Social reasoning skills in adults with Down syndrome: the role of language, executive functions and socio-emotional behaviour

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

OVERVIEW

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

METHOD

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

RESULT

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

CONCLUSION

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

Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health

OBJECTIVE

The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health.

METHODS

An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level.

RESULTS

The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation.

CONCLUSIONS

It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

Cognitive predictors of Social processing in congenital atypical development

According to current accounts of social cognition, the emergence of verbal and non-verbal components of social perception might rely on the acquisition of different cognitive abilities. These components might be differently sensitive to the pattern of neuropsychological impairments in congenital neurodevelopmental disorders. Here, we explored the association between social and non-social cognitive domains by administering subtests of the NEPSY-II battery to 92 patients with Intellectual and Developmental Disability (IDD). Regardless the level of intellectual functioning and presence of congenital brain malformations, results revealed that visuospatial skills predicted emotion recognition and verbal component of Theory of Mind, whereas imitation predicted the non-verbal one. Future interventions might focus on spatial and sensorimotor abilities to boost the development of social cognition in IDD.

Moral judgements among neurotypical children, autistic children and adults with intellectual disability

Background: The present study investigates the possible differences between neurotypical children (NT), autistic children, and adults with intellectual disability (ID) related to (i) morality of the agent, (ii) morality of the action, and (iii) culpability in inappropriate situations. Method: Eighty-four Spanish participants (32 NT, 30 autistic children, and 22 adults with ID) responded to a task of moral transgression with an unambiguous structure (bad intention - bad outcome), where the stories were classified as first-order Theory of Mind (ToM) (based on simple desires) and second-order ToM (based on revenge). Results: Autistic group judged similarly to NT group. However, adults with ID had greater difficulty judging the (ii) morality of the action (compared with the autistic and NT group) and (iii) culpability (compared with the NT group). Also, ID adults encountered problems responding the moral questions in the balloon story (second-order ToM) and ice-cream story (first-order ToM). Conclusions: Autistic and NT children were able to make similar moral judgements, however adults with ID did not respond in the same way - as they were more benevolent in their judgements.

Training Inhibition and Social Cognition in the Classrooms

Executive functions and social cognition competences are associated with many important areas of life, such as school readiness, academic success or sociability. Numerous intervention programs aiming to improve these capacities have emerged and have been shown to be effective. As inhibition in particular, is closely related with social cognition competences, we developed a training program that targets both abilities and implemented it in kindergarten and lower primary school classes for 6 months. We evaluated its effectiveness at improving inhibition and social cognition as well as its possible impact on academic performance. The results showed that tackling inhibition and social cognition in the classroom at an early age improved inhibition, visual attention and flexibility as well as Theory of Mind and social information processing skills. However, the impact on academic learning was weak; a slight effect on a mathematical task was observed.

Social Cognition in Children With Non-specific Intellectual Disabilities: An Exploratory Study

Social cognitive abilities - notably, Theory of Mind (ToM) and social information processing (SIP) - are key skills for the development of social competence and adjustment. By understanding affective and cognitive mental states and processing social information correctly, children will be able to enact prosocial behaviors, to interact with peers and adults adaptively, and to be socially included. As social adjustment and inclusion are major issues for children with intellectual disabilities (IDs), the present study aimed to explore their social cognitive profile by combining cluster analysis of both ToM and SIP competence, and to investigate the structure of relations between these skills in children with IDs. Seventy-eight elementary school children with non-specific IDs were recruited. They had a chronological age ranging from 4 years and 8 months to 12 years and 6 months and presented a preschool developmental age. Performance-based measures were administered to assess ToM and SIP abilities. Questionnaires were completed by the children's parents to evaluate the children's social competence and adjustment and their risk of developing externalizing or internalizing behaviors. Exploratory analysis highlighted strengths and weaknesses in the social cognitive profiles of these children with IDs. It also emphasized that the understanding of affective and cognitive mental states was used differently when facing appropriate vs. inappropriate social behaviors. The present study leads to a better understanding of the socio-emotional profile of children with IDs and offers some suggestions on how to implement effective interventions.

Intervención temprana en Síndrome de Down: Una revisión sistemática

Introducción: El síndrome de Down presenta importantes diferencias en tasas de incidencia según territorios y países, siendo además una de los trastornos genéticos más complejos, aunque su detección sea la más precoz de los trastornos genéticos. En España se ha producido una drástica reducción de nacimientos, existiendo un aumento en otras zonas del mundo como Latinoamérica. Objetivo y método: Se pretende realizar una revisión sistemática sobre el conocimiento científico actual relacionado con intervenciones tempranas en SD desde los años 2000 al 2017, utilizando la metodología PRISMA. Resultados: Se observa intensas lagunas metodológicas, enfatizándose las investigaciones transversales por encima de los longitudinales y sobre todo en zonas concretas del mundo. De este síndrome siguen interesando los factores cognitivos en detrimento de variables familiares y otros aspectos claves para un desarrollo psicoevolutivo adecuado. No se observan trabajos de intervención temprana ni de evaluación de programas en países hispanohablantes, y la mayoría de publicaciones científicas mezclan edades y sexos en sus muestras. Discusión: Se discuten los resultados obtenidos de la revisión realizada. Conclusiones: A lo largo del tiempo se observa una importante reducción del interés científico por este síndrome. Se siguen realizando trabajos de manera redundante sobre los mismos aspectos, sin valorar subdimensiones imprescindibles para el desarrollo biopsicosocial de este colectivo.

Relations between Everyday Executive Functioning and Language in Youth with Down Syndrome and Youth with Autism Spectrum Disorder

Language and executive functioning are major impairments in many neurodevelopmental disorders, but little is known about the relations between these constructs, particularly using parent-report. Thus, the current research sought to examine relations between executive function and language in two groups - Down syndrome (DS; n=41; Mage = 11.2) and autism spectrum disorder (ASD; n=91; Mage = 7.7). Results were as follows: in DS, executive function predicted pragmatic, but not structural language after covarying for age, sex, and social functioning; in ASD, executive function predicted both. Findings highlight the interrelatedness of language and executive functioning and may have implications for intervention development.

Social adaptive skills and psychopathology in adults with intellectual disabilities of non-specific origin and those with Down syndrome

The present study aimed to assess the psychometric proprieties of a new social adaptive skills questionnaire and examine the impact of maladaptive behaviour on social functioning in adults with ID of non-specific aetiology and those with Down syndrome. The results of an exploratory factor analysis led to the exclusion of 20 items out of 48 and yielded a four-factor structure. The Confirmatory Factor Analysis conducted on 28 remaining items confirmed a four-factor structure explaining 43% of the total variance. The results computed on the global sample (n = 567) showed a "very good" internal consistency for the global score (.89) for all four factors with a very good fit (.97). Thus, this new assessment tool presented a good conceptual validity for assessing social-adaptive skills in adults with ID. The results also showed that participants with DS (no = 92) exhibited a higher global score of social adaptive skills on three subscales (sociability, social relating and respect for social rules) compared to adults with ID of non-specific aetiology (no = 328), and presented a lower level of psychopathology problems. Although aetiology was significantly related to these group differences even after controlling for level of ID and chronological age, the general level of psychopathology fully mediated these relations. In conclusion, the regression coefficient analyses showed that the general level of psychopathology fully mediated the relationship between aetiology and social adaptive skills. A combined assessment of these dimensions should provide information about their predictive value for social functioning in ID adults and target specific remediation goals.

Social Cognition in Down Syndrome: Face Tuning in Face-Like Non-Face Images

Individuals with Down syndrome (DS) are widely believed to possess considerable socialization strengths. However, the findings on social cognition capabilities are controversial. In the present study, we investigated whether individuals with DS exhibit shortage in face tuning, one of the indispensable components of social cognition. For this purpose, we implemented a recently developed Face-n-Food paradigm with food-plate images composed of food ingredients such as fruits and vegetables. The key benefit of such face-like non-face images is that single elements do not facilitate face processing. In a spontaneous recognition task, 25 children with DS aged 9 to 18 years were presented with a set of Face-n-Food images bordering on the Giuseppe Arcimboldo style. The set of images was administered in a predetermined order from the least to most resembling a face. In DS individuals, thresholds for recognition of the Face-n-Food images as a face were drastically higher as compared not only with typically developing controls, but also with individuals with autistic spectrum disorders and Williams-Beuren syndrome. This outcome represents a significant step toward better conceptualization of the visual social world in DS and neurodevelopmental disorders in general.

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.

Outcome Measures for Clinical Trials in Down Syndrome

Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.

Motor, linguistic, personal and social aspects of children with Down syndrome

A global developmental delay is expected from Down syndrome, affecting motor, cognitive, linguistic and personal-social skills. However, not always these delays are proportional; different conditions occur due to several intrinsic and extrinsic variables that must be controlled to form groups of greater homogeneity.

The association between a single bout of moderate physical activity and executive function in young adults with Down syndrome: a preliminary study

BACKGROUND

This study was aimed at investigating the impact of a single exercise intervention on executive function in young adults with Down syndrome (DS).

METHODS

Considering the relations among executive function, physical and mental health and early onset of Alzheimer's disease in this population, we tested three components of executive function (e.g. choice-response time, attention shifting and inhibition) that have been shown to be impaired in previous studies. Ten persons with DS were assigned to an exercise group, who walked on a treadmill for 20 min at moderate intensity and ten additional persons with DS were assigned to an attentional control group, who watched a video. Measures of executive function were tested pre and post interventions.

RESULTS

These results showed non-significant improvements in choice-response time (P = 0.32) and attention shifting (P = 0.13) but a statistically significant improvement in inhibition (P = 0.03) after the exercise intervention.

CONCLUSIONS

Given the improved inhibition ability, exercise may be an effective intervention, even in a signal session. However, only a few studies have focused on this topic. Based on theoretical models linking exercise to executive function, we proposed that exercise may increase arousal status or enhance neural transmission. Hence, future work is needed to examine the exact mechanism in the relationship between exercise and executive function for individuals with DS.

Practical and social skills of 16-19-year-olds with Down syndrome: independence still far away

Survival of children with Down syndrome (DS) has improved considerably, but insight into their level of daily functioning upon entering adulthood is lacking. We collected cross-sectional data from a Dutch nationwide cohort of 322 DS adolescents aged 16-19 (response 62.8%) to assess the degree to which they master various practical and social skills, using the Dutch Social competence rating scale and the Children's Social Behavior Questionnaire. Up to 60% mastered some of the skills required for independent functioning, such as maintaining adequate standards of personal hygiene and preparing breakfast. Less than 10% had achieved basic skills such as basic cooking and paying in a shop. It is difficult for DS people to master all the skills necessary to live independently. Ninety percent of adolescents with DS experience significant problems in social functioning.

Processing of facial expressions of emotions by adults with Down syndrome and moderate intellectual disability

The processing of facial expressions of emotions by 23 adults with Down syndrome and moderate intellectual disability was compared with that of adults with intellectual disability of other etiologies (24 matched in cognitive level and 26 with mild intellectual disability). Each participant performed 4 tasks of the Florida Affect Battery and an original task in which they had to match facial expressions after observing the complete face or one of its halves. Adults with Down syndrome did not show any specific difficulties in recognizing facial expressions in spite of showing a poorer discrimination between facial expressions and tended to take more notice of the lower half of the face.

Relationships, sexuality and decision-making capacity in people with an intellectual disability

PURPOSE OF REVIEW

The current review attempts to summarize the current status of our knowledge and clinical practice in the complex and challenging area of relationships and sexuality for people with an intellectual disability.

RECENT FINDINGS

Although there has been an ideological shift within services for people with an intellectual disability towards person-centredness and inclusivity, this change has not manifested in an obvious way at the practice level in the area of relationships and sexual expression. Recent surveys of caregivers and service providers do show a greater awareness of the fact that sexuality is a central part of personal identity, yet generally restrictive or prohibitive attitudes prevail at both individual and organizational levels. These attitudes appear to reflect a fear of possible legal sanction as well as ethical and moral conflicts. The views and experiences of people with an intellectual disability generally confirm this impression that, whereas some small changes have taken place, the prevailing experience is of restriction. Whereas there is now an abundance of sexuality and relationship educational programmes available, they require more rigorous and systematic evaluation both in terms of their effectiveness for enhancing knowledge and, more importantly, for examining the impact of that education on behaviour and capacity to make sexuality-related decisions, which we know to be a fluid ability.

SUMMARY

There is a need for greater education of caregivers and a need for discussion of the complex issues regarding relationships and sexuality at a societal and policy level. The development of self-advocacy in disability services provides a vehicle to operationalize the changing service ideologies in a way that provides greater opportunities for enriching relationship experiences whilst also preventing undue risk of harm. However, successful self-advocacy requires organizational support, and this remains the greatest challenge for service providers.