The Effects of Syntactic, Semantic, and Pragmatic Prominence on Pronoun Interpretation in Adults With Intellectual and Developmental Disabilities.

PURPOSE: Pronouns are referentially ambiguous: For example, "she" could refer to any female. Nonetheless, errors in pronoun interpretation rarely occur for adults with typical development (TD) due to several strategies implicitly shared between the talker and listener. The purpose of this study was to test the impacts of syntactic, semantic, and prosodic prominence on pronoun interpretation for adults with intellectual and developmental disabilities (IDD) and TD. METHOD: Adults with IDD (n = 28) and TD (n = 27) listened to ministories involving a pronoun with two potential antecedents that varied in syntactic, semantic, and pragmatic prominence. Subject/first-mentioned antecedents are more syntactically prominent than object antecedents. Semantic prominence was manipulated via verb transitivity: Subjects are more semantically prominent when the verb is highly transitive (e.g., "hit" vs. "see," a low-transitivity verb for which the subject is merely experiencing the action). Pragmatic prominence was manipulated by placing prosodic focus on one of the two potential antecedents. Eye gaze to images representing the potential antecedents was tracked as a measure of online processing. Responses to a follow-up pronoun interpretation question were also recorded. RESULTS: Adults with TD used syntactic, semantic, and-in early processing-pragmatic prominence when interpreting ambiguous pronouns. Adults with IDD were sensitive to syntactic prominence but to a significantly lesser extent than their peers with TD. CONCLUSIONS: Pronouns are an integral part of everyday conversation, and when the conversational partners do not share common strategies to link ambiguous pronouns with their antecedents, misunderstandings will occur. Results show that adults with IDD only weakly share pronoun interpretation strategies with adults with TD, suggesting that pronouns may be an important focus for intervention for this population. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23875809.

Home-literacy environments and language development in toddlers with Down syndrome.

Introduction: The present study aimed to (1) characterize the home-literacy environments (HLE) of toddlers with Down syndrome (DS) and (2) examine if richness of the HLE, child engagement during shared storybook reading activities, quality of a caregiver-child shared storybook reading activity, and exposure to language in the home environment predicted child receptive vocabulary concurrently (Time 1) and 6 months later (Time 2). Methods: Participants were toddlers with DS (n = 13 at Time 1, 11-29 months of age; n = 10 at Time 2) and their mothers. Mothers completed a Home Literacy Environment Questionnaire at Time 1, which was used to characterize the HLE and to calculate two composite variables: richness of the HLE and child engagement in shared storybook reading. Also at Time 1, the home language environment was measured using adult word count from the LENA Recorder DLP©. The LENA was also used to audio-record and capture the quality of a caregiver-child storybook reading task in the child's home using the book Dear Zoo. At both time points, mothers completed the MacArthur-Bates Communicative Development Inventories, and the number of words understood variable was used to measure receptive vocabulary. Results/Discussion: Results indicated that toddlers with DS experience rich HLEs and interactive shared storybook reading encounters with their mothers. A multiple linear regression revealed that child engagement and the home language environment correlated with both toddlers' concurrent and later receptive vocabularies, while the richness of the HLE and the shared storybook reading task emerged as moderate predictors of receptive vocabulary 6 months later.

Research Note: Testing the Simple View of Reading in Adolescents and Adults With Down Syndrome.

PURPOSE: The Simple View of Reading is a well-supported framework in typical development that proposes that reading comprehension is predicted by word identification and language comprehension abilities. Although there has been some research examining relations between reading comprehension, word identification, and language comprehension, there has been little research directly testing the Simple View in individuals with Down syndrome, a population that often has difficulties with reading comprehension. Therefore, the purpose of this study was to test the Simple View model in English-speaking readers with Down syndrome and examine the contributions of word identification and language comprehension abilities to their reading comprehension success. METHOD: Twenty-one adolescent and adult readers with Down syndrome (16-36 years of age) completed standardized reading, language, and IQ assessments. RESULTS: Multiple regression assessed the contribution of word identification/phonological decoding and language comprehension skills to reading comprehension outcomes. The full model explained 59% of the variance in reading comprehension. However, language comprehension emerged as the only significant unique predictor, explaining 29% of that variance. Together then, word identification and language comprehension explained approximately 30% of the variance in reading comprehension. CONCLUSIONS: The pattern of results suggests that language comprehension is particularly important to reading comprehension success for individuals with Down syndrome, at least those who can already identify printed words. To support reading comprehension development for individuals with Down syndrome, practitioners, educators, and parents should support language comprehension processes.

Perspectives on adaptive functioning and intellectual functioning measures for intellectual disabilities behavioral research.

Introduction: Intellectual disability (ID) is a significant limitation in both intellectual ability and adaptive functioning, but many studies of participants with ID only include a measure of overall intellectual functioning when describing their samples. The purpose of this perspective article was to provide a starting point for future research regarding the utility of including measures of both intellectual and adaptive functioning in research focused on ID. In this article, we discuss the differences and similarities between the constructs of intellectual and adaptive functioning, how they are measured, and the benefits of using both measures to describe participant abilities. Data are presented to demonstrate that intellectual and adaptive functioning measures capture separate but related skills in a sample of individuals with ID (i.e., children with Down syndrome [DS]; the leading genetic cause of ID). Methods: Thirty children with DS (7-31 months) were administered the Mullen Scales of Early Learning and their mothers were interviewed using the Vineland Adaptive Behavior Scales. Results: At the group level, Vineland and Mullen composite scores were relatively normally distributed and positively correlated. At the individual level, a concordance correlation coefficient indicated moderate agreement between Vineland and Mullen composite scores. Discussion: Although many children showed consistency between measures, others did not. Our discussion and findings, though preliminary, highlight that intellectual and adaptive functioning are separate but related skills and that there are benefits to including both measures when describing samples with ID. We discuss considerations for including adaptive functioning measures to enhance future research on individuals with ID.

Exploring Caregiver Perceptions of Post-High School Employment Experiences Among Young Adults With Down Syndrome.

This qualitative study explored employment experiences and perceived satisfaction of young adults with Down syndrome (DS) who recently exited high school, as reported by their caregivers (n = 101). We analyzed caregivers' open-ended responses about their young adults' type of employment (n = 52 were employed) and identified themes associated with reported satisfaction (for both employed and unemployed). Natural supports were key to caregiver satisfaction; few opportunities for paid, community-based employment and long waiting lists for formal services were related to caregiver dissatisfaction. Job fit (e.g., hours, responsibilities, location), socialization opportunities, and independence were related to caregiver and perceived young adult (dis)satisfaction. These findings highlight unmet service needs, including assistance with finding a job that is the right fit for the individual with DS.

Inclusion of Individuals With Neurodevelopmental Disorders in Norm-Referenced Language Assessments.

Standardized, norm-referenced language assessment tools are used for a variety of purposes, including in education, clinical practice, and research. Unfortunately, norm-referenced language assessment tools can demonstrate floor effects (i.e., a large percentage of individuals scoring at or near the lowest limit of the assessment tool) when used with some groups with neurodevelopmental disorders (NDDs), such as individuals with intellectual disability and neurogenetic syndromes. Without variability at the lower end of these assessment tools, professionals cannot accurately measure language strengths and difficulties within or across individuals. This lack of variability may be tied to poor representation of individuals with NDDs in normative samples. Therefore, the purpose of this study was to identify and examine common standardized, norm-referenced language assessment tools to report the representation of individuals with NDDs in normative samples and the range of standard/index scores provided. A systematic search identified 57 assessment tools that met inclusion criteria. Coding of the assessment manuals identified that most assessment tools included a "disability" or "exceptionality" group in their normative sample. However, the total number of individuals in these groups and the number of individuals with specific NDDs was small. Further, the characteristics of these groups (e.g., demographic information; disability type) were often poorly defined. The floor standard/index scores of most assessment tools were in the 40s or 50s. Only four assessment tools provided a standard score lower than 40. Findings of this study can assist clinicians, educators, and researchers in their selections of norm-referenced assessment tools when working with individuals with NDDs.

Speech-Language Pathologist Reading Survey: Scope of Practice, Training, Caseloads, and Confidence.

PURPOSE: The purpose of this study was to examine speech-language pathologists' (SLPs) opinions on their scope of practice related to reading, self-reported background training, current caseloads, and confidence in their abilities to define, assess, and provide effective treatment for reading-related difficulties. METHOD: SLPs (N = 271) from across the United States completed an online survey assessing their opinions on scope of practice, education and training in reading, and confidence in defining, assessing, and treating reading-related difficulties. RESULTS: A majority of respondents agreed that the identification, assessment, prevention, and intervention of reading disabilities are all within the scope of practice of SLPs. However, a majority also reported that literacy instruction is more heavily the responsibility of teachers than SLPs, and approximately half felt similarly regarding prevention, assessment, identification, and intervention of reading disabilities. Many respondents did not feel that their training in reading was adequate and felt that more graduate coursework should be dedicated to literacy. There was a lot of variability in responses when asked how often respondents focus on reading skills with clients, ranging from almost daily to never; however, results indicate that SLPs rarely administer reading assessments. Overall, respondents were more confident in their ability to define versus assess or provide therapy for various reading subskills. CONCLUSION: Despite SLPs agreeing that reading is within their scope of practice and feeling confident in some aspects of reading, graduate programs for speech-language pathology may need to provide greater training in literacy, especially related to reading assessment and diagnosis.

Post-High School Transition Outcomes for Young Adults With Down Syndrome.

There is limited available research on the post-high school outcomes of young adults with Down syndrome (DS). The purpose of this study, therefore, was to characterize employment, community-based living, and community engagement outcomes and their correlates among young adults with DS who recently transitioned out of high school. Caregivers (n = 100) of young adults with DS who exited high school within the past 5 years completed an online survey. Approximately half of the individuals with DS were working in some capacity; almost all were living with caregivers. Individuals with DS were engaging in a variety of community activities each week. Adaptive functioning was related to both employment and community engagement. Parent involvement in transition planning was also related to community engagement.

Reading Skills in Down Syndrome: Implications for Clinical Practice.

Though children with Down syndrome can learn to read, they may have difficulty developing some component skills, including phonological awareness and word decoding. Given reading's foundation in language, speech-language pathologists (SLPs) should play a central role in supporting access to and providing reading instruction for children with Down syndrome. This article reviews the available research on reading in Down syndrome and offers guidance for SLPs working with this population. We start by reviewing the Down syndrome phenotype, highlighting physical features and cognitive and linguistic patterns of strength and weakness that impact reading development. Next, we define different reading subskills and outline typical reading development, including stages of prereading, learning to read, and transitioning to using reading as a tool for learning. We then use these stages to review what is known about reading in Down syndrome, including relevant intervention work. We also incorporate considerations for clinical practice. In particular, we encourage SLPs to advocate for supporting reading development in children with Down syndrome, to work with families to develop rich home literacy environments, and to work with educators to promote phonological awareness and decoding skills. Lastly, we note limitations in our current knowledge and include a call for more research.

A meta-analysis of prosody in autism, Williams syndrome, and Down syndrome.

Prosody, the rhythm and melody of speech, is an important component of effective communication, and it is an area of difficulty for many populations who struggle with communication. This paper is a meta-analysis of nine studies (and two sets of unpublished data) that assessed prosody using the Profiling Elements of Prosody in Speech-Communication (PEPS-C; Peppé & McCann, 2003) in autism spectrum disorder, Williams syndrome, and Down syndrome. Our original goal was to include studies involving any neurodevelopmental disorder that is commonly associated with intellectual disability, yet our systematic search, which included three databases (i.e., PsychInfo, ERIC, and PubMed), only identified studies involving these three groups. To be included in the meta-analysis, studies had to include a group (n ≥ 3 participants) with a neurodevelopmental disorder commonly associated with intellectual disability and a typically developing comparison group matched on chronological age, nonverbal abilities, or verbal abilities. Studies also needed to report original data using the PEPS-C and be available in English. Study quality was assessed using a checklist adapted from Downes et al. (2016). Results revealed that prosodic form was a weakness for each etiology, while unique patterns of strengths and weaknesses were evident for prosodic functions. Groups with autism (n = 5), all classified as high-functioning or with Asperger's syndrome, exhibited weakness in emotional affect but some relative strengths with turn-end and focus tasks. Groups with Williams syndrome (n = 4) demonstrated weaknesses on phrase/sentence-level tasks and relative strengths on word-level tasks. Groups with Down syndrome (n = 2) had the greatest difficulty overall, though performance was better on receptive (vs. expressive) function tasks. By combining studies and related subtasks of the PEPS-C, we are able to more confidently generalize findings for each population and identify targets for intervention. However, given the limited number of studies identified, this paper also highlights the need for more research on prosody in intellectual disability.

Verb production by individuals with Down syndrome during narration.

BACKGROUND: Despite research identifying verb knowledge as a strong predictor of later syntactic skills in typical development, virtually no research has examined verb development in Down syndrome. AIMS: The purpose of this study was to examine verb production (density, diversity, and type-token ratios) by individuals with Down syndrome in the context of story generation relative to two comparison groups - nonverbal cognitive ability level matches with typical development and chronological age matches with mixed-etiology intellectual disability. METHODS AND PROCEDURES: Thirty-five participants with Down syndrome (11-21 years), 27 participants with intellectual disability (13-20 years), and 29 participants with typical development (4-6 years) completed a narrative story generation task. Transcripts were coded and analyzed for verb production. OUTCOMES AND RESULTS: Examining overall verb production, participants with Down syndrome produced narratives with less verb density than participants with typical development and had smaller verb type-token ratios than participants with intellectual disability. Upon examining lexical verb production, participants with Down syndrome produced narratives with less lexical verb density than participants with typical development. CONCLUSIONS AND IMPLICATIONS: The results indicate that individuals with Down syndrome have a developmentally appropriate diversity of verbs in their lexicon but are not using verbs as frequently as comparison groups.

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.

Narrative Language Sampling in Typical Development: Implications for Clinical Trials.

Purpose: This study examined cross-sectional age-related trajectories of expressive language variables (syntactic complexity, lexical diversity, unintelligibility, dysfluency, and talkativeness) derived from a narrative language sampling procedure. Method: Narrative samples were analyzed from 103 typically developing individuals, ages 4-21 years. Results: Results showed that this procedure was effective for the entire age range, with participants producing an utterance on virtually every page of the wordless picture books used to prompt the narrative. Importantly, the cross-sectional trajectories for syntactic complexity and lexical diversity showed age-related increases through the age of 18 years, although measures of other dimensions of language showed different relationships with age. Conclusions: These data inform developmental work and document the extent to which the narrative procedure can be used to characterize expressive language over a wide age range. This procedure has been proposed as an outcome measure for clinical trials and interventions involving individuals with intellectual and developmental disabilities. The present data document the developmental levels for which the procedure and metrics derived are appropriate.

Receptive vocabulary analysis in Down syndrome.

The present study is an in-depth examination of receptive vocabulary in individuals with Down syndrome (DS) in comparison to control groups of individuals of similar nonverbal ability with typical development (TD) and non-specific etiology intellectual disability (ID). Verb knowledge was of particular interest, as it is known to be a predictor of later syntactic development. Fifty participants with DS, aged 10-21 years, 29 participants with ID, 10-21 years, and 29 participants with TD, 4-9 years, completed measures of receptive vocabulary (PPVT-4), nonverbal ability (Leiter-R), and phonological memory (Nonword Repetition subtest of the CTOPP). Groups were compared on percentage correct of noun, verb and attribute items on the PPVT-4. Results revealed that on verb items, the participants with ID performed significantly better than both participants with DS and TD, even when overall receptive vocabulary ability and phonological memory were held constant. Groups with DS and TD showed the same pattern of lexical knowledge, performing better on nouns than both verbs and attributes. In contrast, the group with ID performed similarly on nouns and verbs, but worse on attributes.

Reading Skills in Down Syndrome: An Examination of Orthographic Knowledge.

The primary goal of this study was to examine the word identification domain of the Simple View of Reading in participants with Down syndrome (DS) by comparing them to participants with typical development (TD) matched on word identification ability. Two subskills, phonological recoding and orthographic knowledge, were measured. Results revealed that individuals with DS performed similarly to controls on 2 measures of orthographic knowledge, but more poorly on phonological recoding and a third measure of orthographic knowledge. The first two orthographic tasks included real words as stimuli; the third task used letter patterns, not real words. These results suggest that individuals with DS may have a relative strength in word-specific orthographic knowledge but not in general orthographic knowledge.

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.

Matching variables for research involving youth with Down syndrome: Leiter-R versus PPVT-4.

Much of what is known about the cognitive profile of Down syndrome (DS) is based on using either receptive vocabulary (e.g., PPTV-4) or nonverbal ability (e.g., Leiter-R) as a baseline to represent cognitive developmental level. In the present study, we examined the relation between these two measures in youth with DS, with non-DS intellectual disability (ID), and with typical development (TD). We also examined the degree to which these two measures produce similar results when used as a group matching variable. In a cross-sectional developmental trajectory analysis, we found that the relation between PPVT-4 and Leiter-R was largely similar across groups. However, when contrasting PPVT-4 and Leiter-R as alternate matching variables, the pattern of results was not always the same. When matched on Leiter-R or PPVT-4, the group with DS performed below that of the groups with ID and TD on receptive grammar and below the group with TD on category learning. When matched on the PPVT-4, the group with ID performed below that of the group with TD on receptive grammar and category learning, but these differences between the groups with ID and TD were not found when matched on the Leiter-R. The results of the study suggest that the PPVT-4 and Leiter-R are interchangeable at least for some outcome measures for comparing youth with DS and TD, but they may produce different results when comparing youth with ID and TD.

Phonological recoding, rapid automatized naming, and orthographic knowledge.

Phonological recoding, orthographic knowledge, and rapid automatized naming (RAN) are three major contributors to word identification. However, the interrelations between these components remain somewhat unclear. The current analyses focus on how phonological recoding and alphanumeric versus non-alphanumeric RAN contribute to different components of orthographic knowledge (word specific vs. general). Results indicate that alphanumeric and non-alphanumeric RAN contribute to orthographic knowledge components differently. Alphanumeric RAN relates more to word-specific orthographic knowledge, whereas non-alphanumeric RAN relates more to general orthographic knowledge. Furthermore, phonological recoding is more closely related to word-specific orthographic knowledge than to general orthographic knowledge.

Individuals with intellectual disability can self-teach in reading.

Previous research has suggested that individuals with intellectual disability (ID) underperform in several areas of reading compared to mental age-matched peers. However, it is unclear how they compare on orthographic aspects of reading, which have to do with learning and matching the specific letter patterns in words. The leading approach to understanding orthographic learning is the self-teaching hypothesis, which suggests that orthographic learning is acquired through the experience of phonologically recoding words. The present study was a first test of the self-teaching hypothesis for individuals with ID in comparison to a group of typically developing children matched on verbal mental age. Results indicated that both groups were able to self-teach.

Strengths and weaknesses in reading skills of youth with intellectual disabilities.

Reading-related skills of youth with intellectual disability (ID) were compared with those of typically developing (TD) children of similar verbal ability level. The group with ID scored lower than the TD group on word recognition and phonological decoding, but similarly on orthographic processing and rapid automatized naming (RAN). Further, phonological decoding significantly mediated the relation between group membership and word recognition, whereas neither orthographic processing nor RAN did so. The group with ID also underperformed the TD group on phonological awareness and phonological memory, both of which significantly mediated the relation between group membership and phonological decoding. These data suggest that poor word recognition in youth with ID may be due largely to poor phonological decoding, which in turn may be due largely to poor phonological awareness and poor phonological memory. More focus on phonological skills in the classroom may help students with ID to develop better word recognition skills.