerged between groups regarding the association between mental state language and other developmental factors.

Emotional Lexicon in Down Syndrome

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

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

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

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

The COVID-19 pandemic: The evaluation of the emergency remote parent training program based on at-home support for children with down syndrome

During the COVID-19 pandemic, the development of emergency remote training programs for young children with Down syndrome, learning difficulties, and severe health problems and their parents became a requirement. The present study aimed to evaluate the impact of the "applied emergency remote training program", prepared to address the needs of parents with children with Down syndrome and to offer them at-home support. It is an evaluative case study conducted with 11 parents of 11-35 months old children with Down syndrome. The findings demonstrated that the program could be conducted in a home environment, it improved the interactional behavior of both parents and children, reduced the number of difficult routines, and was considered as an educational, instructive, and band-aid solution. Issues such as the development of systematic psycho-social support systems that increase full participation and motivation of parents in distance education programs are important during extreme times such as the pandemic. Difficulties in online data collection, the employment of coaching and counseling systems in information maintenance, individualization of the program, the improvement of the interactivity in the program, and the development of applied training programs on different topics still wait for a solution.

Development of Down Syndrome Research Over the Last Decades-What Healthcare and Education Professionals Need to Know

Down syndrome (DS) is the most prevalent neurodevelopmental disorder, with a known genetic cause. Besides facial dysmorphologies and congenital and/or acquired medical conditions, the syndrome is characterized by intellectual disability, accelerated aging, and an increased likelihood of an early onset Alzheimer's disease in adulthood. These common patterns of DS are derived from the long-held standard in the field of DS research, that describes individuals with DS as a homogeneous group and compares phenotypic outcomes with either neurotypical controls or other neurodevelopmental disorders. This traditional view has changed, as modern research pinpoints a broad variability in both the occurrence and severity of symptoms across DS, arguing for DS heterogeneity and against a single "DS profile." Nevertheless, prenatal counseling does not often prioritize the awareness of potential within-group variations of DS, portraying only a vague picture of the developmental outcomes of children with DS to expectant parents. This mini-review provides a concise update on existent information about the heterogeneity of DS from a full-spectrum developmental perspective, within an interdisciplinary context. Knowledge on DS heterogeneity will not only enable professionals to enhance the quality of prenatal counseling, but also help parents to set targeted early interventions, to further optimize daily functions and the quality of life of their children.

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

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

Mental State Language Use in Children with Down Syndrome and the Role of Caregivers

Children with Down syndrome (DS) have both strengths and difficulties in speech, language, and social communication. Mental state language-the ability to discuss others' perspectives such as their thoughts, feelings, and intentions-represents a foundational social communicative skill that is delayed in many children with DS, even into the school-age years. The purpose of this article is to review the evidence base on mental state language development in school-age children with DS, focusing in particular on assessment and intervention. We discuss assessment procedures that are both age appropriate and developmentally appropriate for this population. We also present preliminary data highlighting the role of caregivers in supporting mental state language development in school-age children with DS through shared storytelling. We propose that interventions aimed at supporting mental state language development in DS should include a focus on caregiver-child shared storybook reading, even in the school-age years. Therefore, we discuss key considerations for clinicians when teaching caregivers strategies for supporting mental state language and social communication in children with DS.

Exploring different aspects of emotion understanding in adults with Down Syndrome

BACKGROUND

Adults with Down Syndrome (DS) present difficulties in emotion understanding, although research has mainly focused on emotion recognition (external aspects), and little is known about their performance in other complex components (mental and reflective aspects).

AIMS

This study aims to examine different aspects of emotion understanding in adults with DS, including a codification of their error pattern, and also to determine the association with other variables that are commonly impaired in adults with DS.

METHODS AND PROCEDURES

Twenty-two adults with DS and twenty-two children with typical development (TD) matched for vocabulary level were assessed with the Test of Emotion Comprehension (TEC), along with other non-verbal reasoning (NVR), structural language and working memory (WM) tasks.

OUTCOMES AND RESULTS

Adults with DS showed lower emotion competence than children with TD in different components of the TEC, and also a different pattern of errors was observed. Structural language, NVR and WM predicted distinct emotion understanding skills in different ways.

CONCLUSIONS AND IMPLICATIONS

It is important to plan interventions aimed at improving particular aspects of emotion understanding skills for adults with DS, taking into account the different components, the type of error and the different cognitive and linguistic skills involved in each emotion understanding skill.

Psychometric Evaluation of Social Cognition and Behavior Measures in Children and Adolescents with Down Syndrome

Individuals with Down syndrome (DS) are often described as socially engaged; however, challenges with social cognition, expressive language, and social interaction are also common in DS and are prospective outcomes of interest for clinical trials. The current study evaluates the psychometric properties of standardized measurements of social cognition and social behavior for potential use as outcome measures for children and adolescents with DS. Seventy-three youth ages 6 to 17 years old (M = 12.67, SD = 3.16) with DS were assessed on social cognition subtests of a neuropsychological assessment at two time points. Caregivers also completed a parent-report measure of social behavior. Measures were evaluated for feasibility, test-retest reliability, practice effects, convergent validity, and associations with broader developmental domains (i.e., age, cognition, and language). All social cognition and behavior measures met criteria for a portion of the psychometric indices evaluated, yet feasibility limitations were identified for the Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) Affect Recognition subtest, and the NEPSY-II Theory of Mind subtest had problematic floor effects for percentile ranks. The Social Responsiveness Scale, Second Edition (SRS-2; T-scores) had high feasibility, moderate to excellent test-retest reliability, and no practice effects, suggesting this measure could be appropriate for use in clinical trials involving youth with DS.

Scaling of Early Social Cognitive Skills in Typically Developing Infants and Children with Autism Spectrum Disorder

We delineate the sequence that typically developing infants pass tasks that assess different early social cognitive skills considered precursors to theory-of-mind abilities. We compared this normative sequence to performance on these tasks in a group of autistic (AUT) children. 86 infants were administered seven tasks assessing intention reading and shared intentionality (Study 1). Infants responses followed a consistent developmental sequence, forming a four-stage scale. These tasks were administered to 21 AUT children (Study 2), who passed tasks in the same sequence. However, performance on tasks that required following others' eye gaze and cooperating with others was delayed. Findings indicate that earlier-developing skills provide a foundation for later-developing skills, and difficulties in acquiring some early social cognitive skills in AUT children.

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.

A multi-level developmental approach to exploring individual differences in Down syndrome: genes, brain, behaviour, and environment

In this article, we focus on the causes of individual differences in Down syndrome (DS), exemplifying the multi-level, multi-method, lifespan developmental approach advocated by Karmiloff-Smith (1998, 2009, 2012, 2016). We evaluate the possibility of linking variations in infant and child development with variations in the (elevated) risk for Alzheimer's disease (AD) in adults with DS. We review the theoretical basis for this argument, considering genetics, epigenetics, brain, behaviour and environment. In studies 1 and 2, we focus on variation in language development. We utilise data from the MacArthur-Bates Communicative Development Inventories (CDI; Fenson et al., 2007), and Mullen Scales of Early Learning (MSEL) receptive and productive language subscales (Mullen, 1995) from 84 infants and children with DS (mean age 2;3, range 0;7 to 5;3). As expected, there was developmental delay in both receptive and expressive vocabulary and wide individual differences. Study 1 examined the influence of an environmental measure (socio-economic status as measured by parental occupation) on the observed variability. SES did not predict a reliable amount of the variation. Study 2 examined the predictive power of a specific genetic measure (apolipoprotein APOE genotype) which modulates risk for AD in adulthood. There was no reliable effect of APOE genotype, though weak evidence that development was faster for the genotype conferring greater AD risk (ε4 carriers), consistent with recent observations in infant attention (D'Souza, Mason et al., 2020). Study 3 considered the concerted effect of the DS genotype on early brain development. We describe new magnetic resonance imaging methods for measuring prenatal and neonatal brain structure in DS (e.g., volumes of supratentorial brain, cortex, cerebellar volume; Patkee et al., 2019). We establish the methodological viability of linking differences in early brain structure to measures of infant cognitive development, measured by the MSEL, as a potential early marker of clinical relevance. Five case studies are presented as proof of concept, but these are as yet too few to discern a pattern.

Psychometric properties of the Emotional Quotient Inventory: Youth Version-EQ-i:YV in Spanish adolescents with Down syndrome

BACKGROUND

The people with Down syndrome who are now adolescents can face a self-report questionnaire with guarantees of being answered with validity to evaluate areas of development that traditionally have not been able to be evaluated. This is the case of emotional intelligence, measured in this research with the Emotional Quotient Inventory: Youth Version-EQ-i:YV.

AIMS

To validate and analyse the scale's psychometric properties in adolescents with Down syndrome.

METHODS

A two-stage cross-sectional investigation was conducted. The inventory consists of 60 items that measure 5 dimensions. The test was administered to 644 adolescents with Down syndrome. We carried out exploratory and confirmatory factor analyses.

OUTCOMES

The 5-factor structure of the test was confirmed. The internal consistency of four dimensions and the EQ-i:YV's total calculated score yielded high values.

CONCLUSIONS

This new version of the EQ-i:YV represents a valid and reliable tool to assess emotional intelligence in Spanish adolescents with Down syndrome.

Assessment of emotional intelligence in adults with down syndrome: Psychometric properties of the Emotional Quotient Inventory

Introduction

The Emotional Quotient Inventory: Youth version-EQ-i:YV was developed by Bar-On & Parker in 2000 and later translated and adapted for the general Spanish adolescent population by Ferrandiz et al. in 2012. The Spanish scale presents similar psychometric properties to the original version (54 items and five subdimensions). The Emotional Quotient Inventory assesses a set of personal, emotional, and social skills that influence adaptation to and coping with environmental demands and pressures. These factors can influence an adolescent’s success later in life, health, and psychological well-being. Traditionally, research in Down syndrome (DS) has focused on identifying cognitive deficits, relatively little is known about emotional intelligence (EI) and there are no scales that measure EI in people with DS adults.

Objectives

To validate and analyze the psychometric properties of the scale in the clinical population, specifically in Spanish adults with DS (EQ-i: SVDS).

Methods

A cross-sectional investigation was carried out in several stages. Descriptive, exploratory factorial (n = 345), confirmatory (n = 397), and scale reliability analyses were performed with better goodness-of-adjustment indices.

Results

A new scale named Emotional Quotient Inventory: Short Version for DS adults was obtained with a structure of four factors called mood, stress management, interpersonal, and intrapersonal. This new scale was reduced to 25 items. Goodness-of-fit indices were excellent (RMSEA [95% CI] = 02[.01; .03]; CFI = .99; TLI = .98; GFI = .87; AGFI = .89). The internal consistency of the four dimensions and the calculated total score (α = .91, ω = .93 and divided halves = .90) yielded high values in this clinical sample.

Discussion

The results recommend the use of the revised EQ-i: YV, the EQ-i: SVDS, to assess EI in adults with DS. The psychometric properties of this study are satisfactory but have four factors. The findings are discussed in terms of future research and practical implication to gain a more thorough understanding of how this population behaves on both a general and preventive level in order to teach EI properly.

Conclusions

This new version is a valid and reliable tool to evaluate emotional intelligence in people with intellectual disabilities and specifically in Spanish adults with DS.

Emotion knowledge in neurotypical children and in those with down syndrome

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

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.

How Individuals With Down Syndrome Process Faces and Words Conveying Emotions? Evidence From a Priming Paradigm

Emotion recognition from facial expressions and words conveying emotions is considered crucial for the development of interpersonal relations (Pochon and Declercq, 2013). Although Down syndrome (DS) has received growing attention in the last two decades, emotional development has remained underexplored, perhaps because of the stereotype of high sociability in persons with DS. Yet recently, there is some literature that is suggesting the existence of specific deficits in emotion recognition in DS. The current study aimed to expand our knowledge on how individuals with DS process emotion expressions from faces and words by adopting a powerful methodological paradigm, namely priming. The purpose is to analyse to what extent emotion recognition in DS can occur through different processes than in typical development. Individuals with DS (N = 20) were matched to a control group (N = 20) on vocabulary knowledge (PPTV) and non-verbal ability (Raven’s matrices). Subsequently a priming paradigm was adopted: stimuli were photos of faces with different facial expressions (happy, sad, neutral) and three words (happy, sad, neutral). On a computer screen the first item (face or word) was presented for a very short time (prime) and afterward a stimulus (face or word) appeared (target). Participants had to recognize whether the target was an emotion (sad/happy) or not (neutral). Four prime-target pairs were presented (face-word; word-face; word-word; face-word) in two conditions: congruent (same emotion prime/target) and incongruent (different emotion prime/target). The results failed to show evidence for differential processing during emotion recognition between the two groups matched for verbal and non-verbal abilities. Both groups showed a typical priming effect: In the incongruent condition, slower reaction times were recorded, in particular when the target to be recognized is the face, providing evidence that the stimuli were indeed processed. Overall, the data of the current work seem to support the idea of similar developmental trajectories in individuals with DS and TD of the same verbal and non-verbal level, at least as far as the processing of simple visual and linguistic stimuli conveying basic emotions is concerned. Results are interpreted in relation to recent finding on emotion recognition from faces and words in DS.

The Social Responsiveness Scale (SRS-2) in school-age children with Down syndrome at low risk for autism spectrum disorder

BACKGROUND AND AIMS

Little is known about how autism spectrum disorder (ASD) symptoms present in individuals with Down syndrome (DS). Some behaviors may be symptomatic of comorbid ASD or more broadly representative of the DS phenotype. A prior research study documented elevated ASD-like symptoms in adolescents and young adults with DS without comorbid ASD, using a common ASD risk screening tool-the Social Responsiveness Scale (SRS). The current study applied a similar approach to younger children with DS using the SRS-2. The primary aim was to document patterns of ASD-like symptoms in children with DS at low risk of comorbid ASD to distinguish the symptoms that may be present across DS in general.

METHODS

SRS-2 standard scores were analyzed in a sample of 40 children with DS, 6-11 years old, who were considered to be at low risk for ASD based on the Social Communication Questionnaire (SCQ) screener. Other developmental characteristics (i.e., age, nonverbal IQ, expressive language), social skills, and problem behaviors were also examined across the sample.

RESULTS

SRS-2 scores were significantly elevated in this sample compared to the normative population sample. A pattern of ASD-like symptomatology was observed across SRS-2 subdomains. These findings were similar to the findings of the prior study. However, nuanced differences were observed across the two samples that may represent developmental differences across different ages in this population.

CONCLUSIONS

Replicating and extending a prior study's findings, certain ASD-like behaviors may occur in individuals with DS who are at low risk for comorbid ASD.

IMPLICATIONS

Understanding the pattern of ASD-like behaviors that occur in children with DS who are at low risk for comorbid ASD will help clinicians in screening and identification efforts. In particular, it will lead to better specification of the behaviors or symptoms that are not characteristic of the DS phenotype and thus are red flags for comorbid ASD in this population.

Parenting behaviour and executive function in children with Down syndrome

BACKGROUND

Parenting behaviours influence many domains of child development, and recent work has demonstrated the specific effects of parenting on the development of executive function (EF) abilities. The relationship between parent-child interaction patterns and EF has been examined in typically developing (TD) children but has not yet been examined in dyads where the child has a diagnosis of Down syndrome (DS).

METHOD

The current study examines the differences in patterns of parenting behaviours between DS dyads and dyads with TD children equated on nonverbal mental age. DS dyads (n = 42), child ages 59 to 118 months, and TD dyads (n = 28), child ages 30 to 49 months, participated in a modified version of the Parent-Child Challenge Task. Parent directive and teaching behaviours were coded, along with child compliance and noncompliance. Child participants also completed a laboratory measure of inhibition and working memory, and parents completed the Behaviour Rating Inventory of Executive Function-Preschool.

RESULTS

There was a greater frequency of parenting directives and child compliance in the DS dyads, and parents of children with DS were more likely to follow child compliance with directives than parents of TD children. In both groups, parenting directive behaviour was a significant predictor of child EF laboratory performance.

CONCLUSIONS

Results characterise the relationship between specific parenting behaviours and child EF in DS and TD dyads. The implications for parent training and intervention are discussed.

Relation between processing facial identity and emotional expression in typically developing school-age children and those with Down syndrome

The main purposes of this research were to examine the relation between the processing of face identity and emotion expressions and then discern the significance of emotional expressions using Bruce et al. tasks. Two studies were conducted. Study 1 examined 225 typically developing (TD) children age 4 to 12. Results suggested that early recognition of complete faces and interpretation of emotional expression might depend on local processing abilities, while the recognition of masked faces and emotion expression matching seemed to share configural processing. Study 2 compared 22 children with Down syndrome (DS) to two TD groups matched on mental age (MA group) and chronological age (CA group). Results showed that children with DS processed the identity of complete faces (local processing) similarly to the MA and CA groups. In contrast, their performances for masked faces (configural processing) indicated a developmental delay as they were only comparable to the MA group. Children with DS were also able to identify the emotion expressions according to labels as well as the two control groups, while they had more difficulties on the matching condition. Furthermore, specific difficulties in processing the surprise expression were observed, rather than general difficulties in encoding emotion expressions. Finally, their performances on emotion matching tasks seemed to be supported by local information processing, which might explain their lower scores compared to CA controls that mainly used configural information. These results could aid in the development of targeted interventions for DS to improve their social skills.

Specificity: A Phenotypic Comparison of Communication-Relevant Domains Between Youth With Down Syndrome and Fragile X Syndrome

Despite the shared presence of an intellectual disability (ID), there is a growing literature documenting important phenotypic differences between Down syndrome (DS) and fragile X syndrome (FXS). These conclusions, however, are based on a synthesis across studies, each of which typically includes only measures of a limited number of constructs, and with differing participant characteristics. Firmer conclusions regarding specific phenotypes require a single comprehensive multi-domain assessment of participants with the syndrome groups being well matched on chronological age (CA) and cognitive functioning. The current study was designed to fill this gap by assessing several important cognitive and behavioral domains relevant to communication, such as: structural language skills, false belief understanding, as well as pragmatics and behavioral difficulties, in 30 adolescents of both sexes with DS and 39 males with FXS, matched on CA and nonverbal (NV) cognition. After statistically controlling for NV cognition, we did not find significant syndrome differences in expressive and receptive structural language or false belief understanding. In contrast, participants with DS displayed less stereotyped language and fewer behavioral difficulties compared to males with FXS. Within-syndrome associations among the targeted domains are described. Finally, females with DS were less impaired than males with DS in almost all structural language domains, whereas no significant sex-related differences were observed in NV cognition, false belief understanding, pragmatics, or behavior. Clinical and methodological implications of the findings are discussed.

Social knowledge and social reasoning abilities in a neurotypical population and in children with Down syndrome

Social knowledge refers to the ability to analyze and reason about social situations in relation to social rules which are essential to the development of social skills and social behavior. The present research aimed to assess these abilities with the "Social resolution task" in a neurotypical population of 351 children (4 to 12 years) and 39 young adults, and in 20 participants (10 to 18 years) with Down syndrome. Results showed that young children aged 4 to 6 were well able to distinguish between appropriate and inappropriate social behavior but they had significantly more difficulties in judging and identifying social cues for the transgression of conventional rules than for moral ones. Between age 4 and 8, their social reasoning was mainly based on factual answers, while older children showed significantly more social awareness, making more reference to emotional and social consequences for the "victims". The representation of a more universal applicability of social rules seemed to develop later in childhood, as of age 8. In contrast, participants with Down syndrome exhibited significantly more difficulties in judging, identifying and reasoning about transgression of social rules without social awareness. In conclusion, the results have shown that social reasoning abilities develop throughout childhood. Social awareness seems to have a long developmental course, which includes a sensibility about welfare and intersubjectivity, critical for the development of prosocial behavior. The clinical population with difficulties in social interaction and socio-emotional behavior could benefit from an early assessment and from learning social reasoning abilities to improve social skills.

Joint attention in Down syndrome: A meta-analysis

BACKGROUND

Some studies have indicated that joint attention may be a relative strength in Down syndrome (DS), but other studies have not.

AIM

To conduct a meta-analysis of joint attention in DS to more conclusively determine if this is a relative strength or weakness when compared to children with typical development (TD), developmental disabilities (DD), and autism spectrum disorder (ASD).

METHODS AND PROCEDURES

Journal articles published before September 13, 2016, were identified by using the search terms "Down syndrome" and "joint attention" or "coordinating attention". Identified studies were reviewed and coded for inclusion criteria, descriptive information, and outcome variables.

OUTCOMES AND RESULTS

Eleven studies (553 participants) met inclusion criteria. Children with DS showed similar joint attention as TD children and higher joint attention than children with DD and ASD. Meta-regression revealed a significant association between age and joint attention effect sizes in the DS vs. TD contrast.

CONCLUSIONS AND IMPLICATIONS

Joint attention appears to not be a weakness for children with DS, but may be commensurate with developmental level. Joint attention may be a relative strength in comparison to other skills associated with the DS behavioral phenotype. Early interventions for children with DS may benefit from leveraging joint attention skills.

Acoustic parameters of infant-directed singing in mothers of infants with down syndrome

This study compared the acoustic parameters and degree of perceived warmth in two types of infant-directed (ID) songs - the lullaby and the playsong - between mothers of infants with Down syndrome (DS) and mothers of typically-developing (TD) infants. Participants included mothers of 15 DS infants and 15 TD infants between 3 and 9 months of age. Each mother's singing voice was digitally recorded while singing to her infant and subjected to feature extraction and data mining. Mothers of DS infants and TD infants sang both lullabies and playsongs with similar frequency. In comparison with mothers of TD infants, mothers of DS infants used a higher maximum pitch and more key changes during playsong. Mothers of DS infants also took more time to establish a rhythmic structure in their singing. These differences suggest mothers are sensitive to the attentional and arousal needs of their DS infants. Mothers of TD infants sang with a higher degree of perceived warmth which does not agree with previous observations of "forceful warmth" in mothers of DS infants. In comparison with lullaby, all mothers sang playsong with higher overall pitch and slower tempo. Playsongs were also distinguished by higher levels of spectral centroid properties related to emotional expressivity, as well as higher degrees of perceived warmth. These similarities help to define specific song types, and suggest that all mothers sing in an expressive manner that can modulate infant arousal, including mothers of DS infants.

A Multi-Method Investigation of Pragmatic Development in Individuals With Down Syndrome

This longitudinal study examined pragmatic language in boys and girls with Down syndrome (DS) at up to three time points, using parent report, standardized and direct assessments. We also explored relationships among theory of mind, executive function, nonverbal mental age, receptive and expressive vocabulary, grammatical complexity, and pragmatic competence. Controlling for cognitive and language abilities, children with DS demonstrated greater difficulty than younger typically developing controls on parent report and standardized assessments, but only girls with DS differed on direct assessments. Further, pragmatic skills of individuals with DS developed at a delayed rate relative to controls. Some sex-specific patterns of pragmatic impairments emerged. Theory of mind and executive function both correlated with pragmatic competence. Clinical and theoretical implications are discussed.

Emotion Recognition in Adolescents with Down Syndrome: A Nonverbal Approach

Several studies have reported that persons with Down syndrome (DS) have difficulties recognizing emotions; however, there is insufficient research to prove that a deficit of emotional knowledge exists in DS. The aim of this study was to evaluate the recognition of emotional facial expressions without making use of emotional vocabulary, given the language problems known to be associated with this syndrome. The ability to recognize six emotions was assessed in 24 adolescents with DS. Their performance was compared to that of 24 typically developing children with the same nonverbal-developmental age, as assessed by Raven’s Progressive Matrices. Analysis of the results revealed no global difference; only marginal differences in the recognition of different emotions appeared. Study of the developmental trajectories revealed a developmental difference: the nonverbal reasoning level assessed by Raven’s matrices did not predict success on the experimental tasks in the DS group, contrary to the typically developing group. These results do not corroborate the hypothesis that there is an emotional knowledge deficit in DS and emphasize the importance of using dynamic, strictly nonverbal tasks in populations with language disorders.

Emotion Recognition in Children With Down Syndrome: Influence of Emotion Label and Expression Intensity

Some children with Down syndrome may experience difficulties in recognizing facial emotions, particularly fear, but it is not clear why, nor how such skills can best be facilitated. Using a photo-matching task, emotion recognition was tested in children with Down syndrome, children with nonspecific intellectual disability and cognitively matched, typically developing children (all groups N = 21) under four conditions: veridical vs. exaggerated emotions and emotion-labelling vs. generic task instructions. In all groups, exaggerating emotions facilitated recognition accuracy and speed, with emotion labelling facilitating recognition accuracy. Overall accuracy and speed did not differ in the children with Down syndrome, although recognition of fear was poorer than in the typically developing children and unrelated to emotion label use. Implications for interventions are considered.

Attention allocation to facial expressions of emotion among persons with Williams and Down syndromes

Individuals with Williams syndrome and those with Down syndrome are both characterized by heightened social interest, although the manifestation is not always similar. Using a dot-probe task, we examined one possible source of difference: allocation of attention to facial expressions of emotion. Thirteen individuals with Williams syndrome (mean age = 19.2 years, range = 10-28.6), 20 with Down syndrome (mean age = 18.8 years, range = 12.1-26.3), and 19 typically developing children participated. The groups were matched for mental age (mean = 5.8 years). None of the groups displayed a bias to angry faces. The participants with Williams syndrome showed a selective bias toward happy faces, whereas the participants with Down syndrome behaved similarly to the typically developing participants with no such bias. Homogeneity in the direction of bias was markedly highest in the Williams syndrome group whose bias appeared to result from enhanced attention capture. They appeared to rapidly and selectively allocate attention toward positive facial expressions. The complexity of social approach behavior and the need to explore other aspects of cognition that may be implicated in this behavior in both syndromes is discussed.

Empathic responsiveness and helping behaviours in young children with Williams syndrome

BACKGROUND

Anecdotal and caregiver reports often highlight the sociability and empathy of children with Williams syndrome (WS), a genetically based neurodevelopmental disorder characterised by a distinctive, cognitive and social phenotype. Despite these characteristics, people with WS have many difficulties navigating the social world. In this study, we investigated whether the heightened social motivation and empathy demonstrated by children with WS lead to prosocial behaviours such as instrumental helping.

METHODS

We compared 2;8 to 5;8 year olds with WS to an age-matched and developmental quotient-matched group of children with Down syndrome (DS) and an age-matched group of typically developing children, in their responses to semi-structured naturalistic situations designed to elicit empathic and helping behaviours.

RESULTS

Children with WS showed more empathic concern than both comparison groups towards a person in distress but did not differ from controls in their level of helping behaviour. Children in both the WS and DS groups consistently received higher ratings on empathy than on helpfulness, in contrast to the balanced profile shown by the typically developing children.

DISCUSSION

Findings suggest that the heightened emotional responsivity displayed by children with WS or DS does not readily translate into other forms of socially competent behaviour. The complex relations between empathy and prosocial behaviours in typical and atypical development are discussed.

The importance of understanding individual differences in Down syndrome

In this article, we first present a summary of the general assumptions about Down syndrome (DS) still to be found in the literature. We go on to show how new research has modified these assumptions, pointing to a wide range of individual differences at every level of description. We argue that, in the context of significant increases in DS life expectancy, a focus on individual differences in trisomy 21 at all levels-genetic, cellular, neural, cognitive, behavioral, and environmental-constitutes one of the best approaches for understanding genotype/phenotype relations in DS and for exploring risk and protective factors for Alzheimer's disease in this high-risk population.

Joint Attention and Early Social Developmental Cascades in Neurogenetic Disorders

This review examines what is known about joint attention and early social development in three neurogenetic syndromes: Down syndrome, Williams syndrome, and fragile X syndrome. In addition, the potential cascading effects of joint attention on subsequent social development, especially social interaction and social cognition are proposed. The potential issues and complexities associated with conducting prospective, longitudinal studies of infant social development in neurogenetic disorders are discussed.

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.

Patterns of autism spectrum symptomatology in individuals with Down syndrome without comorbid autism spectrum disorder

BACKGROUND

Prevalence estimates of autism spectrum disorder (ASD) in Down syndrome (DS) are highly varied. This variation is partly due to the difficulty of screening for and diagnosing comorbid ASD in individuals with a syndrome that carries its own set of social communicative and behavioral difficulties that are not well documented. The aim of this study was to identify the typical range of social communicative impairments observed in children, adolescents, and young adults with DS who do not have comorbid ASD.

METHODS

We examined patterns of scores from the five subscales of the Social Responsiveness Scale (SRS) in 46 individuals with DS (ages 10-21 years) without comorbid ASD relative to the published normative sample. We also explored the correlations between SRS symptomatology and age, nonverbal cognition, and receptive language.

RESULTS

SRS scores were elevated (i.e., more ASD symptoms endorsed), with mean scores falling into the clinically significant range. Analysis by subscale revealed a specific pattern, with Autistic Mannerisms and Social Cognition scores significantly more elevated than Social Communication scores, which were significantly more elevated than Social Awareness and Social Motivation scores. Correlations between SRS scores and the other measures varied by subscale.

CONCLUSIONS

General elevated ASD symptomatology on the SRS indicates the need for developing population-based norms specific to DS. The pattern of scores across subscales should inform clinicians of the typical range of behaviors observed in DS so that individuals with atypical patterns of behavior can be more easily identified and considered for a full ASD evaluation.

Emotion knowledge in children and adolescents with Down syndrome: a new methodological approach

Emotion knowledge was examined in 19 youth with Down syndrome (DS) and compared to typically developing (TD) children of similar developmental levels. This project expanded upon prior research on emotion knowledge in DS by utilizing a measure that minimized the need for linguistic skills, presented emotion expressions dynamically, and included social context cues. In Study 1, participants with DS were as accurate as TD participants when judging emotions from static or dynamic expression stimuli and from facial or contextual cues. In Study 2, participants with DS and TD participants showed similar cross-sectional developmental trajectories of emotion knowledge across mental age. This project highlights the importance of measure selection when examining emotion knowledge in samples with intellectual and developmental disabilities.

Profiles of everyday executive functioning in young children with down syndrome

We investigated executive functioning (EF) in children with Down syndrome (DS; n  =  25) and typically developing (TD) children matched for mental age (MA; n  =  23) using the Behavior Rating Inventory of Executive Function-Preschool. We sought to (1) compare children with DS to a developmentally matched control group, and (2) to characterize the EF profile of children with DS. Across teacher and parent reports, significant deficits in working memory and planning were observed in the DS group. Parents, but not teachers, of children with DS also reported difficulties in inhibitory control relative to the comparison group. Results extend earlier findings regarding EF impairments in children with DS. The complementary role inhibitory control may play in this profile is discussed.

Early intersubjective skills and the understanding of intentionality in young children with Down syndrome

This study examined the relationship between early intersubjective skills (joint attention and affect sharing) and the development of the understanding of intentionality in 16 young children with Down syndrome (DS) and 16 developmentally matched children with other developmental disabilities (DD). The study of intentionality focuses on how children come to understand the goal-directed actions of others and is an important precursor to the development of more complex social cognitive skills, such as theory of mind. Joint attention and affect sharing were examined using the Early Social Communication Scales (Mundy, Sigman, & Kasari, 1990; Seibert, Hogan, & Mundy, 1982). Meltzoff's (1995) behavioral reenactment paradigm was used to examine the understanding of intentionality. For children with DS, higher rates of affect sharing were associated with poorer intention reading abilities. This pattern was not observed in children with other DD. These results suggest that the intersubjective strengths associated with DS may not support the development of intentionality-interpretation skills. Future research is needed to explore if children with DS have the joint attention behaviors needed to be intentional.

Emotion recognition by children with Down syndrome: a longitudinal study

BACKGROUND

According to the literature, children with Down syndrome (DS) have difficulties recognising facial expressions. Yet abilities to recognise emotional expressions are often assessed in tasks that imply comprehension of words for emotions. We investigated the development of these abilities in children with DS in a longitudinal study that did not involve lexical knowledge of emotions.

METHOD

Children with DS and nonspecific intellectual disability and typically developing children matched for developmental age (DA) were assessed once a year over 3 years. They were asked to recognise the facial expression of an emotion after hearing a vocalisation.

RESULTS

In each annual session, children with DS were not significantly different from others at recognising emotions. Their abilities to discriminate basic emotions improved significantly and to a similar extent to those of other children.

CONCLUSION

The findings indicate that children with DS develop emotion recognition abilities similarly to other children of the same DA.