Stuttering treatment for a school-age child with Down syndrome: A descriptive case report

BackgroundLittle is known about optimal treatment approaches and stuttering treatment outcomes for children with Down syndrome.Aims and methodThe purpose of this study was to investigate outcomes for a child with Down syndrome who received a combination of fluency shaping therapy and parent delivered contingencies for normally fluent speech, prolonged speech, and stuttered speech.ResultsIn-clinic speech measures obtained at post-treatment and at 4 months follow-up reflected improvements in fluency of 89.0% and 98.6%, respectively. The participant's beyond-clinic follow-up sample reflected an improvement of 95.5%. Following treatment, the participant demonstrated improved self-confidence, self-esteem, and improved participation and functioning at school.ConclusionsFindings suggest that fluency shaping with parental contingencies may be a viable treatment approach to reduce stuttering in children with Down syndrome. Future research using an experimental research design is warranted.Educational objectives: Readers will be able to describe (a) prevalence estimates of stuttering in individuals with Down syndrome, (b) the main components of a fluency shaping program for a child with Down syndrome who stutters and has co-occurring speech and language delays, and (c) speech and parent-, teacher-, and self-report treatment outcomes.     

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.     

Supporting communication in young children with developmental disabilities

The behavior of parents, adult caregivers, and peers comprises the critical features of community support for the development of communication in young children with developmental disabilities. In a bio-ecological model of development, communication development is the result of the interactions of individuals with specific characteristics, in particular contexts over time. From the perspective of this model, foundational findings of intervention research to current views of communication development in children with developmental disabilities are summarized. The contributions of individual child characteristics to child-caregiver interactions that support language development are illustrated based on research with children who have autism, Williams syndrome, Down syndrome, and children who use augmentative communication systems. Parent-child interaction and the quality and quantity of parent talk are discussed as factors in children's language development. The effects of young children's delayed language on their interactions with peers, the contributions of peers to children's language learning and use, and the critical features of classroom settings that support child language development are reviewed. MRDD Research Reviews 7:143-150, 2001.     

Language phenotypes and intervention planning: bridging research and practice

This paper focuses on the communication and language phenotypes associated with three genetic disorders: Down syndrome, Williams syndrome, and fragile X syndrome. It is argued that there is empirical evidence that these disorders predispose children to specific profiles of strength and weakness in some areas of speech, language, and communication, and that intervention planning for children with each syndrome may take an approach informed by these profiles. Issues related to within-group variability, shared outcomes among syndromes, and the need for empirical validation for syndrome-specific recommendations are discussed.     

Behavioral phenotype of individuals with Down syndrome

Evidence is reviewed for a developmentally-emerging behavioral phenotype in individuals with Down syndrome that includes significant delay in nonverbal cognitive development accompanied by additional, specific deficits in speech, language production, and auditory short-term memory in infancy and childhood, but fewer adaptive behavior problems than individuals with other cognitive disabilities. Evidence of dementia emerges for up to half the individuals studied after age 50. Research issues affecting control group selection in establishing phenotypic characteristics are discussed, as well as the possible genetic mechanisms underlying variation in general cognitive delay, specific language impairment, and adult dementia. MRDD Research Reviews 2000;6:84-95. Wiley-Liss, Inc.     

Down syndrome: cognitive phenotype

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

TEACHING RESPONSES TO QUESTIONS TO YOUNG CHILDREN WITH DOWN SYNDROME

Despite extensive evidence of significant and pervasive impairments in communication in individuals with Down syndrome, there is relatively little empirical and behavior analytic research demonstrating effective intervention procedures. In this study, we examined a behavior analytic intervention to teach answers to questions in two children with Down syndrome. Children acquired the target responses and generalized across settings and people. This contributes to the growing body of demonstrations of behavior analytic interventions to address the needs of children with Down syndrome. Copyright © 2013 John Wiley & Sons, Ltd.     

Cerebral Specialization and the Control of Oral and Limb Movements for Individuals With Down’s Syndrome

In this paper we review existing research on cerebral specialization in Down’s syndrome (DS) individuals, and we present a preliminary model. The model proposes that the cerebral organization of DS persons is such that there is a dissociation of brain areas responsible for speech perception and the production of complex movement including speech. Research is presented that confirms some initial predictions of the model.     

Language and communicative development in Williams syndrome

Williams syndrome, a genetic disorder caused by a microdeletion of approximately 25 genes on chromosome 7q11.23, is associated with mild to moderate intellectual disability or learning difficulties. Most individuals with Williams syndrome evidence a cognitive profile including relative strengths in verbal short-term memory and language, and considerable weakness in visuospatial construction. The syndrome has often been argued to provide strong evidence for the independence of language from other aspects of cognition. We provide a brief history of early research on the language abilities of individuals with Williams syndrome and then review contemporary studies of language and cognition in Williams syndrome, beginning with a consideration of performance on standardized assessments. In the remainder of the article, we first consider early language acquisition, with a focus on speech production and perception, vocabulary acquisition, and communicative/pragmatic development and then consider the language abilities of school-age children and adolescents, focusing on semantics, grammar, and pragmatics. We argue that rather than being the paradigm case for the independence of language from cognition, Williams syndrome provides strong evidence of the interdependence of many aspects of language and cognition.     

Memory coding in individuals with Down syndrome

Previous research has identified a deficit in phonological short-term memory in individuals with Down syndrome.

The present work aimed to analyze how a group of 30 individuals with Down syndrome performed in a picture span task compared with 30 typically developing children of the same mental age. The task involved four conditions (i.e., dissimilar, phonologically similar, visually similar, and long-name items) chosen to analyze the strategy used by individuals with Down syndrome to code visually presented nameable items.

Individuals with Down syndrome performed less well than typically developing children. Both groups showed the visual similarity effect.

Taken together, our results confirm that individuals with Down syndrome have a verbal working memory deficit, even when nameable items are presented visually. Mental age appears to be an important determinant of memory coding stage in individuals with Down syndrome.     

The seeds of spatial grammar in the manual modality

Sign languages modulate the production of signs in space and use this spatial modulation to refer back to entities—to maintain coreference. We ask here whether spatial modulation is so fundamental to language in the manual modality that it will be invented by individuals asked to create gestures on the spot. English speakers were asked to describe vignettes under 2 conditions: using gesture without speech, and using speech with spontaneous gestures. When using gesture alone, adults placed gestures for particular entities in non-neutral locations and then used those locations to refer back to the entities. When using gesture plus speech, adults also produced gestures in non-neutral locations but used the locations coreferentially far less often. When gesture is forced to take on the full burden of communication, it exploits space for coreference. Coreference thus appears to be a resilient property of language, likely to emerge in communication systems no matter how simple.     

Développement des capacités sociolinguistiques chez des enfants et adolescents porteurs de trisomie 21 et étude de l'environnement sociolinguistique maternel

The aim of our research is to understand the language disturbances in Down syndrome children. Several studies demonstrated substantial differences between sociolanguage behaviours of mothers' Down syndrome children and those of mothers of non retarded children. We propose that these differences can explain DS language disturbances. So, we have compared 12 mother-child dyads (4 Down syndrome children are from 8 to 9 years, 4 are from 12 to 13 years and 4 are from 16 to 17 years). Dyads play in tutorial interaction. Results show language abilities evolution for Down syndrome subjects. Nevertheless, mothers' sociolanguage behaviors do no change.     

Practice Guidelines for Communicating a Prenatal or Postnatal Diagnosis of Down Syndrome: Recommendations of the National Society of Genetic Counselors

Down syndrome is one of the most common conditions encountered in the genetics clinic. Due to improvements in healthcare, educational opportunities, and community inclusion over the past 30?years, the life expectancy and quality of life for individuals with Down syndrome have significantly improved. As prenatal screening and diagnostic techniques have become more enhanced and widely available, genetic counselors can expect to frequently provide information and support following a new diagnosis of Down syndrome. This guideline was written for genetic counselors and other healthcare providers regarding the communication of a diagnosis of Down syndrome to ensure that families are consistently given up-to-date and balanced information about the condition, delivered in a supportive and respectful manner.     

Sources of variability in children’s language growth

The present longitudinal study examines the role of caregiver speech in language development, especially syntactic development, using 47 parent–child pairs of diverse SES background from 14 to 46 months. We assess the diversity (variety) of words and syntactic structures produced by caregivers and children. We use lagged correlations to examine language growth and its relation to caregiver speech. Results show substantial individual differences among children, and indicate that diversity of earlier caregiver speech significantly predicts corresponding diversity in later child speech. For vocabulary, earlier child speech also predicts later caregiver speech, suggesting mutual influence. However, for syntax, earlier child speech does not significantly predict later caregiver speech, suggesting a causal flow from caregiver to child. Finally, demographic factors, notably SES, are related to language growth, and are, at least partially, mediated by differences in caregiver speech, showing the pervasive influence of caregiver speech on language growth.     

Impaired verbal short-term memory in Down syndrome reflects a capacity limitation rather than atypically rapid forgetting

Individuals with Down syndrome suffer from relatively poor verbal short-term memory. Recent work has indicated that this deficit is not caused by problems of audition, speech, or articulatory rehearsal within the phonological loop component of Baddeley and Hitch's working memory model. Given this, two experiments were conducted to investigate whether abnormally rapid decay underlies the deficit. In a first experiment, we attempted to vary the time available for decay using a modified serial recall procedure that had both verbal and visuospatial conditions. No evidence was found to suggest that forgetting is abnormally rapid in phonological memory in Down syndrome, but a selective phonological memory deficit was indicated. A second experiment further investigated possible problems of decay in phonological memory, restricted to item information. The results indicated that individuals with Down syndrome do not show atypically rapid item forgetting from phonological memory but may have a limited-capacity verbal short-term memory system.     

Resolving ambiguity: a psycholinguistic approach to understanding prosody processing in high-functioning autism

Individuals with autism exhibit significant impairments in prosody production, yet there is a paucity of research on prosody comprehension in this population. The current study adapted a psycholinguistic paradigm to examine whether individuals with autism are able to use prosody to resolve syntactically ambiguous sentences. Participants were 21 adolescents with high-functioning autism (HFA), and 22 typically developing controls matched on age, IQ, receptive language, and gender. The HFA group was significantly less likely to use prosody to disambiguate syntax, but scored comparably to controls when syntax alone or both prosody and syntax indicated the correct response. These findings indicate that adolescents with HFA have difficulty using prosody to disambiguate syntax in comparison to typically developing controls, even when matched on chronological age, IQ, and receptive language. The implications of these findings for how individuals with autism process language are discussed.     

Exploring the correlates of impaired non‐word repetition in Down syndrome

Non‐word repetition, in which participants hear and repeat unfamiliar verbal stimuli, is thought to provide a particularly sensitive measure of verbal short‐term memory capacity. However, performance on this task can also be constrained by hearing and speech production skills, and by an individuals' linguistic knowledge. This study examined real word and non‐word repetition in a sample of 18 children and adolescents with Down syndrome, and compared their performance to that of a control group of 18 typically developing children in order to determine the extent of any impairment in repetition performance in Down syndrome, and the correlates of performance in each group. Individuals with Down syndrome were impaired in repetition performance, although both groups showed similar benefits of linguistic knowledge on repetition accuracy. An analysis of the correlates of non‐word repetition revealed a double dissociation between the patterns of associations seen in the two groups. Among typically developing individuals, non‐word repetition was related to an independent measure of verbal short‐term memory but not to vocabulary knowledge. However, among individuals with Down syndrome, performance was related to vocabulary knowledge but not verbal short‐term memory span. This contrast is consistent with the view that impairment to verbal short‐term memory prevents this system from fully supporting non‐word repetition in Down syndrome.     

Sources of variability in children’s language growth

The present longitudinal study examines the role of caregiver speech in language development, especially syntactic development, using 47 parent–child pairs of diverse SES background from 14 to 46 months. We assess the diversity (variety) of words and syntactic structures produced by caregivers and children. We use lagged correlations to examine language growth and its relation to caregiver speech. Results show substantial individual differences among children, and indicate that diversity of earlier caregiver speech significantly predicts corresponding diversity in later child speech. For vocabulary, earlier child speech also predicts later caregiver speech, suggesting mutual influence. However, for syntax, earlier child speech does not significantly predict later caregiver speech, suggesting a causal flow from caregiver to child. Finally, demographic factors, notably SES, are related to language growth, and are, at least partially, mediated by differences in caregiver speech, showing the pervasive influence of caregiver speech on language growth.     

Language input and child syntax

Existing work on the acquisition of syntax has been concerned mainly with the early stages of syntactic development. In the present study we examine later syntactic development in children. Also, existing work has focused on commonalities in the emergence of syntax. Here we explore individual differences among children and their relation to variations in language input. In Study 1 we find substantial individual differences in children's mastery of multiclause sentences and a significant relation between those differences and the proportion of multiclause sentences in parent speech. We also find individual differences in the number of noun phrases in children's utterances and a significant relation between those differences and the number of noun phrases in parent speech. In Study 2 we find greater syntactic growth over a year of preschool in classes where teachers' speech is more syntactically complex. The implications of our findings for the understanding of the sources of syntactic development are discussed.