Stuttering in individuals with Down syndrome: a systematic review of earlier research.

The main objective of this systematic review was to synthesize the evidence on the occurrence and characteristics of stuttering in individuals with Down syndrome and thus contribute knowledge about stuttering in this population. Group studies reporting outcome measures of stuttering were included. Studies with participants who were preselected based on their fluency status were excluded. We searched the Eric, PsychInfo, Medline, Scopus, and Web of Science Core Collection databases on 3rd January 2022 and conducted supplementary searches of the reference lists of previous reviews and the studies included in the current review, as well as relevant speech and language journals. The included studies were coded in terms of information concerning sample characteristics, measurement approaches, and stuttering-related outcomes. The appraisal tool for cross-sectional studies (AXIS) was used to evaluate study quality. We identified 14 eligible studies, with a total of 1,833 participants (mean = 131.29, standard deviation = 227.85, median = 45.5) between 3 and 58 years of age. The estimated occurrence of stuttering ranged from 2.38 to 56%, which is substantially higher than the estimated prevalence (1%) of stuttering in the general population. The results also showed that stuttering severity most often was judged to be mild-to-moderate and that individuals with Down syndrome displayed secondary behaviors when these were measured. However, little attention has been paid to investigating the potential adverse effects of stuttering for individuals with Down syndrome. We judged the quality of the evidence to be moderate-to-low. The negative evaluation was mostly due to sampling limitations that decreased the representability and generalizability of the results. Based on the high occurrence of stuttering and the potential negative effects of this condition, individuals with Down syndrome who show signs of stuttering should be referred to a speech and language pathologist for an evaluation of their need for stuttering treatment.

Vocabulary interventions for second language (L2) learners up to six years of age.

BACKGROUND: Second language (L2) learners are a heterogeneous group. Their L2 skills are highly varied due to internal factors (e.g. cognitive development) and external factors (e.g. cultural and linguistic contexts). As a group, their L2 vocabulary skills appear to be lower than their monolingual peers. This pattern tends to persist over time and may have negative consequences for social interaction and inclusion, learning, and academic achievement. OBJECTIVES: To examine the immediate and long-term effects of second language (L2) vocabulary interventions targeting L2 learners up to six years of age on vocabulary and social-emotional well-being. To examine the associations between L2 vocabulary interventions and the general characteristics of L2 learners (e.g. age, L2 exposure, and L1 skills). SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was December 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the effects of vocabulary interventions for L2 learners up to six years of age with standard care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcomes were 1. receptive and 2. expressive L2 vocabulary (both proximal and distal), and 3. mean length of utterance (MLU; which is a measure of potential adverse effects). Our secondary outcomes were 4. L2 narrative skills, 5. L1 receptive vocabulary (both proximal and distal), 6. L1 expressive vocabulary (both proximal and distal), 7. L1 listening comprehension, 8. L2 grammatical knowledge, 9. L2 reading comprehension (long-term), and 10. socio-emotional well-being (measured with Strengths and Difficulties Questionnaire). MAIN RESULTS: We found 12 studies involving 1943 participants. Two studies were conducted in Norway, seven in the USA, and single studies conducted in Canada, China, and the Netherlands. Ten studies were conducted in preschool settings, with a preschool teacher being the most common delivery agent for the intervention. The interventions were mainly organised as small-group sessions, with three or four children per group. The mean dosage per week was 80 minutes and ranged from 24 to 120 minutes. The studies commonly applied shared book reading (reading aloud with the children), with target words embedded in the books. Standard care differed based on the setting and local conditions in each country or (pre)school. In some studies, the comparison groups received vocabulary instruction in preschool groups. Compared to standard care, the effect of L2 vocabulary interventions varied across outcome measures. For vocabulary measures including words that were taught in the intervention (proximal outcome measures), the intervention effects were large for both receptive L2 vocabulary (i.e. understanding of words; standardised mean difference (SMD) 0.97, 95% confidence interval (CI) 0.64 to 1.30; 4 studies, 1973 participants; very low-certainty evidence) and expressive L2 vocabulary (i.e. expressing or producing words; SMD 0.86, 95% CI 0.56 to 1.17; 6 studies, 1121 participants; very low-certainty evidence). However, due to some concerns in the overall risk of bias assessment, substantial heterogeneity, and wide CIs, we have limited confidence in these results. For language measures that did not include taught vocabulary (distal outcome measures), the intervention effects were small for receptive vocabulary (SMD 0.29, 95% CI 0.02 to 0.55; 6 studies, 1074 participants; low-certainty evidence) and probably made little to no difference to expressive vocabulary (SMD 0.10, 95% CI -0.02 to 0.23; 7 studies, 960 participants; moderate-certainty evidence). There was little to no intervention effect on L2 listening comprehension (SMD 0.19, 95% CI -0.31 to 0.68; 2 studies, 294 participants; very low-certainty evidence), but the evidence was uncertain, and the interventions probably increased L2 narrative skills slightly (SMD 0.37, 95% CI 0.14 to 0.59; 2 studies, 487 participants; moderate-certainty evidence). Only one study reported data on MLU, and we were unable to examine the effect of intervention on this outcome. The level of certainty of the evidence was downgraded mainly due to inconsistency and imprecision. We were unable to draw conclusions about socio-emotional well-being, or conduct the planned subgroup analyses to examine the second objective, due to lack of data. AUTHORS' CONCLUSIONS: Findings from this review suggest that, compared to standard care, vocabulary interventions may benefit children's L2 vocabulary learning but have little to no effect on their listening comprehension, though the evidence is uncertain. Vocabulary interventions probably improve the children's storytelling skills slightly. Due to the limited number of studies that met our inclusion criteria and the very low- to moderate-certainty evidence as a result of inconsistency and imprecision, implications for practice should be considered with caution. This review highlights the need for more high-quality trials (e.g. RCTs) of vocabulary interventions for L2 learners, particularly studies of learners outside the USA.

Stuttering Behavior in a National Age Cohort of Norwegian First-Graders With Down Syndrome.

PURPOSE: The aims of this study were to investigate the occurrence of stuttering behavior across time and to evaluate the relationship between stuttering behavior and language ability in children with Down syndrome. METHOD: A national age cohort of Norwegian first graders with Down syndrome (N = 75) participated in the study. Speech samples from a story-retelling task and a picture book dialogue as well as standardized measures of vocabulary, grammar, and nonverbal mental ability were collected at two time points approximately 5 months apart. Stuttering behavior was evaluated through counting stuttering-like disfluencies and stuttering severity ratings. The relationship between stuttering behavior and language ability was investigated through hierarchical regression analysis. RESULTS: The participants had stuttering severity ratings ranging from no stuttering behavior to severe and displayed all types of stuttering-like disfluencies. There were significant relationships between stuttering behavior and language ability at the first time point, whereas the relationships were not significant at the second time point. The stuttering severity ratings were significantly predicted by language ability across time, whereas the frequency of stuttering-like disfluencies was not. CONCLUSIONS: The occurrence of stuttering behavior was high across the measures and time points; however, the relationship between stuttering behavior and language ability varied across these variables. Thus, the nature of the relationship does not seem to follow a strict pattern that can be generalized to all children across time.

The Association between Difficulties with Speech Fluency and Language Skills in a National Age Cohort of Children with Down Syndrome.

The present study (a) addressed difficulties in speech fluency in children with Down syndrome and typically developing children at a similar non-verbal level and (b) examined the association between difficulties with speech fluency and language skills in children with Down syndrome. Data from a cross-sectional parent survey that included questions about children's difficulties with speech fluency, as well as clinical tests from a national age cohort of 43 six-year-olds with Down syndrome and 57 young typically developing children, were collected. Fisher's exact test, Student's t-test, linear regression, and density ellipse scatter plots were used for analysis. There was a significantly higher occurrence of parent-reported difficulties with speech fluency in the children with Down syndrome. Higher language scores were significantly associated with a lower degree of difficulties; this association was strongest for vocabulary and phonological skills. Although difficulties with speech fluency were not reported for all children with Down syndrome, a substantially higher occurrence of such difficulties was reported compared to that for typically developing children. The significant association between difficulties with speech fluency and the level of language functioning suggests that speech fluency and language skills should be taken into consideration when planning treatment for children with Down syndrome.

Occurrence of Reading Skills in a National Age Cohort of Norwegian Children with Down Syndrome: What Characterizes Those Who Develop Early Reading Skills?

Children with Down syndrome are at risk of reading difficulties. Reading skills are crucial for social and academic development, and thus, understanding the nature of reading in this clinical group is important. This longitudinal study investigated the occurrence of reading skills in a Norwegian national age cohort of 43 children with Down syndrome from the beginning of first grade to third grade. Data were collected to determine which characteristics distinguished those who developed early reading skills from those who did not. The children's decoding skills, phonological awareness, nonverbal mental ability, vocabulary, verbal short-term memory, letter knowledge and rapid automatized naming (RAN) performance were measured annually. The results showed that 18.6% of the children developed early decoding skills by third grade. Prior to onset, children who developed decoding skills had a significantly superior vocabulary and letter knowledge than non-readers after controlling for nonverbal mental abilities. These findings indicate that early specific training that focuses on vocabulary and knowledge of words and letters may be particularly effective in promoting reading onset in children with Down syndrome.

Differences and Similarities in Predictors of Expressive Vocabulary Development between Children with Down Syndrome and Young Typically Developing Children.

The purpose of this study was to examine potential differences in the predictors of expressive vocabulary development between children with Down syndrome and typically developing children to support preparation for intervention development. An age cohort of 43 children with Down syndrome and 57 typically developing children with similar nonverbal mental age levels were assessed at three time points. Linear mixed models were used to investigate the predictors of expressive vocabulary over time. Both groups achieved progress in expressive vocabulary. The typically developing children had steeper growth than the children with Down syndrome (1.38 SD vs. 0.8 SD, p < 0.001). In both groups, receptive vocabulary, auditory memory, and the home literacy environment were significant predictors of development. In the children with Down syndrome, the phonological awareness and oral motor skills were also significant. Group comparisons showed that receptive vocabulary, auditory memory and oral motor skills were stronger predictors in the children with Down syndrome than in the typically developing children. These results indicate that children with Down syndrome are more vulnerable when it comes to risk factors that are known to influence expressive vocabulary than typically developing children. Children with Down syndrome therefore require early broad-based expressive vocabulary interventions.

Caregivers' perceptions of stuttering impact in young children: Agreement in mothers', fathers' and teachers' ratings.

PURPOSE: Prior studies have documented an adverse impact of stuttering on young children's lives. These studies have relied primarily on parent reports, though different caregivers may have unique experiences with children. To date, no study has examined teachers' perceptions of the impact in children below six years of age. Moreover, the agreement between mothers, fathers, and teachers in proxy ratings of impact has not been examined. Caregiver agreement is important to investigate because results from varying assessments of adverse impact can influence treatment recommendations. This study sought to gain an integrated insight into 1) teachers' perceptions and descriptions of the impact of stuttering on young children and 2) agreement in mothers', fathers', and teachers' perceptions of how stuttering affects young children. METHOD: The mothers, fathers, and teachers of 35 young children who stutter (aged 2.0-6.0 years) completed the Overall Assessment of the Speaker's Experience of Stuttering - Caregivers (Parents and Kindergarten Teachers) (OASES-C; Guttormsen, Yaruss, & Næss, 2020). Teachers also responded to open-ended questions about their perceptions of the impact of stuttering on children's lives. RESULTS: Overall, teachers perceived stuttering to affect children's lives to a mild-to-moderate degree. The teachers described communication difficulty and reactions and how these changed across settings in kindergarten. Agreement on the four OASES-C sections and on the total score were calculated for 29 mother-teacher pairs, 29 father-teacher pairs, and 33 mother-father pairs. Results indicate good agreement between mothers and fathers and fair agreement between parents and teachers. Across caregiver pairs, agreement was high (good or excellent) when reporting on observable impact, while agreement was low (fair or poor) on ratings of internal impact. CONCLUSION: The finding that teachers also perceive stuttering to have an adverse effect on young children adds to the literature of impact, particularly because the teachers reported observing impact in situations that are unique to the kindergarten setting. In line with previous literature on proxy reporting, our results indicate good agreement between caregivers observing the children in the same arena (mothers and fathers) and fair agreement between caregivers observing the children in different arenas (parents and teachers). The results indicate that information from more than one caregiver can contribute to an integrated assessment of impact across arenas.

Children with Down syndrome can benefit from language interventions; Results from a systematic review and meta-analysis.

Language disorder is a cardinal challenge for children with Down syndrome, and their learning capacity has been debated. The aim of the current study was to conduct a systematic review and meta-analysis of existing language interventions for children with Down syndrome to reveal knowledge about the effects of these interventions and identify any common characteristics specific to effective or ineffective interventions. A systematic search was conducted in databases relevant for education, speech and language therapy, and psychology. Based on a set of predefined inclusion criteria, the hits were screened and coded. Eight studies were synthesised in a systematic review and four in a meta-analysis. The overall effect of the interventions was large (g = 1.01), but significant transfer effects to untrained aspects of language were rarely found. Interventions showing significant effects varied with regards to numerous characteristics including the age of the target group, the intervention approach, the dosage, and the implementer. The common characteristic across the effective interventions was simply the aim of improving language skills in children with Down syndrome. Overall, there was a moderate to high risk of bias across all studies. To conclude, children with Down syndrome have the potential to respond to language intervention. However, more interventions that reach transfer effects are needed to maximise children's language outcomes. Based on the limited number of studies and a moderate to high risk of bias across the studies, there is a great need for more robust intervention studies to ensure that future interventions are informed by high-quality research.

Figurative language comprehension in individuals with autism spectrum disorder: A meta-analytic review.

We present a meta-analysis of studies that compare figurative language comprehension in individuals with autism spectrum disorder and in typically developing controls who were matched based on chronological age or/and language ability. A total of 41 studies and 45 independent effect sizes were included based on predetermined inclusion criteria. Group matching strategy, age, types of figurative language, and cross-linguistic differences were examined as predictors that might explain heterogeneity in effect sizes. Overall, individuals with autism spectrum disorder showed poorer comprehension of figurative language than their typically developing peers (Hedges' g = -0.57). A meta-regression analysis showed that group matching strategy and types of figurative language were significantly related to differences in effect sizes, whereas chronological age and cross-linguistic differences were not. Differences between the autism spectrum disorder and typically developing groups were small and nonsignificant when the groups were matched based on the language ability. Metaphors were more difficult to comprehend for individuals with autism spectrum disorder compared with typically developing controls than were irony and sarcasm. Our findings highlight the critical role of core language skills in figurative language comprehension. Interventions and educational programmes designed to improve social communication skills in individuals with autism spectrum disorder may beneficially target core language skills in addition to social skills.

Assessing pragmatic communication in children with Down syndrome.

PURPOSE: Successful communication depends on language content, language form, and language use (pragmatics). Children with Down syndrome (DS) experience communication difficulties, however little is known about their pragmatic profile, particularly during early school years. The purpose of the present study was to explore the nature of pragmatic communication in children with DS. METHOD: Twenty-nine six-year-old children with DS were assessed, in the areas of 1) initiation, 2) scripted language, 3) understanding context and 4) nonverbal communication, as reported by children's parents via the Children's Communication Checklist-2 (Bishop, 2003). Additionally, the relationships between pragmatics and measures of vocabulary, nonverbal mental ability and social functioning were explored. RESULTS: Children with DS were impaired relative to norms from typically developing children in all areas of pragmatics. A profile of relative strengths and weaknesses was found in the children with DS; the area of nonverbal communication was significantly stronger, while the area of understanding context was significantly poorer, relative to the other areas of pragmatics assessed in these children. Relationships between areas of pragmatics and other linguistic areas, as well as aspects of vocabulary and social functioning were observed. CONCLUSIONS: By the age of six children with DS experience significantly impaired pragmatic communication, with a clear profile of relative strengths and weaknesses. The study highlights the need to teach children with DS pragmatic skills as a component of communication, alongside language content and form.

The profile of social functioning in children with Down syndrome.

BACKGROUND: Practitioners and researchers have asserted for decades that social functioning is a strength in children with Down syndrome (DS). Nevertheless, some studies have concluded that children with DS may be at greater risk of impaired social functioning compared to typically developing controls. This cross-sectional study explores the profile of social functioning (social capabilities and social problems) in six-year-old children with DS, compares it with that of typically developing children and reveals possible differences in predictors between groups. METHOD: Parental reports and clinical tests were utilized. RESULTS: The children with DS had generally weaker social capabilities compared to nonverbal mental age-matched controls, but no significant differences were found for social interactive play, community functioning and prosocial behaviour. No significant differences in predictors for social capabilities between the groups were found. The children with DS had more social problems than the typically developing controls with a similar chronological age and those with a similar nonverbal mental age, but no significant differences in emotional symptoms were found between the children with DS and either comparison group. Vocabulary was a more important predictor of social problems in the children with DS than in the typically developing control groups. CONCLUSION: Interventions for children with DS should strongly focus on integrating vocabulary skills and social functioning starting at an early age. Implications for Rehabilitation Children with Down syndrome need help and support in social functioning. Systematic training to optimize social capabilities and to prevent social problems should be prioritized. Structured and explicit learning of words important for social interaction with peers and for conflict solutions should be emphasized. Integrated interventions focusing on social functioning and vocabulary should begin in preschool to prepare children for participation in mainstream education.

Cognitive stimulation of pupils with Down syndrome: A study of inferential talk during book-sharing.

In the education of pupils with Down syndrome, "simplifying" literal talk and concrete stimulation have typically played a dominant role. This explorative study investigated the extent to which teachers stimulated abstract cognitive functions via inferential talk during book-sharing and how pupils with Down syndrome responded. Dyadic interactions (N=7) were videotaped, transcribed and coded to identify levels of abstraction in teacher utterances and to evaluate the adequacy of pupil responses. One-third of the teachers' utterances contained high levels of abstraction and promoted inferential talk. Six of the seven children predominantly responded in ways which revealed inferential thinking. Dialog excerpts highlighted individual, contextual and interactional factors contributing to variations in the findings. Contrary to previous claims, the children with Down syndrome in the current sample appear able to draw inferences beyond the "here-and-now" with teacher support. This finding highlights the educational relevance and importance of higher-order cognitive stimulation of pupils with intellectual disabilities, to foster independent metacognitive skills.

Development of phonological awareness in Down syndrome: A meta-analysis and empirical study.

Phonological awareness (PA) is the knowledge and understanding of the sound structure of language and is believed to be an important skill for the development of reading. This study explored PA skills in children with Down syndrome and matched typically developing (TD) controls using a dual approach: a meta-analysis of the existing international literature and a longitudinal empirical study. The results from both the meta-analysis and the empirical study showed that the children with Down syndrome initially had weaker PA skills compared to the controls; in particular, the awareness of rhyme was delayed. The longitudinal empirical data indicated that, as a result of formal education, the children with Down syndrome exhibited greater improvement on all PA measures compared with the controls who had not yet entered school. The results reach significance for rhyme awareness. With respect to dimensionality, the performance of the children with Down syndrome loaded on 1 factor, whereas the performance of the younger TD controls was multidimensional. In sum, these findings underline the need for studies that compare interventions designed especially to stimulate development of PA in this group of children and to provide insight into the underlying causes of the developmental profile of children with Down syndrome.

Communication attitudes in children who stutter: A meta-analytic review.

BACKGROUND: This article presents a meta-analytic review of differences in communication attitudes between children who stutter (CWS) and children who do not stutter (CWNS). METHOD: To be included in this review, the studies had to include a group of CWS and CWNS between the ages of 3-18 years and a measurement of communication attitudes. The journal articles were identified by using the key words stutter*, speech disfluenc*, fluency disorder*, and stammer* cross-referenced to awareness*, reaction*, attitude*, KiddyCAT, CAT, A-19 Scale, PASS and OASES. RESULTS: A total of 18 studies met the inclusion criteria for this meta-analysis. The results showed that CWS exhibit more negative communication attitudes than CWNS from the preschool years. The differences between the groups increased with age, but were not influenced by gender. CONCLUSION: The results indicate that negative communication attitudes can be an effect of stuttering. Key issues requiring further investigation are whether communication attitudes differ as a function of age at stuttering onset and whether communication attitudes influence the development of stuttering. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (a) summarise empirical findings with regard to the relationship between communication attitudes and childhood stuttering; (b) describe the different instruments used to measure communication attitudes; (c) discuss the relationship between communication attitudes, age and gender.

Longitudinal relationships between language and verbal short-term memory skills in children with Down syndrome.

Children with Down syndrome are at risk for language difficulties, the nature of which is not well understood. This study compared the longitudinal predictors of language skills in children with Down syndrome with those in typically developing control children matched for initial level of nonverbal mental ability. An age cohort of children with Down syndrome (n=43) and 57 typically developing control children was assessed on measures of vocabulary, grammar, and verbal short-term memory three times at yearly intervals. Children with Down syndrome showed slower development on all measures than the typically developing controls. Longitudinal analyses showed moderate to high stability of language and verbal short-term memory skills. Our results confirm earlier evidence of pervasive language learning difficulties in this group and suggest that early language intervention should be given high priority.

What communication strategies do AAC users want their communication partners to use? A preliminary study.

PURPOSE: This study aims to investigate which communication strategies the people, who use augmentative and alternative communication (AAC), want their communication partners to use. METHODS: We interviewed eight children using Talking Mats to examine the AAC users' own opinion. RESULTS: The results showed that they wanted their communication partners to take the initiative, to repair the breaks when communication breakdowns occurred, and to invest time in understanding what AAC users wanted to express. CONCLUSIONS: These results underlined the significant responsibility of communication partners and revealed the need for AAC user interventions to help them be active communicators. More research needs to emphasise AAC users' opinions about communication partner strategies to improve the communication processes for AAC-users and thereby promote social inclusion in natural environment. Implications for Rehabilitation Communication partner strategies can affect communication as well as personal development and life quality for augmentative and alternative communication (AAC) users. In AAC-users opinion, their communication partners should take the communicative initiative, repair the breaks when communication breakdowns occurred, and invest time in understanding what AAC-users want to express. There is a need to inform and educate communication partners, especially those unfamiliar to AAC users. Practical training sessions, clinician modelling and written materials may be helpful. A communication partner guide can be adapted to each individual AAC user who explains his or her communication preferences. Additionally, there is a need that the clinicians promote active rather than passive communication from AAC users, which requires that they have access to the necessary symbols.

Reading skills in children with Down syndrome: a meta-analytic review.

The authors examine the reading profile in children with Down syndrome by comparing the nonword decoding skills in children with Down syndrome and typically developing children matched for word recognition level. Journal articles published before 04.05.2010 were identified by using the keyword Down* cross-referenced to 'reading', 'literacy', 'decoding', and 'reading comprehension' were selected. A total of eight papers met the criteria for inclusion. Each study was reviewed and coded on both inclusion criteria and coding protocol before the analysis was performed. Children with Down syndrome had equivalent nonword decoding skills to typically developing children matched for word recognition level, but showed deficits on measures of two important underlying skills, vocabulary and phonological awareness. Differences in vocabulary, but not phonological awareness, were predictive of differences in nonword decoding skills. The practical and theoretical implications of these findings are discussed.

Language and verbal short-term memory skills in children with Down syndrome: a meta-analytic review.

This study presents a meta-analytic review of language and verbal short-term memory skills in children with Down syndrome. The study examines the profile of strengths and weaknesses in children with Down syndrome compared to typically developing children matched for nonverbal mental age. The findings show that children with Down syndrome have broad language deficits (that are not restricted to measures of expressive language) and associated verbal short-term memory deficits. The profile of language skills in children with Down syndrome shows similarities to that seen in children with Specific Language Impairment. The practical and theoretical implications of these findings are discussed.