Developing a screening instrument for underlying core domains of communicative competence in children with communication support needs.

A socio-neurocognitive approach to augmentative and alternative communication (AAC) shows several underlying domains of communicative competence: Attention, perception, cognition, memory, orientation, socio-emotional development, motor skills, and language. To determine developmental markers of these underlying core domains of communicative competence in children with communication support needs, we developed a new screening instrument. The present article consists of three consecutive studies. In study 1, we constructed the first version of the screening instrument based on a sample of both children without disabilities and children with Down syndrome. In study 2, we confirmed the reliability (i.e., internal consistency) of the screening instrument in a new group of young children with typical development and established concurrent validity with the Early Language Scale. In study 3, we established concurrent validity with the Communication Matrix in a clinical sample of children with communication support needs. The screening instrument can be used in clinical practice as part of AAC assessment to provide comprehensive insights into strengths and weaknesses in the underlying core domains of communicative competence of children with communication support needs.

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.

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.

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.

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.

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.

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.

Conversational behaviour of children with Developmental Language Delay and their caretakers.

BACKGROUND: A subset of children with Developmental Language Delay (DLD) encountered difficulties with the regulation of spoken discourse. In the conversations of caretakers with DLD children, several studies report difficulties with turn-taking, a proneness to use the non-verbal register, child and caretaker problems with topic management. Longitudinal research has yet to be conducted on the conversational behaviour of young DLD children and their caretakers. AIMS: The study investigates the development of style and structure of conversations between preschool-aged DLD children and their caretakers. METHOD & PROCEDURES: In a longitudinal design, language samples from twelve DLD children and six Normal Language-Acquiring (NLA) children and their caretakers were recorded in semi-structured play situations at two-month intervals across a period of 18 months. The children were between 2 and 3 years of age at the start of the study. OUTCOMES & RESULTS: The data show that the DLD children predominantly use restricted linguistic forms, non-verbal register and experience difficulties with turn-taking, topic initiation and topic maintenance. The conversational style of the caretakers in dialogue with their DLD children consistently showed more attention-gathering turns, formulaic corrections, self-repetitions and re-introductions of topics when compared with the conversational style of caretakers in dialogue with their NLA children across the 18 months. CONCLUSIONS & IMPLICATIONS: Caretakers in DLD dyads appear to develop a less facilitative conversational style and a decrease of contingencies in initiations and responses over time. The result is little opportunity for the conversational and linguistic skills of the DLD children to develop. Parental guidance in the form of conversational training, child-adjusted register, contingent response behaviour and the provision of language materials which can help the child discover his or her role as a conversational partner and recognize the different perspectives of conversational partners is emphasized.

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.

Immersive communication intervention for speaking and non-speaking children with intellectual disabilities.

The current study demonstrates the effectiveness of an intervention that addresses both home care and day care for children with intellectual disabilities while also taking the large individual differences between the children into account. The KLINc Studio intervention was designed to improve the language development, communication skills, and emergent literacy of 10 children with complex communication needs. The focus of the anchor-based intervention program was on the stimulation of vocabulary learning via the incorporation of AAC into the learning environment in the most natural manner possible. While all of the children showed significant progress across the intervention period of 2 years, the group of speaking children showed greater development in the domains of receptive language and productive syntax than the group of non-speaking children. For heterogeneous groups of children with disabilities, the use of a combined intervention such as that described here appears to be promising.

Home literacy environment: characteristics of children with cerebral palsy.

BACKGROUND: Various aspects of the home literacy environment are considered to stimulate the emergent literacy development in children without disabilities. It is important to gain insight into the home literacy environment of children with cerebral palsy given that they have been shown to have difficulty acquiring literacy skills. AIMS: The aims of the present study were to investigate whether the home literacy environment of children with cerebral palsy was comparable with that of peers without disabilities and to investigate to what extent speech, fine motor, and intellectual impairments limit their home literacy experiences. METHODS & PROCEDURES: Questionnaires addressed to the parents of the children were devised to investigate differences in the home literacy environment in 40 children with cerebral palsy and in 62 peers without disabilities who were comparable on chronological age, i.e., 6 years old, socio-economic status (SES) and sex. The relative influence of speech intelligibility, fine motor skills, and intelligence skills for the home literacy environment factors of children with cerebral palsy was investigated. OUTCOMES & RESULTS: Only a few group differences were significant: children with cerebral palsy were less interested in participating in writing activities, and less involved in word-orientation activities during shared storybook reading. On the other hand, parents of children with cerebral palsy were doing more leisure activities with their child. The speech intelligibility scores of the children with cerebral palsy predicted the amount of emergent literacy activities they were doing with their parents, as wells as their active participation in word-related activities during storybook reading. In addition, the active participation of the child in story-related activities could be predicted by his or her fine motor skills. Furthermore, parents of the children in the comparison group often had high expectations, while parents of the children with cerebral palsy often did not know what expectations to have for their child's literacy level at the end of elementary school. CONCLUSIONS & IMPLICATIONS: Although both groups have stimulating home literacy environments, children with cerebral palsy with speech or fine motor impairments are disadvantaged in a small number of literacy activities. Teachers and speech and language therapists can work with parents to give them suggestions on how to conduct emergent literacy activities with their child with speech impairments as well as how on to involve their child with speech and fine motor dysfunctions more actively in storybook reading activities. Furthermore, parents should be given more information about their child's language development in order the better to understand what goals are achievable so they may begin to form realistic expectations.

Cognitive predictors of language development in children with specific language impairment (SLI).

BACKGROUND: Language development is generally viewed as a multifactorial process. There are increasing indications that this similarly holds for the problematic language development process. AIMS: A population of 97 young Dutch children with specific language impairment (SLI) was followed over a 2-year period to provide additional evidence for the existence of underlying language factors. Furthermore, the children's language development was related to their non-verbal intellectual reasoning capacity. METHODS & PROCEDURES: The language abilities were assessed via the administration of an extensive battery of language tests. Cognition was assessed via administration of the Raven progressive matrices, short-term memory capacity via administration of the Digit Span task. OUTCOMES & RESULTS: The results provide empirical support for distinct language factors for children with language problems. The detected factors were labelled: phonology, lexical-semantics, syntax, and speech production, and were found to be stable and interrelated. Short-term memory showed strong relations with the language factor syntax and medium relations with the other language factors. Intellectual capacity showed weak to medium relations with three language factors but no relation with the factor speech. CONCLUSIONS & IMPLICATIONS: The language development of 5- and 6-year-old Dutch children with SLI appears to be divided into four language factors. The language factors are very stable in this sample and correspond with language factors found in recent studies on language development in children with SLI. Short-term auditory memory turns out to play an important role in the problematic language acquisition of children with SLI. It is recommended that children with SLI should be assessed on possible deficits in information processing and/or short-term memory. The existence of such deficits calls for specific neuropsychological intervention.

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.

Working memory limitations in children with severe language impairment.

UNLABELLED: In the present study, the relations of various aspects of working memory to various aspects of language problems in a clinical sample of 97 Dutch speaking 5-year-old children with severe language problems were studied. The working memory and language abilities of the children were examined using an extensive battery of tests. Working memory was operationalized according to the model of Baddeley. Confirmative factor analyses revealed three memory factors: phonological, visual and central executive. Language was construed as a multifactorial construct, and confirmative factor analyses revealed four factors: lexical-semantic abilities, phonological abilities, syntactic abilities and speech production abilities. Moderate to high correlations were found between the memory and language factors. Structural equation modelling was used to further explore the relations between the different factors. Phonological memory was found to predict phonological abilities; central-executive memory predicted lexical-semantic abilities; and visual memory predicted speech production abilities. Phonological abilities also predicted syntactic abilities. Both the theoretical and clinical implications of the findings are discussed. LEARNING OUTCOMES: The reader will be introduced to the concepts of multifactorial components of working memory as well as language impairment. Secondly the reader will recognize that working memory and language impairment factors can be related. Particular emphasis will be placed on phonological memory, central-executive memory and visual memory and their possible prediction of specific components of language impairment.

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.

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.

Subtypes of severe speech and language impairments: psychometric evidence from 4-year-old children in The Netherlands.

Most, if not all, of the studies of subtypes of children with language impairments have been conducted with English-speaking children. The possibility and validity of identified subtypes for non-English clinical populations are, as yet, unknown. This study was designed to provide cross-linguistic evidence of language subtypes. A broad battery of tests was administered to measure the phonological, lexical, morphosyntactic, semantic, discourse, and pragmatic abilities of a representative sample of 110 4-year-old Dutch children who had been previously diagnosed as severely speech and language impaired. Principal components analyses revealed 4 subtypes of speech and language impairments, which were labeled lexical-semantic, speech production, syntoctic-sequential, and auditory perception. These results were consistent with recent theoretical claims about the classification of English-speaking children with speech and language impairments.

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.