Aided communication, mind understanding and co-construction of meaning.

Mind understanding allows for the adaptation of expressive language to a listener and is a core element when communicating new information to a communication partner. There is limited knowledge about the relationship between aided language and mind understanding. This study investigates this relationship using a communication task. The participants were 71 aided communicators using graphic symbols or spelling for expression (38/33 girls/boys) and a reference group of 40 speaking children (21/19 girls/boys), aged 5;0-15;11 years. The task was to describe, but not name, drawings to a communication partner. The partner could not see the drawing and had to infer what was depicted from the child's explanation. Dyads with aided communicators solved fewer items than reference dyads (64% vs 93%). The aided spellers presented more precise details than the symbol users (46% vs 38%). In the aided group, number of correct items correlated with verbal comprehension and age.

Diagnosis and management in Pitt-Hopkins syndrome: First international consensus statement.

Pitt-Hopkins syndrome (PTHS) is a neurodevelopmental disorder characterized by intellectual disability, specific facial features, and marked autonomic nervous system dysfunction, especially with disturbances of regulating respiration and intestinal mobility. It is caused by variants in the transcription factor TCF4. Heterogeneity in the clinical and molecular diagnostic criteria and care practices has prompted a group of international experts to establish guidelines for diagnostics and care. For issues, for which there was limited information available in international literature, we collaborated with national support groups and the participants of a syndrome specific international conference to obtain further information. Here, we discuss the resultant consensus, including the clinical definition of PTHS and a molecular diagnostic pathway. Recommendations for managing particular health problems such as dysregulated respiration are provided. We emphasize the need for integration of care for physical and behavioral issues. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimization of diagnostics and care.

Predictors of receptive and expressive vocabulary development in children with Down syndrome.

PURPOSE: There is a lack of longitudinal data on predictors of vocabulary development in children with Down syndrome (DS). In typically developing children, many internal and external predictors of vocabulary development have been determined before. The purpose of the present study was to investigate the role of these variables in the receptive and expressive vocabulary development of children with DS. METHOD: The present study used a longitudinal design in young children with DS to study the vocabulary development over a period of 1.6 years and investigated the possible predictive role of child-related and environmental variables. RESULT: Receptive vocabulary development was best predicted by the adaptive level of functioning and early receptive vocabulary skills. Expressive vocabulary development was best predicted by the adaptive level of functioning, receptive vocabulary, maternal educational level, level of communicative intent of the child, attention skills and phonological/phonemic awareness. CONCLUSION: A wide range of internal and external predictors for vocabulary development of children with DS was found. Predictors resemble those predicting vocabulary development in peers with typical development between 1 and 6 years of age, as identified in other studies.

Constructing narratives to describe video events using aided communication.

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication.

Visual-spatial cognition in children using aided communication.

Children with severe motor impairments are restricted in their manipulation and exploration of objects, but little is known about how such limitations influence cognitive development. This study investigated visual-constructional abilities in 75 children and adolescents, aged 5;0-15;11 (years;months), with severe speech impairments and no intellectual disabilities (aided group) and in 56 children and adolescents with typical development (reference group). Verbal comprehension, non-verbal reasoning, and visual-spatial perception were assessed with standardized tests. The task of the participants was to verbally instruct communication partners to make physical constructions identical to models that the partner could not see. In the aided group, 55.7% of the constructions were identical to the models participants described, compared to 91.3% in the reference group. In the aided group, test results explained 51.4% of the variance in construction errors. The results indicate that the participants' language skills were decisive for construction success. Visual-perceptual challenges were common among the aided communicators, and their instructions included little information about size and spatial relations. This may reflect less experience with object manipulation and construction than children with typical development, and using aided communication to instruct others to make three-dimensional constructions. The results imply a need for interventions that compensate for the lack of relevant experience.

Modeling individual variation in early literacy skills in kindergarten children with intellectual disabilities.

In the present study, we investigated (i) to what extent the early literacy skills (phonological awareness, letter knowledge, and word decoding) along with cognitive (nonverbal reasoning, attention, phonological short-term memory, sequential memory, executive functioning) and linguistic (auditory discrimination, rapid naming, articulation, vocabulary) precursor measures of 53 six-year old children with intellectual disabilities (ID) differ from a group of 74 peers with normal language acquisition (NLA) and (ii) whether the individual variation of early literacy skills in the two groups to the same extent can be explained from the precursor measures. Results showed that children with ID scored below the NLA group on all literacy and precursor measures. Structural equation modeling evidenced that in the children with NLA early literacy was directly predicted by phonological awareness, PSTM and vocabulary, with nonverbal reasoning and auditory discrimination also predicting phonological awareness. In children with ID however, the variation in word decoding was predicted by letter knowledge and nonverbal reasoning, whereas letter knowledge was predicted by rapid naming, which on its turn was predicted by attentional skills. It can be concluded phonological awareness plays a differential role in the early literacy skills of children with and without ID. As a consequence, the arrears in phonological awareness in children with ID might put them on hold in gaining proper access to literacy acquisition. WHAT THIS PAPER ADDS: This paper adds to the theoretical knowledge base on literacy acquisition in a special population, namely children with intellectual disabilities (ID). It addresses factors that influence early literacy learning, which have not been investigated thoroughly in this special and specific group. Furthermore, the children are not tested solely on literacy, but also on cognitive measures that may influence literacy acquisition. Whereas most research in ID focuses on groups with specific syndromes/etiologies, this paper takes a varied group of children with ID into account. The paper also adds to educational insights, since the findings imply that children with ID are able to use phonological pathways in learning to read. Educators could teach these children phonics-based literacy skills tailored to their individual learning needs.

Core vocabulary of young children with Down syndrome.

The aim of this study was to develop a core vocabulary list for young children with intellectual disabilities between 2 and 7 years of age because data from this population are lacking in core vocabulary literature. Children with Down syndrome are considered one of the most valid reference groups for researching developmental patterns in children with intellectual disabilities; therefore, spontaneous language samples of 30 Dutch children with Down syndrome were collected during three different activities with multiple communication partners (free play with parents, lunch- or snack-time at home or at school, and speech therapy sessions). Of these children, 19 used multimodal communication, primarily manual signs and speech. Functional word use in both modalities was transcribed. The 50 most frequently used core words accounted for 67.2% of total word use; 16 words comprised core vocabulary, based on commonality. These data are consistent with similar studies related to the core vocabularies of preschoolers and toddlers with typical development, although the number of nouns present on the core vocabulary list was higher for the children in the present study. This finding can be explained by manual sign use of the children with Down syndrome and is reflective of their expressive vocabulary ages.

Foundations of reading comprehension in children with intellectual disabilities.

BACKGROUND: Knowledge about predictors for reading comprehension in children with intellectual disabilities (ID) is still fragmented. AIMS: This study compared reading comprehension, word decoding, listening comprehension, and reading related linguistic and cognitive precursor measures in children with mild ID and typically developing controls. Moreover, it was explored how the precursors related to reading achievement. METHOD AND PROCEDURES: Children with mild ID and typical controls were assessed on reading comprehension, decoding, language comprehension, and linguistic (early literacy skills, vocabulary, grammar) and cognitive (rapid naming, phonological short-term memory, working memory, temporal processing, nonverbal reasoning) precursor measures. It was tested to what extent variations in reading comprehension could be explained from word decoding, listening comprehension and precursor measures. OUTCOMES AND RESULTS: The ID group scored significantly below typical controls on all measures. Word decoding was at or above first grade level in half the ID group. Reading comprehension in the ID group was related to word decoding, listening comprehension, early literacy skills, and temporal processing. CONCLUSION AND IMPLICATIONS: The reading comprehension profile of children with mild ID strongly resembles typical early readers. The simple view of reading pertains to children with mild ID, with additional influence of early literacy skills and temporal processing.

Investigating executive functions in children with severe speech and movement disorders using structured tasks.

Executive functions are the basis for goal-directed activity and include planning, monitoring, and inhibition, and language seems to play a role in the development of these functions. There is a tradition of studying executive function in both typical and atypical populations, and the present study investigates executive functions in children with severe speech and motor impairments who are communicating using communication aids with graphic symbols, letters, and/or words. There are few neuropsychological studies of children in this group and little is known about their cognitive functioning, including executive functions. It was hypothesized that aided communication would tax executive functions more than speech. Twenty-nine children using communication aids and 27 naturally speaking children participated. Structured tasks resembling everyday activities, where the action goals had to be reached through communication with a partner, were used to get information about executive functions. The children (a) directed the partner to perform actions like building a Lego tower from a model the partner could not see and (b) gave information about an object without naming it to a person who had to guess what object it was. The executive functions of planning, monitoring, and impulse control were coded from the children's on-task behavior. Both groups solved most of the tasks correctly, indicating that aided communicators are able to use language to direct another person to do a complex set of actions. Planning and lack of impulsivity was positively related to task success in both groups. The aided group completed significantly fewer tasks, spent longer time and showed more variation in performance than the comparison group. The aided communicators scored lower on planning and showed more impulsivity than the comparison group, while both groups showed an equal degree of monitoring of the work progress. The results are consistent with the hypothesis that aided language tax executive functions more than speech. The results may also indicate that aided communicators have less experience with these kinds of play activities. The findings broaden the perspective on executive functions and have implications for interventions for motor-impaired children developing aided communication.

Cognitive and linguistic predictors of reading comprehension in children with intellectual disabilities.

A considerable number of children with intellectual disabilities (ID) are able to acquire basic word reading skills. However, not much is known about their achievements in more advanced reading comprehension skills. In the present study, a group of 49 children with ID and a control group of 21 typically developing children with word decoding skills in the normal ranges of first grade were compared in lower level (explicit meaning) and higher level (implicit meaning) reading comprehension abilities. Moreover, in the group of children with ID it was examined to what extent their levels of lower level and higher level reading comprehension could be predicted from their linguistic skills (word decoding, vocabulary, language comprehension) and cognitive skill (nonverbal reasoning). It was found that children with ID were weaker than typically developing children in higher level reading comprehension but not in lower level reading comprehension. Children with ID also performed below the control group on nonverbal reasoning and language comprehension. After controlling for nonverbal reasoning, linguistic skills predicted lower level reading comprehension but not higher level reading comprehension. It can be concluded that children with ID who have basic decoding skill do reasonably well on lower level reading comprehension but continue to have problems with higher level reading comprehension.

Predictors of early literacy skills in children with intellectual disabilities: a clinical perspective.

The present study investigated the linguistic and cognitive predictors of early literacy in 17 children with intellectual disabilities (ID) (mean age: 7; 6 years) compared to 24 children with normal language acquisition (NLA) (mean age: 6; 0 years), who were all in the so-called partial alphabetic phase of reading (Ehri, 2005). In each group, children's performances in early literacy skills (phonological awareness, letter knowledge, and word decoding) were assessed, as well as their achievement in linguistic and cognitive measures associated to these skills. The results showed that, notwithstanding the fact that there were no differences in word decoding, children with ID lagged behind on all predictor measures relevant to early literacy skills compared to children with NLA. Moreover, whereas children with NLA showed a regular predictive pathway of early literacy skills, children with ID showed a deviant pattern, in which nonverbal intelligence and rhythmic skills proved to be of major importance. Also letter knowledge appeared to be involved in their early literacy processing. It can be tentatively concluded that in the ID group, children's level of nonverbal intellectual abilities in combination with rhythmic ability proves pivotal in the development of their early literacy skills.

Linguistic transfer in bilingual children with specific language impairment.

BACKGROUND: In the literature so far the limited research on specific language impairment (SLI) in bilingual children has concentrated on linguistic skills in the first language (L1) and/or the second language (L2) without paying attention to the relations between the two types of skills and to the issue of linguistic transfer. AIMS: To examine the first and second language proficiency of 75 Turkish-Dutch bilingual children with SLI in the age range between 7 and 11 years living in the Netherlands. A multidimensional perspective on language proficiency was taken in order to assess children's Turkish and Dutch proficiency levels, whereas equivalent tests were used in order to determine language dominance. A second aim was to find out to what extent the children's proficiency in L2 can be predicted from their L1 proficiency, while taking into account their general cognitive abilities. METHODS & PROCEDURES: The children's performance on a battery of equivalent language ability tests in Turkish and Dutch was compared at three age levels. By means of analyses of variance, it was explored to what extent the factors of language and grade level as well as their interactions were significant. Bivariate correlations and partial correlations with age level partialled out were computed to examine the relationships between L1 and L2 proficiency levels. Moreover, regression analysis was conducted to find out to what extent the variance in general L2 proficiency levels could be explained by children's L1 proficiency, short-term memory and non-verbal intelligence. OUTCOMES & RESULTS: Repeated measures analyses showed that the children had generally higher scores on L1 as compared with L2 and that with progression of age the children's scores in L1 and L2 improved. Medium to high correlations were found between phonological memory, phonological awareness, grammatical skills and story comprehension in the two languages. Regression analysis revealed that children's L2 proficiency levels could be explained by their proficiency levels in L1, even after controlling for children's non-verbal intelligence and working memory. CONCLUSIONS & IMPLICATIONS: It is concluded that children's formal linguistic skills in L1 and L2 tend to be related and that their level of L1 proficiency may help to develop linguistic skills in L2.

Assessment of second language proficiency in bilingual children with specific language impairment: a clinical perspective.

The goal of this study was to examine to what extent the conditions of restricted input of L2 and SLI have an additive impact on language acquisition. Therefore, the Dutch language achievement of 6-, 7-, and 8-year-old bilingual children with SLI was compared with that of typically developing monolingual Dutch children, typically developing bilingual children, and monolingual Dutch children with SLI. Assuming that speaking a language in varying environments involves distinct subskills that can be acquired in differential patterns, the achievement of phonological, lexical, morphosyntactic and textual abilities were assessed separately. For each of these abilities, it was determined to what extent the conditions of restricted input (first vs. second language) and language deficit (typically developing vs. SLI) cause stagnation or a delay in language acquisition. Bilingual children with SLI perform at a lower level than the other groups in almost all aspects of achievement in Dutch. For language tasks related to the mental lexicon and grammar, an additional disadvantage was evidenced as a result of the combination of learning Dutch as second language and having SLI.

How cognitive factors affect language development in children with intellectual disabilities.

The present study investigated the language development of 50 children with intellectual disabilities (ID) and 42 typically developing children from age 4 to 5 years, and was designed to shed more light on the respective roles of phonological working memory (WM) and nonverbal intelligence in vocabulary and syntax development. Results showed that nonverbal intelligence predicted phonological WM, vocabulary and syntax of children with ID at age 4 and 5, and that it only predicted these skills at age 4 in typically developing children. Furthermore, syntax at age 5 was predicted by vocabulary at age 4 in children with ID, which points to children with ID requiring a larger critical mass of vocabulary for syntactic development to be initiated.

Verb morphology as clinical marker of specific language impairment: evidence from first and second language learners.

The goal of this study was to search for verb morphology characteristics as possible clinical markers of SLI in Dutch as a first and second language. We also wanted to find out to what extent bilingual children with SLI are additionally disadvantaged in comparison to monolingual children with SLI, on the one hand, and to typically developing bilingual children, on the other hand. Therefore, we examined the use of verb morphology in the narratives of four groups of 7- and 9-year-old children: native Dutch (monolingual) children without SLI, bilingual children without SLI, native Dutch (monolingual) children with SLI, and bilingual children with SLI. The narrative performance in Dutch as measured by mean length of utterance and number of ungrammatical sentences was found to be generally worse for children learning Dutch as a second language, for children suffering from SLI, and for younger children. Furthermore, omission of an agreement marker in the third person singular verb form can be seen as a clinical marker of SLI in both first and second language learners. Bilingual children with SLI were found to be in an additionally disadvantaged position as far as their use of L2 verb morphology.

Predicting word decoding and word spelling development in children with Specific Language Impairment.

UNLABELLED: This longitudinal investigation on Dutch children with Specific Language Impairment (SLI) aimed at determining the predictive value of statistically uncorrelated language proficiencies on later reading and spelling skills in Dutch. Language abilities, tested with an extensive test battery at the onset of formal reading instruction, were represented by four statistically uncorrelated factors: lexical-semantic abilities, auditory perception, verbal-sequential processing, and speech production. All factors contributed significantly to the prediction of word reading and spelling development seven months later. Verbal-sequential processing was the strongest predictor for both word decoding and spelling. Furthermore, autoregression effects of word decoding and spelling were strong and verbal-sequential processing had predictive value on word spelling nineteen months later when pre-existing spelling abilities were accounted for. Children with SLI and normal literacy skills performed better on most of the language and language-related measures than children with SLI and poor literacy skills. LEARNING OUTCOMES: As a result of this activity, readers will describe four language domains that are related to later literacy skills in children with Specific Language Impairment (SLI). As a result of this activity, readers will recognize the predictive value of each of these language domains and the important role of verbal-sequential processing in learning to decode and writing words for children with SLI. As a result of this activity, readers will recall the differences in language proficiencies between children with SLI who develop normal literacy skills and those who encounter literacy problems.

Early language intervention for children with intellectual disabilities: a neurocognitive perspective.

For children with intellectual disabilities (ID), stimulation of their language and communication is often not a priority. Advancements in brain research provide guidelines for early interventions aimed at the stimulation of language and communication skills. In the present study, the effectiveness of an early language intervention which draws upon neurocognitive principles of language processing and language learning was assessed. Ten children participated in the intervention and 18 were followed for control purposes. The intervention group showed greater progress than the control group. The higher learning gains for the intervention group were mostly driven by the non-speaking children. However, the progress of the intervention children slowed down significantly following intervention. An early language intervention such as that studied here can accelerate the language development of children with ID. To maintain the effects, however, the intervention should be prolonged in several settings that focus on consecutive learning (e.g., day-care centres and schools).

The nature of auditory discrimination problems in children with specific language impairment: an MMN study.

Many children with specific language impairment (SLI) show impairments in discriminating auditorily presented stimuli. The present study investigates whether these discrimination problems are speech specific or of a general auditory nature. This was studied using a linguistic and nonlinguistic contrast that were matched for acoustic complexity in an active behavioral task and a passive ERP paradigm, known to elicit the mismatch negativity (MMN). In addition, attention skills and a variety of language skills were measured. Participants were 25 five-year-old Dutch children with SLI having receptive as well as productive language problems and 25 control children with typical speech- and language development. At the behavioral level, the SLI group was impaired in discriminating the linguistic contrast as compared to the control group, while both groups were unable to distinguish the non-linguistic contrast. Moreover, the SLI group tended to have impaired attention skills which correlated with performance on most of the language tests. At the neural level, the SLI group, in contrast to the control group, did not show an MMN in response to either the linguistic or nonlinguistic contrast. The MMN data are consistent with an account that relates the symptoms in children with SLI to non-speech processing difficulties.

Literacy learning in users of AAC: A neurocognitive perspective.

The understanding of written or printed text or discourse - depicted either in orthographical, graphic-visual or tactile symbols - calls upon both bottom-up word recognition processes and top-down comprehension processes. Different architectures have been proposed to account for literacy processes. Research has shown that the first steps in perceiving, processing and deriving conceptual meaning from words, graphic symbols, manual signs, and co-speech gestures or tactile manual signing and tangible symbols can be seen as identical and collectively (sub)activated. Results from recent brain research and neurolinguistics have revealed new insights in the reading process of typical and atypical readers and may provide verifiable evidence for improved literacy assessment and the validation of early intervention programs for AAC users.