Protocol for a randomised controlled feasibility trial of parent-delivered early language intervention for children with Down syndrome (PACT-DS).

BACKGROUND: Down syndrome is the most common genetic cause of intellectual disability, affecting 700-800 babies annually in the UK (Wu J, Morris J, Eur J Hum Genet 21:1016-9, 2013). Children with Down syndrome have difficulties developing language skills. These difficulties can have long-term negative consequences for all aspects of their lives including social development, education and employment opportunities, and emotional wellbeing and mental health (Irwin LG et. al 2007). These aspects all have the potential to be improved through targeted early language intervention. Parents and Children Together (PACT) is a parent-delivered early language teaching programme for typically developing pre-school children at risk of language delays. A previous project (Burgoyne K, J Child Psychol Psychiatry 59(5):545-55, 2018) showed that PACT leads to improvements in children's language and early literacy skills. Our team has worked closely with six families to adapt PACT for children with Down syndrome. The aim of the current study is to conduct a feasibility randomised controlled trial (RCT) to evaluate the feasibility of a definitive RCT and explore initial evidence of the adapted programme's potential to support children's language and literacy development. METHOD: This is a two-arm feasibility randomised controlled trial in which children will be randomly allocated to either a PACT-DS group or to a waiting control group (who will receive intervention at the end of the project). We aim to recruit 28-30 children with Down syndrome (aged 3-6 years) and their parents/caregivers to take part. The PACT-DS group will be trained to deliver PACT-DS every day (20 min a day; 5 days a week) to their child over 30 weeks. We will collect data using assessments of child language and early literacy, measures of parent wellbeing, qualitative surveys and interviews, and monitoring data to explore trial feasibility (including recruitment and retention of families and adherence and acceptability of intervention) and cost and benefits. Data will be collected before intervention, immediately after the 30-week intervention programme, and 6 months after intervention ends. Clear progression criteria will be used to assess suitability for a definitive trial. DISCUSSION: This study represents initial steps in developing a definitive trial of the PACT-DS programme and will add to the limited evidence base on early language intervention for children with Down syndrome. This programme of research has the potential to make significant advancements in early language intervention research and practice for this group. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry: study ID ISRCTN63251282 . Registered on 14 July 2023.

Views of educators working with pupils with Down syndrome on their roles and responsibilities and factors related to successful inclusion.

BACKGROUND: Whilst the majority of primary-school aged children with Down syndrome are educated in mainstream schools, little is known about the roles of Teachers and TAs in their education provision or their views on issues related to their effective inclusion. AIMS: This study explored the perceptions of Teachers and TAs working with pupils with Down syndrome in mainstream primary schools in the UK using an online survey. METHODS AND PROCEDURES: Responses from 105 TAs and 94 Teachers were collected. OUTCOMES AND RESULTS: Teachers and TAs tended to view themselves as primarily responsible for a range of teaching and learning activities. TAs were more likely to have attended Down syndrome specific training and were frequently viewed as primarily responsible for delivering teaching, alongside other teaching and learning activities. TAs were less likely than Teachers to agree with statements relating to satisfaction with support from internal teaching staff and external agencies, and more likely to disagree with statements relating to sufficient time for planning and preparation. Both Teachers and TAs indicated positive attitudes to inclusion, though TAs felt more confident and competent in meeting the needs of pupils with Down syndrome. CONCLUSIONS AND IMPLICATIONS: Data suggest a lack of clarity and consistency in relation to the roles and responsibilities of Teachers and TAs supporting pupils with Down syndrome, and concerns relating to several factors associated with successful inclusion. These findings are discussed in relation to the Down Syndrome Act (2022) and guidance for educators working with pupils with Down syndrome. WHAT THIS PAPER ADDS: This paper reports the views of teachers and TAs working with pupils with Down syndrome in primary schools across the UK, including their satisfaction with factors which support successful inclusion, gathered through an online survey. The data demonstrates differences in teacher and TA views on who is primarily responsible for teaching and learning activities for pupils with Down syndrome. Factors associated with successful inclusion cover training and support, planning and preparation as well as attitudes, confidence and competence of educators. In general, educators reported the need for Down syndrome specific training and sufficient time to plan and prepare. Overall TAs reported higher levels of confidence, competence and ability to meet pupil's needs. Ultimately this paper highlights the views of those responsible for educating pupils with Down syndrome and the need for clear guidance around roles and responsibilities and training to ensure successful inclusion of pupils with Down syndrome in the UK.

Shared book reading as a context for language intervention for children with Down syndrome: a mini-review.

Acquiring language and communication skills is one of the biggest challenges for children with Down syndrome (DS). However, few evidence-based interventions exist to enhance the development of language and communication in this population. Shared book reading (SBR) is well-established as an effective intervention for language and communication development of typically developing children, and evidence of the possible effectiveness of this approach for those at risk of language difficulties is emerging. This paper provides a mini-review of the existing evidence for SBR in relation to language and communication outcomes for young children with DS. A systematic literature search was conducted with the following inclusion criteria: children with DS aged 0-6;11 years, SBR, language or communication outcomes. The results show that interventions which incorporate SBR strategies are associated with improved language and communication outcomes for young children with DS, improved parental sensitivity, and continuing implementation of SBR strategies following intervention instruction. However, evidence is limited in scope, of low quality, including mostly single case studies, with only one study having a control group. We conclude that although SBR may hold promise as a possible intervention, further research is essential to establish what specific components of SBR intervention are most effective for young children with DS and what further adaptations are needed to accommodate the cognitive profile and variability within this population.

Educational experiences of pupils with Down syndrome in the UK.

BACKGROUND: Though research has identified that increasing numbers of pupils with Down syndrome (DS) in the UK are educated in mainstream schools, little detailed information about the educational experiences of pupils with DS is available. AIMS: This study explored parent views of the educational experiences of pupils with DS attending UK schools (Reception-Year 11) using an online survey. METHODS AND PROCEDURES: Responses from 569 parents were collected. OUTCOMES AND RESULTS: Overall, 65 % of pupils were in mainstream schools but this was more common at primary (80 %) than secondary school (37 %). Pupils participated in most academic and social activities alongside their peers but were commonly not accessing all opportunities. Many pupils received additional support in school including external professional services. Frequent meetings between parents and teachers/teaching assistants indicated high levels of collaboration. Teachers and teaching assistants were largely viewed as responsible for children's learning. Overall, respondents reported satisfaction with provision. CONCLUSIONS AND IMPLICATIONS: Many pupils with DS in the UK are able to access a broad and balanced curriculum but this is not the case for all. Ways in which provision can be enhanced are discussed.

Data on numerosity discrimination, inhibition and arithmetic during the early school years.

Participants consisted of 496 children (mean age = 6 years; 9 months) recruited from 11 schools in Brisbane, Australia. Children were assessed on the addition and subtraction subtests of the Test of Basic Arithmetic and Number Skills (TOBANS), an adapted version of the Head-Toes-Knees-Shoulders task to measure inhibition, numerosity discrimination using eight subtests varying ratio (2:3 or 5:6) and congruency, and non-verbal cognitive ability using an adapted version of Raven's Coloured Progressive Matrices. Information on children's demographics (gender, English as an additional language, and learning difficulty status) is also provided. All assessments were administered during the second year of formal schooling (i.e. Grade 1). Findings regarding the impact of inhibition on the relation between numerosity discrimination and arithmetic are reported elsewhere [1].

Stage 2 Registered Report: There is no appreciable relationship between strength of hand preference and language ability in 6- to 7-year-old children.

Background: Weak or inconsistent hand preference has been postulated to be a risk factor for developmental language delay. Following on from our Registered Stage 1 report this study assessed the extent to which variations in language skills are associated with the strength of hand preference. Methods: Data are drawn from a large sample ( N = 569) of 6- to 7-year-old children unselected for ability, assessed at two time points, 6 months apart. Hand preference was assessed using the Quantitative Hand Preference (QHP) task and five uni-manual motor tasks. Language skills (expressive and receptive vocabulary, receptive grammar, and morphological awareness) were assessed with standardized measures. Results: We found QHP scores did not distinguish children with weaker language skills from those with stronger language skills and the correlation between QHP scores and language ability was negligible in this study. Hand preference on the QHP task was significantly stronger among right-handed than left-handed children and left-handed children were typically inconsistent in the hand used across different tasks.  Conclusions: The findings presented here fail to provide any support for the theory that weak cerebral lateralisation (as assessed here by the QHP task) places children at risk of language difficulties . Stage 1 report:  https://doi.org/10.12688/wellcomeopenres.15077.1.

The relationship between numerosity discrimination and arithmetic skill reflects the approximate number system and cannot be explained by inhibitory control.

Numerosity discrimination tasks (judging which of two random dotarrays contains the larger number) have been widely used as a measure of the efficiency of an approximate number system (ANS) and are a correlate of early arithmetic skills. Recently, it has been suggested that the relationship between numerosity discrimination and arithmeticis explained by inhibition rather than the ANS. We assessed this hypothesis in astudy of 496 children (mean age = 81.23 months) using numerosity discrimination tasks that manipulated the congruency between surface area and numerosity. Numerosity discrimination for incongruent arrays (which are postulated to require inhibition due to a conflict between judgments based on surface area rather than numerosity) was more difficult than that for congruent arrays. However, all numerosity discrimination tasks showed substantial correlations with each other and correlated with arithmetic. A latent variable path model showed that a general numerosity judgment factorcorrelated witharithmetic even after controlling for a measure of response inhibition. In contrast, numerosity discrimination for incongruent arrays showed no unique relationship with arithmetic ability. Our results do not support the view that the relationship between numerosity discrimination and arithmetic is largely attributable to inhibition; rather, theyare consistent withthe view that numerosity discrimination tasks tap the operation of an ANS.

Stage 1 Registered Report: The relationship between handedness and language ability in children.

Weak or inconsistent hand preference may be a risk factor for developmental language delay.  This study will test the extent to which variations in language skills are associated with the strength of hand preference. Data are drawn from a large sample (n = 569) of 6- to 7-year-old children unselected for ability, assessed at two time points, 6 months apart. Hand preference is assessed using the Quantitative Hand Preference task (QHP) and five uni-manual motor tasks. Language skills (expressive and receptive vocabulary, receptive grammar, and morphological awareness) are assessed with standardized measures. If weak cerebral lateralisation (as assessed by the QHP task) is a risk factor for language difficulties, it should be possible to detect such effects in the large representative sample of children examined here.

Learning correspondences between magnitudes, symbols and words: Evidence for a triple code model of arithmetic development.

According to the Triple Code Model, early arithmetic development depends on learning the mappings between non-verbal representations of magnitude (quantity) and symbolic verbal (number words) and visual (Arabic numerals) representations of number. We examined this hypothesis in a sample of 166 4- to 7-year old children. Children completed 4 paired-associate learning tasks and a broad range of measures assessing early numerical (symbolic and non-symbolic magnitude comparison, digit writing, arithmetic) and reading skills (letter-sound knowledge, phoneme awareness, rapid automatized naming, word reading). A path model showed that paired-associate learning tasks involving mapping magnitudes onto verbal or visual stimuli predicted arithmetic performance over and above other well-established predictors. This relationship was specific to arithmetic and, consistent with the Triple Code Model, highlights that mapping between non-symbolic magnitude representations and the corresponding symbolic forms (verbal and visual) is important to the development of arithmetic skills.

Learning to read in Chinese: Evidence for reciprocal relationships between word reading and oral language skills.

This study investigates the longitudinal predictors of the development of Chinese word reading skills and potential bidirectional relationships between Chinese word reading and oral language skills. We examine, in a 2-year longitudinal study, a wide range of theoretically important predictors (phonological awareness, tone awareness, morphological awareness, visual skills, rapid automatized naming, Pinyin knowledge, and vocabulary knowledge) of reading in 143 primary-school children living in mainland China. Initial levels of reading were predicted by vocabulary knowledge, phonological awareness, and visual discrimination skills. Only initial reading levels predicted growth in reading. Initial reading also predicted growth in vocabulary knowledge and morphological construction. This pattern demonstrates that the early stages of learning to read in Chinese places demands on semantic (vocabulary) and visual skills in addition to phonological skills. Furthermore, early levels of word reading predict the growth of vocabulary knowledge and morphological awareness suggesting that the development of these oral language skills is facilitated by learning to read.

Evaluation of a parent-delivered early language enrichment programme: evidence from a randomised controlled trial.

BACKGROUND: It is widely believed that increasing parental involvement can improve children's educational outcomes although we lack good evidence for such claims. This study evaluated the effectiveness of a parent-delivered early language enrichment programme. METHODS: We conducted a randomised controlled trial (RCT) with 208 preschool children and their parents living in socially diverse areas in the United Kingdom. Families were allocated to an oral language programme (N = 103) or an active control programme targeting motor skills (N = 105). Parents delivered the programmes to their child at home in daily 20-min sessions over 30 weeks of teaching. RESULTS: Children receiving the language programme made significantly larger gains in language (d = .21) and narrative skills (d = .36) than children receiving the motor skills programme at immediate posttest. Effects on language were maintained 6 months later (d = .34), and at this point, the language group also scored higher on tests of early literacy (d values=.35 and .42). There was no evidence that the movement programme improved motor skills. CONCLUSIONS: This study provides evidence for the effectiveness of a parent-delivered language enrichment programme. Further large-scale evaluations of the programme are needed to confirm and extend these findings.

The efficacy of early language intervention in mainstream school settings: a randomized controlled trial.

BACKGROUND: Oral language skills are a critical foundation for literacy and more generally for educational success. The current study shows that oral language skills can be improved by providing suitable additional help to children with language difficulties in the early stages of formal education. METHODS: We conducted a randomized controlled trial with 394 children in England, comparing a 30-week oral language intervention programme starting in nursery (N = 132) with a 20-week version of the same programme starting in Reception (N = 133). The intervention groups were compared to an untreated waiting control group (N = 129). The programmes were delivered by trained teaching assistants (TAs) working in the children's schools/nurseries. All testers were blind to group allocation. RESULTS: Both the 20- and 30-week programmes produced improvements on primary outcome measures of oral language skill compared to the untreated control group. Effect sizes were small to moderate (20-week programme: d = .21; 30-week programme: d = .30) immediately following the intervention and were maintained at follow-up 6 months later. The difference in improvement between the 20-week and 30-week programmes was not statistically significant. Neither programme produced statistically significant improvements in children's early word reading or reading comprehension skills (secondary outcome measures). CONCLUSIONS: This study provides further evidence that oral language interventions can be delivered successfully by trained TAs to children with oral language difficulties in nursery and Reception classes. The methods evaluated have potentially important policy implications for early education.

Bilingualism and Biliteracy in Down Syndrome: Insights From a Case Study.

We present the case study of MB-a bilingual child with Down syndrome (DS) who speaks Russian (first language [L1]) and English (second language [L2]) and has learned to read in two different alphabets with different symbol systems. We demonstrate that, in terms of oral language, MB is as proficient in Russian as English, with a mild advantage for reading in English, her language of formal instruction. MB's L1 abilities were compared with those of 11 Russian-speaking typically developing monolinguals and her L2 abilities to those of 15 English-speaking typically developing monolinguals and six monolingual English-speaking children with DS; each group achieving the same level of word reading ability as MB. We conclude that learning two languages in the presence of a learning difficulty need have no detrimental effect on either a child's language or literacy development.

The cognitive foundations of early arithmetic skills: It is counting and number judgment, but not finger gnosis, that count.

Following on from ideas developed by Gerstmann, a body of work has suggested that impairments in finger gnosis may be causally related to children's difficulties in learning arithmetic. We report a study with a large sample of typically developing children (N=197) in which we assessed finger gnosis and arithmetic along with a range of other relevant cognitive predictors of arithmetic skills (vocabulary, counting, and symbolic and nonsymbolic magnitude judgments). Contrary to some earlier claims, we found no meaningful association between finger gnosis and arithmetic skills. Counting and symbolic magnitude comparison were, however, powerful predictors of arithmetic skills, replicating a number of earlier findings. Our findings seriously question theories that posit either a simple association or a causal connection between finger gnosis and the development of arithmetic skills.

Efficacy of a reading and language intervention for children with Down syndrome: a randomized controlled trial.

BACKGROUND: This study evaluates the effects of a language and literacy intervention for children with Down syndrome. METHODS: Teaching assistants (TAs) were trained to deliver a reading and language intervention to children in individual daily 40-min sessions. We used a waiting list control design, in which half the sample received the intervention immediately, whereas the remaining children received the treatment after a 20-week delay. Fifty-seven children with Down syndrome in mainstream primary schools in two U.K. locations (Yorkshire and Hampshire) were randomly allocated to intervention (40 weeks of intervention) and waiting control (20 weeks of intervention) groups. Assessments were conducted at three time points: pre-intervention, after 20 weeks of intervention, and after 40 weeks of intervention. RESULTS: After 20 weeks of intervention, the intervention group showed significantly greater progress than the waiting control group on measures of single word reading, letter-sound knowledge, phoneme blending and taught expressive vocabulary. Effects did not transfer to other skills (nonword reading, spelling, standardised expressive and receptive vocabulary, expressive information and grammar). After 40 weeks of intervention, the intervention group remained numerically ahead of the control group on most key outcome measures; but these differences were not significant. Children who were younger, attended more intervention sessions, and had better initial receptive language skills made greater progress during the course of the intervention. CONCLUSIONS: A TA-delivered intervention produced improvements in the reading and language skills of children with Down syndrome. Gains were largest in skills directly taught with little evidence of generalization to skills not directly taught in the intervention.